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| A PAs View of Healthcare Reform: Are We Going Backward or Forward? |
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by David Mittman, PA - August 17, 2009
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 Provided by Clinician 1
I find it all so amazing. The people who favor national healthcare reform are looked at as socialists. The people who oppose it looked at as ultra-conservatives. Where did the rank and file Americans go? The Town Hall meetings attract many marginalized people on both sides.They also attract people with vested interests. People show up with signs, not addressing the issues, but addressing tyranny or addressing other problems having nothing to do with healthcare delivery. Some people who oppose the Obama healthcare plan seem to say this is about government ruining our lives and all our great country is about. We are abandoning the Constitution. People who support the plan (do we really know just what the plan is yet?) want universal care but for what reason and at whose expense? Can they explain who will pay? Can they explain the macro-economics of healthcare or are many thinking what what someone told them to?
Who is “right”? What do I as a PA and somewhat of a medical politics watcher over the last 35 years think? What can we as PAs and NPs agree on? What really are the issues in this mess?
I will attempt to outline the issues that are really contributing to this mess below:
- Medical costs are skyrocketing. Does anyone disagree on that one? The system is out of control and for many years the insurance companies and before them the physicians have been running it. We pay more for less than most other countries. Why is healthcare spending 16% of our GDP and 10% of Canada and about half of that for Japan, England, Australia, Turkey, and other industrialized countries? That’s significantly more we are paying, just about double. We can even quibble about the percentages but will you argue that we are getting less while paying more? I know most of us could start to list why and where we see waste. Also please realize that there are 200,000 NPs and PAs in our country that other industrialized countries do not use. If we really believe we hold down costs, how much more would it cost the system if we were all physicians? Can we do it better than we are doing it now? You bet we can.
-Millions of people lack coverage. Many of them are working people who can not afford insurance. As a healthcare professional I truly have come to the conclusion that we need to cover all of our citizens. I would say not necessarily with the best coverage but at least with catastrophic coverage. I paid close to $20,000 a year to insure my family and that was for high deductible coverage, not anything like concierge care.
-People warn us of the government getting into healthcare. I have news for them. The government has been in healthcare for ages. Look at the VA, Medicare, Medicaid, the military , the Public Health Service and other huge providers of care. Many in our country have government provided care. Do they do it well? Sometimes yes, sometimes no. But to want government not to mess with healthcare, we missed that boat a long time ago. There are many elderly people who thank their stars that Medicare exists, many more that wish it did not. And remember in 1962 when Medicare was created, people lived many years LESS than the average American does now. Medicare was never designed to cover people for 20 or 30 years as it routinely does now. Others are very critical of some of the other government healthcare systems and deservedly so. We would all agree they can be better.
-Commercial for profit insurance has also not provided the answer. Many people who have insurance have to hold onto jobs they don’t want to work at, just to keep their coverage. The people who have insurance are scared that their employer will not be able to afford it, or that a pre-existing condition will be used to not reimburse their care, or that they will be dropped for reasons they don’t understand. I have seen more bureaucracy with the forms and papers required by private insurance companies than I ever filled out when I was in the Air Force.
-Future US businesses will not compete internationally if they will have to pay to provide healthcare to their employees. If you start a business and want to cover 4 employees healthcare, you start out needing $50,000 (or more) in profit that first crucial year just to cover that one cost. Realize that if you start the same business in India, Israel, London, Montreal or Mexico City you don’t have that worry. How many of our small businesses can successfully compete on a global level with this yoke? If we want to lead the world in innovation somehow we will have to make this problem go away. Also if you choose to stay in your job just to not lose your healthcare coverage, you won’t ever start a new business. It's common sense that it is harder to start and much harder to be successful in a business that needs $50,000 a year in extra capital to succeed than one that does not. Does anyone disagree?
