(April 10, 2010)
The average consumer of Mainstream Media doesn't grasp the precariousness of
U.S. sickcare. Those providing the care can and will opt out of our broken system.
Here we go again, tackling another absolutely verboten, politically incorrect and
extremely inconvenient reality: individual providers can and will opt out of
the broken U.S. "healthcare" system. That the system is made up of individuals
is itself politically inconvenient; the political "solution" is 2,400 pages of
complexity added to an already diseased system.
All the happy-happy assumptions about sickcare "reform"--a codeword
for the diversion of ever more of the national income to a group of
insatiable cartels--depend on the base assumption that doctors and nurses will
happily continue toiling away in a venal, inefficient, destructive and completely broken
Guess what, America--they don't have to put up with the grinding insanity of the system or
the increasingly burdensome task of taking care of us. At some point, no amount of
money is worth it.
Do people outside of the "healthcare" system really think all the providers prefer this
costly, obtuse mess to a single-payer/universal care system? Think again, and
consider the point of view of those who have to work inside the crazy-making
system we have now--and which 2,400 more pages of complexity ("reform") will not fix.
Let's begin with a commentary from M.L., R.N.
I enjoyed your article
Tyranny of the Majority, Corporate Welfare and Complicity
and I wanted to make a few comments, as I noticed you wrote that some people find
you contrary (or feel that you are writing about unpopular ideas).
I am nicu nurse for almost 14 yrs and have been at my current job for 3 yrs.
It has been an eye-opener, to say the least. In my working life, I have known people on
welfare who have taken complete "advantage" of the system and those who were on
just long enough to recover from having their baby and gotten back to work or school.
So I always thought the system was "fair" and was "working."
At my job now, 90% of my unit has patients on welfare.
Our "typical" patient mom is around 27 and has 3-5 kids, some of whom live with her
and some that live with relatives, taken by the state, etc.
We have had quite a few moms who were 18 and working on their 3rd babies
(I am not kidding). We even have had moms come from Mexico specifically to have
their babies in the U.S. (and the delivery and care of those babies can cost up to $800k!).
I love my job and would never do anything else. However, with the economic downturn
and people losing their jobs, etc., my coworkers and I frequently discuss how
come the system allows these moms to have thousands upon thousands of dollars of
completely free care, while some of us are charged $400 for tests our insurance
refuses to cover (the same insurance that *we* pay hundreds of dollars for a month)?
It just seems that something is terribly wrong with the system and it cannot continue
(as you describe so eloquently in your book).
Actually, almost all of my coworkers, from secretaries to nurses to respiratory
therapists, all wanted universal heathcare, since we are already paying for
everyone in one way or another (via e.r. visits, etc). I was also surprised at
how many of my coworkers (dems, repubs and libertarians alike) told me they
*would* pay more in taxes if the $$ would go to fixing the healthcare system
(and not just keeping up the status quo with insurance companies).
More clinics with drs/nurse practitioners/physician's asst/nurses/techs--
that would free up our e.r.'s (emergency rooms) and create many, many jobs.
Too bad it's not going in that direction.
Thank you, M.L., for a report from the inside. Next, we hear from "ER/Primary Care Dr."
The American Medical Association has some interesting statistics on Medical Student Debt:
* 79 percent of graduates have debt of at least $100,000.
* 58 percent of graduates have debt of at least $150,000.
* 87 percent of graduating medical students carry outstanding loans.
According to the Association of American Medical Colleges (AAMC), the average
educational debt of indebted graduates of the class of 2009 is $156,456.
when you graduate $200,000 in debt, what would you choose - a high paying
specialty, or low paying primary care medicine? It's a simple choice.
In socialist Canada, my university and med school tuition was highly state
subsidized (I paid $780 in 1974 dollars for a year of med school).
I also always had academic scholarships. I worked every 6 - 8 week summer break
of med school, and for two years, worked a 12-hour night a week drawing blood at
a hospital while attending med school. I graduated with a few hundred bucks in my
bank account. My parents were chronically short of money, and contributed what
they could, but it was minimal.
In residency training, I got my medical license as soon as I finished my first
year of internship. I moonlighted doing 34-hour continuous shifts per month on
the weekend in a rural hospital E.R. That is where I got my love for emergency
medicine. I made good money at this, and finished my medical training with $48,000
in the bank.