So those are some of the issues that come to mind for me. Solving them will take some real thought, not fear mongering. It will take some of us truly getting involved as leaders in this morass of rumor and truth stretching that has become our healthcare debate. It will take some of us speaking out and giving an opinion based on truth and fact, because many of us can separate healthcare reality from political jargon. Republican or Democrat, Liberal or Conservative, we need to take time to listen and work out a plan that actually works. The devil will wind up in the details. I still don’t know if we can have government run healthcare or if that would even be the right thing for us. I know we have problems that must be solved.
I DO know a few things. We need more time to sort this out; why rush into this? We as PAs and NPs need to challenge the talking heads on both sides. We need to make sure our professions are an important part of this plan, because, for it to work, it needs us practicing with as few barriers as possible and in a system that recognizes the sizable contribution we offer. We need not to be turned against each other. I do know our system badly needs competition and choice above that of regular for profit insurance, as that’s how real change will come. Mostly, we need to fix this problem in a way that incorporates things not talked about on CNN or Fox News; malpractice reform, reduction of medical errors, dropping pre-existing conditions, covers all who need it and incorporates WELLNESS into the equation. If we can get that done over the cluelessness of so many I have seen this week on television, it will be a miracle.
That being said, miracles do happen.
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| Jared (Vail, CO) |
on 01 Sep 2009 at 11:51 am |
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Bob Finlay may be onto something here.... As much as greedy Insurance Companies run the show (in the post provider era of show running), I think it stinks that Ins Compannies can charge what they charge, and still deny 10% of the patients their care based on MD dictations or history and physical exams when the MD responsible for the claim denial is working directly for the Ins Company, yet hasn't seen the patient except on paper. What is wrong w/ this picture? See Michael Moore Documentary "Sicko".
I think we should look into what Bob Finlay suggests, and take this financial, capitalist system to a new/different level. It needs to be regulated like the Public Utilities and Works... No CEO is really profiting 3/4 Billion, (yes w/ a B) from the sale of Power and Water... Do a search and find out what Xcel Energy net earnings for 2009 are and what the CEO salary was.... Why can't we apply the past 60 years of Public Works finances and form of operation for electric and water distribution, also a necessity, to the likes of healthcare for all, another necessity, where profits are made and redistribuited into the whole or individual system? |
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| Joe Maidl (OKC) |
on 31 Aug 2009 at 6:40 pm |
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I don't hear anyone pulling for health insurance companies. Time to stop beating that distraction drum and opacities and get down to the issues. NO ONE is saying that we shouldn't enact responsible improvement - what we're saying is this BILL is positively horrible and it deserves rejection by all who care for our patients, America, and the free world! This is not about insuring the uninsurable. If it were, we could take $30 billion or so from the so-called stimulus bill and insure those people. End of story. Absolutely no need whatsoever to spend more than $2 TRILLION just for that! No, HR3200 is about much more than medicine, just like the stimulus bill was not really about jobs. Exactly what it's about remains to be seen, but no one in Washington who supports this bill can give us a straight answer, and that makes most Americans rightfully suspicious.
Incidentally Larry, I hope you don't tell my military personnel that they're essentially mercenaries - that's a disgraceful remark and has no place on a professional's forum. |
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| Larry (Washington DC) |
on 29 Aug 2009 at 9:03 pm |
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Not one of you is seeing the forest for the trees. All of us will pay ever increasing taxes including the undeclared taxes like parking tickets, red light camera violations, surcharges on fines, and war for profit, so why can't we get universal health care for some portion of the tax dollars we're being fleeced out of?
Frankly, I'm disappointed in most of my colleagues in this posting who seem to advocate for the corporate and vested interests at their own expense and the expense of their patients. Stop cutting off your noses to spite your faces. Healthcare for all is in America's best interest. |
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| connie engler, np (san francisco, ca) |
on 29 Aug 2009 at 4:02 pm |
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The comments that I just read are very true, probably all of it. However, something needs to be done to provide health care to those who cannot afford it or have been turned down due to chronic illnesses. Notwithstanding, somehow our population should have some type of incentive to keep themselves as healthy as possible. For example, that health care coverage will be more available if they keep their weight down (and the healthcare system supplies some type of program to help patients with this), that they do not start or that they stop smoking (also programs available for this). The idea that if health care is free and patients will abuse this is, in many ways, a real issue. I previously worked in the E.D. for over 14 years. People who had medicaid or private insurance with no E.D. co-pay came in for things like a "cold", a superficial "scratch" on their little darlings leg, and on and on. But, on the other hand, when a 29 y.o. patient was brought in with severe abdominal pain, nausea/vomiting and fever, he was worked up for a possible appendicitis, turned out he had severe viral gastroenteritis but indeed needed to be worked up AND treated. He received bills from that visit for over $10,000. He had no insurance and the subsequent bills caused his credit rating to decline, he had to go into credit card debt, and, basically, ruined his life for a long period of time. His parents ended up paying for a lot of his medical bills. And this happened only after numerous letters were written to the hospital, doctors, etc, requesting that the fees be lowered due to the patient's financial situation. I also see legal and illegal immigrants that somehow manage to get on Medcaid, come here to the US to receive their health care and then return to their country of origin for the rest of the year. Again, on the other hand, I saw a patient the other day who is 63 years old, has major medical insurance with a $5000 annual deductible, does not qualify for Medicaid and has a basal cell carcinoma on her ear. She does not have the funds to pay for the cost of the dermatology visit or subsequent minor surgery. Or, God forbid, that she would need something like Moe's. And at this point , she doesn't know exactly what it is. When I saw her I advised that regardless of the cost she needed to see a dermatologist asap and that she should pay the subsequent bills however she could afford. What a sad situation as she worked as a store clerk, was trying to go to school to better herself, and her income was very limited. And, of course, there is the on going stories about patients who choose not to take their anti-hypertensive or diabetic medicines because they need the money for rent or food. Despite the fact that the pharmaceutical companies do have programs to assist with the coverage of a patients medicine (in some cases) if they cannot afford it and it is the only thing that is helping their condition, not all medicines or patients qualify for this. And frequently the medicines that actually help the patient do not qualify for this.
I certainly don't have the answers, but I do believe that something should be done. I have seen MANY patients over the years who are worn out, hate their jobs and/or their supervisors and are miserable in their lives, but cannot quit due to the fact that they have health care through their employment. This situation only exacerbates their hypertension, heart disease, GERD, depression, etc. And I, myself, have seen my health insurance premium go up every year to the point where my husband and I had to lower our level of coverage in order to continue to afford the monthly premiums. Something has to happen to change this. I am hoping that President Obama, in his good will efforts, and the other brainchildren in Washington will come up with some type of plan that will address the situation and the problems that go with it.
And there is one more area that I would like to comment on. When I was in graduate school back in 1985 at a prestigious university in San Francisco, a friend of mine was also in graduate school at Stanford getting her MBA. In my entire career working with patients' health, their lives, in some cases their future, I have never made more than $80,000 a year (usually less than that). My friend went to work with a silicone valley firm and is making well over $200,000 a year and has nothing to do with the core of people's lives. What I am trying to say is, we advanced practices nurses and physician assistants are not given the monetary value that we deserve or the respect we deserve. It has become better over the last few years but, given the roles we play and the services that we provide, I do believe that it could be improved.