Editor's note: this M.D. currently works in the U.S. as a primary-care physician.
As the baby boomers age, they will need more and more medical care. Preventive care
is great, and should be emphasized (made mandatory?), but have you ever met a
1,000 year old person? We all eventually grow old and frail (unless we drop dead
of a heart attack or die of a head-on collision or war), and need medical care.
Primary care is the only field of medicine that addresses preventive care,
and is by far the cheapest way to provide care for illness and injury.
Yes, specialists are necessary, but should only be used when the condition is
beyond a primary care doctor's expertise. You need a neurosurgeon to remove a
brain tumour, and they have the longest residency of any medical specialty, and
deserve high pay. They tend to have genius I.Q.'s, as their field is so
We primary care physicians are gonna quit! You can bet on it. Most of us (as I am)
are working some extra now to replace our lost retirement funds (thanks a lot,
Greenspan, Bernanke, Geithner, et. al.).
When we save up a little more dough - WE ARE OUT! It'll be like Canada - even
without Obamacare - you'll wait ten months to get an appointment with a primary
care doctor to get your blood pressure checked.
This week I got a six page form from an insurance company that had to be filled out--
at my boss' expense, so the company would pay for the treatment of a patient who
CLEARLY was ill - his lab tests spelled it out.
This is harassment, pure and simple. The insurance companies are hoping that
if they make it hard enough to get a claim paid, we'll give up and let the small
claims slide. WE PRIMARY CARE PHYSICIANS ARE GONNA QUIT. Good luck folks--
better throw away the Ben & Jerrys and hit
the exercise bike if you want to make it past 60.
This is from an E.R. MD who has treated a stadium-full of homeless/poor people
in the U.S., so it cannot be dismissed as the views of an elitist. There are
limits to the endurance of people even if they love their job.
The system is now so perniciously and perversely incentivized for both patients
and providers alike that its implosion will be triggered by one of two forces:
fiscal insolvency and/or providers opting out.
Sorry, America--healthcare is not a "right." Those taking it for granted that doctors
and nurses will endure the insanities of the current system forever, regardless of
the burdens placed on them, may well be surprised.
Then there's the point at which the well of endless Federal borrowing finally runs dry.
"That can't happen" because the world will always shower us with trillions to squander every
year. Perhaps, but let's check in around 2015 to see how that fantasy is working out.
By then we will have borrowed another $10 trillion, and perhaps the world's appetite
for more U.S. debt might actually wane.
If you want to read more about opting out,
check out Survival+: Structuring Prosperity for Yourself and the Nation
or the "quickie" 134-page version
Survival+ The Primer.
If you haven't visited the forum, here's a place to start. Click on the link
below and then select "new posts." You'll get to see what other oftwominds.com readers and
contributors are discussing/sharing.
is now open for aggregating our collective intelligence.
Order Survival+: Structuring Prosperity for Yourself and the Nation and/or
Survival+ The Primer
from your local bookseller or from amazon.com or in ebook
A 20% discount is available from the publisher.
Of Two Minds is now available via Kindle:
Of Two Minds blog-Kindle
"This guy is THE leading visionary on reality.
He routinely discusses things which no one else has talked about, yet,
turn out to be quite relevant months later."
--Walt Howard, commenting about CHS on another blog.
NOTE: contributions are acknowledged in the order received. Your name and email
remain confidential and will not be given to any other individual, company or agency.
Thank you, Jeff S. ($10), for your very generous donation
(in response to my 2/21 rant) to the site.
I am greatly honored by your support and readership.
Thank you, Fred S. ($50), for your superbly generous donation
(in response to my 2/21 rant) to the site.
I am greatly honored by your support and readership.
Or send him coins, stamps or quatloos via mail--please
request P.O. Box address.
Your readership is greatly appreciated with or without a donation.
For more on this subject and a wide array of other topics, please visit
All content, HTML coding, format design, design elements and images copyright ©
2010 Charles Hugh Smith, All rights
reserved in all media, unless otherwise credited or noted.
I would be honored if you linked this wEssay to your site, or printed a copy for your own use.