Thank you for the opportunity to relay my feelings. I do pray that the entire health care system in this country will be changed and improved in the coming years. And, more than anything, I would like to see the American people take more responsibility for their own bodies and health care and that of their children. We can assist with this by offering programs or making programs even mandatory in order for patients to qualify for healthcare. There are many things our government could and should do to help with this. One would be to ban the production of cigarettes, to more closely monitor alcohol, and to legalize marijuana. |
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| Joe Maidl (OK) |
on 26 Aug 2009 at 11:01 pm |
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| What I'm not hearing in this discussion is the merits or demerits of the house bill in question. Have any of you read the bill? In addition, most of my colleagues have medical knowledge, and virtually no knowledge of economics or business. Therefore, what good is your theoretical opinion if you don't know the data and couldn't interpret it anyway? That said, the structure this bill proposes is truly frightening. Arguments for socialism need to take some history courses and consider the ultra-dangerous road that leads. 120 million murdered under Marxist governments in the 20th century. No one...repeat...no one can seriously expect the American people to believe that corrupt Washington is holier than American business. And before you start railing that I'm a plant from the nebulous 'special interest' groups, I happen to think that health insurance itself is a big part of the problem. 'Free' healthcare will result in waste and abuse of titanic proportions, even for a national debt tally greater than 9 TRILLION dollars. Not just no, but hell no to this plan. No switching money from one pocket to the other. No plan without conscience clauses and serious tort and immigration reform. |
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| Bob Finlay PA-C (Akutan AK; Westcliffe, CO) |
on 26 Aug 2009 at 4:20 pm |
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I am so tired of the argument that we should not RUSH into this. If I recall, the first real attempt at health (sick) care reform was by the Clinton administration in 1993, so let's see now, 16 years have passed, 8 of them under each administration, and healthcare hasn't progressed other than to see the denial rates for "insurance" claims increased, CEO salaries of the top 10 health insurance companies averaging $12,000,000.00 a year, and the CEO of United Healthcare Corp having 3/4 of a Billion (yes Carl Sagan, with a B) dollars worth of stock options in his for profit company. As Bill Mahar said, "How about this for a New Rule: Not everything in America has to make a profit. It used to be that there were some services and institutions so vital to our nation that they were exempt from market pressures. Some things we just didn't do for money. The United States always defined capitalism, but it didn't used to define us. But now it's becoming all that we are. .......If conservatives get to call universal health care "socialized medicine," I get to call private health care "soulless vampires making money off human pain." The problem with President Obama's health care plan isn't socialism, it's capitalism.
" Read the rest at http://www.huffingtonpost.com/bill-maher/new-rule-not-everything-i_b_244050.html as he says it so much more eloquently than I could hope to.
16 years is not RUSHING. The only RUSH involved here is Limbaugh and his hate mongering. |
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| Harman (Punjab) |
on 26 Aug 2009 at 11:35 am |
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I have been blessed with upscale american education with BSc from Berkley and Msc in Physian Associate program. I think this is the time when we can work together to bring more respect to our profession. I don't know the whole deal with the healthcare yet, But I do stand with all the PA's as the Physician Assistant is a major ego neutralizer for the physicians and I think we should work with yale to bring forward Physician Associate Profession. When I talk to foreighn educated M.D's they do believe Nurse practitioners somehow are practitioners and we are assistants, till they find out my hourly wages.Sorry this not exactly what dave has discussed but I think, it's an important issue to be looked into...
Forgive me for any mistakes Harman |
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| Daryazen (Southern California) |
on 25 Aug 2009 at 5:44 pm |
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Every comment has truth....John's passion, Troutbum's disillusions...all very real. I have resigned myself hopeless as an NP. I can not in good faith allow myself to be whipped by employers who insist on faster service, more patients in less time and to create more charges. I'm currently unemployed and not looking forward to searching among the dung for a good-fit job as a provider. I wish I could open my own clinic treating acne. I can't do this because of the restrictions against prescriptive privileges without a physician in your back pocket. I can't pop a pimple either because of restrictions against "invasive procedures". The bureaucracy of even hanging a shingle for a $35.00 fee for service visit is next to impossible. How come a beautician can create a business and I can't?
Heath care is over-regulated as well as it is OWNED by for-profit insurance companies and fortune 500 pharmaceutical companies.
Nobody has the clout to slay the beasts except God. I'm going back to teaching, I have given up. |
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| Cora (Dallas TX) |
on 25 Aug 2009 at 11:54 am |
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| Sorry, I saw a typo, I waited 19 years for the tonsillectomy, not 29. (Let's not exaggerate, 19 was bad enough)! |
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| Cora (Dallas,TX) |
on 25 Aug 2009 at 11:52 am |
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Having lived under the NHS in the UK for 24 years believe me you do not want it. I waited 29 years for a tonsillecotmy, my father waited 18 months to see a cardiologist after he had been diagnosed with a heart-attack (He went out of country and paid to see a cardiologist and have an angioplasty in Europe or he would be dead). My relative (age 65) was denied a statin medication as she was told "you are no loger a functioning member of society and I cannot in good conscience prescribe this medication for you". (No joke, word for word from her doctor.)
Beyond these problems of scarcity and rationing, there are many new medications and technologies that are simply not available. The US develops the most of the new drugs and technologies. Also,no specialists as they leave the country for higher wages.
Problems with the Obama plan:
1) The government cannot run anything efficiently, e.g. the Post Office, Medicaid, Medicare.
2) The govt should not mandate what medical care I have or want. The govt plan calls for "gold-plated" insurance coverage for all (I don't need or want to pay for substance abuse coverage or mental health coverage, it should be my choice what I cover). It is in the bill that if you do not have a govt approved plan they will remove you from your employer plan and place you in their plan.
3) The plan does not address the trial lawyers , we need tort reform to allow all medical providers to reduce unnecessary defensive medical tetsing and to require ambulance-chasers and their clients to have to pay the defense costs of a lawsuit if they lose. Currently they walk away scot free. there is no cost to a plaintiffs lawyer to roll the dice, even if he loses. the plaintiffs lawyer should have to post a bond to cover the costs of the lawsuit if they lose.
4) I suggest health care accounts:People should not expect insurance to pay for office visits or small things. If everyone had a high deductible and had insurance coverage for the big emergencies, but office visits etc were not covered then people would be more likely to think twice before coming to the doctor for a sniffle. If we all pay cash for office visits, vaccinations etc then there becomes a market to look and see who offers the best price for the best service. The patient needs to become responsible for theiir own health care account. make this tax deuctible.
5) Regarding waste and Medicaid. II have seen multiple repeat offenders in with their children covered by Medicaid even though we have seen them the day before and twice in the last week. They refuse to even pay for OTC tylenol and have asked me to write prescriptions that Medicaid pays for for OTC medications. OTC meds should not be covered by Medicaid. it costs $50 per patient for overhead and Mediacid reimburses $30. These children are taking up resources for kids that are really sick because its free, the parents don't care beacuse they don't have to pay so they are in there every sniffle, and I'm not talking about a kid with a fever even.
6) The actual number of US citizens not covered by insurance is 36 million and of those approximately 6-8 million do not want coverage as they are young and healthy. Illegal aliens should have to buy insurance coverage or not receive care. If I have to pay and I'm a legal citizen why shouldn't they have to pay?
7) Finally, have you thought what is going to happen to your salary if the government mandates health insurance and has the plan you have to be in. PA's are going to get lower wages, working longer hours. The only union with any clout is the nurses union and look at current govt healthcare jobs, the salary at the VA is much lower than in the private sector. If specialists see their fees reduced the specialist PA's who work for them are going to be working more covering the job another PA (who is not hired due to cost cutting) would for less pay. I didn't go to school to work for free. I don't ask my car mechanic to fix my car for less or free, he would laugh at me. My hard work deserves to be paid just as well as the next person, helath care is not free, nor should it be. If you give sonething away for free it loses its value. |
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| Bruce (Kotzebue, AK) |
on 25 Aug 2009 at 3:57 am |
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I have to say that although government run anything can have plenty of waste and bureaucratic red tape, we can look to past government regulation/intervention for an idea of possible benefits. OSHA, National Highway Traffic Safety Admin., FDA, NTSB, EPA and many many others that were fought hard against by industries and individuals who stood to loose some profit, or who just didn't understand the national benfit to be gained. While none of these government entities are without pitfalls, it can not be argued that they have not significantly improved the health and welfare of the American people. The commonality among all these programs is the idea that protection of life and health are too important to be left to "market forces" and are ultimately, I think, part of our protection from forces much larger than ourselves so that we can pursue life, liberty and happiness as best as possible in our time. It is sad to say that government has had to step in to protect it's citizens from corporations bent on making expanding profits, from the railroad barons down to present day financiers. I think it's time for the health insurers and drug companies too.
I agree that government has already been very much in the healthcare business and needs to continue to be so. I believe that some form of guaranteed healthcare (like "socialized" medicine) for basic preventive and primary care is the way to go with the ability to pay for additional coverage or care as you are able. To say this isn't fair is ignore that we already have this except that the bottom folks have NO coverage, instead of just basic coverage. To say it another way, we already have the worst kind of rationing - we just completely cut off those who are underemployed or uninsured.
I am so tired of seeing insurance companies post record profits while increasing premiums and reducing benefits. Someone has to step in to make this stop.
I also agree that PA's and NP's need to be very much included in the solution. At least for those of us who work in Primary Care, we are able to provide quality healthcare for substantially less healthcare dollars. While I would like to make a comfortable living as much as the next person, I do not feel the need to ever increase my practice and income (I am sensitive to the issue of at least similar pay for similar work however).To this end I believe that our medical education system needs some refocus as well, to decrease the costs of obtaining the necessary training to start practicing (instead of continually upgrading the entry degree), and to de-emphasize the monetary potentials of higher end practice.
I think that creating some form of national licensing standards would also be beneficial to reduce costs and barriers associated with entering practice. |
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| diane (florida) |
on 24 Aug 2009 at 10:24 pm |
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| i hear the cry of the uninsured, the under-insured, the scream of the pre-existing condition. i understand the financial and emotional devastation of no insurance, no money, no service. all American citizens need health care; it is a moral imperative. support president Obama health care reform. |
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| mary (durham, north carolina) |
on 24 Aug 2009 at 12:38 pm |
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| I think John HIT the nail on the head, let the elite have the same menu they are trying to cram down our throats and see how fast it changes! There is a lot to be said for disenfranfchise...Fixing a broken system with tape will not help anyone, and starting it now to address the specifics later seems a little like putting the cart before the horse....It is one HUGE mess, and we all pay for it. |
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| troutbum (New Mexico) |
on 18 Aug 2009 at 8:50 pm |
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When you state that "others are critical of government health care and deservedly so" are you referring to OUR various and sundry government health care programs or those in other countries? Those that are so ignorantly slammed by ignorant Americans in OTHER countries usually don't have a clue - they believe Rush Limbaugh horror stories that simply don't exist or are paltry sins compared to what is the pathetic system we own.
The town hall in a small southern Indiana town was dedicated to my grandfather who practiced in that town - for a number of years with my great grandfather. My father was the psychiatrist in chief and medical director of the oldest and during his tenure largest private psych hospital in the country - faculty at Yale, Uconn, and in his retirement Dartmouth among many, many other credentials. All were what I call "real doctors." They always had the patient's interest at heart - it simply wouldn't have occurred to them not to.
The saddest thing I ever heard was my father's statement - retiring early because "son, it isn't about medicine anymore. It's about billing codes... I couldn't, with any integrity, recommend to anyone I cared about, much less a child of mine, that they have anything whatsoever to do with medicine as it stands in America."
I lost my house, beloved land, and most of my material possessions because of a cervical spine surgery that didn't get covered by COBRA because my previous employer changed insurance policies between when the surgery was prior-authed and when it was actually done. The guy who sued me was a spine surgeon I had referred to for years because I thought he was the best cutter in Denver.
I've been seeing Medicare and Medicaid pt.'s for small fraction of collections for years - tribute to Dad, granddad, and great grandad as I see it. Sadly, at 50 years old, I can't even PAY for health insurance - not only can I not afford it, I was turned down by five companies because of HTN and cervical spine surgeries that are over a decade remote. THEY WON'T EVEN LET ME PAY CASH - 600 BUCKS/MONTH FOR INSURANCE. And I've been seeing people for next to nothing for years - imagine my chagrin every time I look at a meager paycheck with medicare and medicaid taxes taken out and I can't even get a cardiac workup unless I pay cash.
Sad, sad, sad. And pathetic. I'm thinking of moving to Canada. Soon. Suspicious anterior chest pain and all. For several months now. |
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| Paul (Jacksonville, FL) |
on 18 Aug 2009 at 3:44 pm |
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| Dave, you make a lot of sense. I'm an NP, and I agree that all Americans need affordable health care. The only thing I disagree with you on is how to get there, particularly referring to your comment about not needing to rush. I'm afraid that what we gain in insight about how to build universal health care we may lose in our odds of actually getting it done in the halls of Congress. Unfortunately a lot of people are quite comfortable allowing many Americans to show up in ERs with illnesses that are too severe too late in the game to be halted. I'd like to use the political capital that pro health care advocates now have in order to get universal coverage passed now, and then we can build more of the details in the months to come. Just my thoughts, take care. |
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| The Aesculapius (Houston TX) |
on 18 Aug 2009 at 2:37 pm |
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Nationalizing - socialized Hellcare - is NOT the answer. As clinicians we are supposed to DIAGNOSED the chief complaint.
PMH - healthcare has been regulated in these USA since 1840. Socialized medicine in the UK and France is facing bankruptcy. Prior to 1965 - prior to medicare-medicaid - healthcare in the US was substantially affordable
A- regulated/socialized medicine is not the answer.
P- Deregulate healthcare - allow the invicible hand of the marketplace to be the sole regulator |
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| john leonhardt (new york ) |
on 18 Aug 2009 at 9:23 am |
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As usual, Dave brings common sense forward, but when I consider the maladies of the health-care system in America, no one wants to tell you about the elephant in your living room. The two greatest players controlling the issues are not even identified. And try to take them on? Fixing Exxon/Mobile and the banking industries are running side-by-side. Lawyers and the pharmaceutical companies are at the core. And, government run health-care? Let's be real! I don't wish to rain on anyone's parade but, when's the last time you were treated at the V.A? Ideally, a good deal of talent lays fallow and it's propagated by the system. As a 3 consecutive tour in Viet Nam, I've been in and around the V.A. Trust me, it's come a long way, but the mentality exists at every V.A. I have ever been to, including one's I've trained in. Progress moves at a snails pace, why work hard? there's always tomorrow. Maybe because I have a different work ethic and like multitasking? I recently applied for a job at the V.A., of course I would never get hired. I was told there's a lot of down time. Just what I need!
Lawyers have made billions of bucks chasing ambulances. I'm sure you're immune to the commercials. If you've been injured, if you have mesothelioma, if...............we're ready to sue somebody and make them pay for it! Therein lies a serious flaw that engulfs more monies than you could imagine. Now add that to frivolous lawsuits and awards with real issues of malpractice and you have another billion dollar industry. Countless thousands of unnecessary operations go unreported generating more big bucks. Oh? they don't? Special interest lobbyist line the pockets of lawmakers behind closed-door deals that no one else can ever know about. The pharmaceutical industry is right there. It wasn't that long ago that you could be lavished with fancy dinners and all kinds of perks by the drug and medical equipment reps. (I'm not complaining here) Box seats to MSG and countless other hedonistic rewards to the docs that steered their products to the hospital committees for approval. Now you're lucky to get free samples, pens and pads, due to corporate compliance, but they are still alive and functioning. A five year exclusive patent can generate billions of dollars on a medication in the guise of R&D. Are we that slow? I don't think so, the greed factor is built in. So in the name of Capitalism and Free Enterprise, raise your hand if you want Socialism or better yet, Communism. I believe the American people deserve better, the people in the trenches do their job every day, these silent heroes go unrewarded for their daily commitment to the welfare of others. Aside of this whole rant, I say, let the elite body of Congress and the Senate and all those sitting in places of higher powers have the very same menu that millions of disenfranchised folks are dealing with and see how fast change will come! |
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| elmostarr (Tempe. AZ) |
on 18 Aug 2009 at 12:54 am |
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Dear Dave,
I have been a P.A-C for 35 years now. I think it is time for everone in the USA to have health care. Just recently there was a free health care session in LA's Staple Center. Eight thousand people showed up. The clinic was extended for another day.
This is a cry from the a majority of US citizens for insuring everyone.
NOW IS THE TIME TO GET HEALTH CARE DONE.
Thanks, Elliott |
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