The Mythology of Obamacare

There's Nothing Like a Surprise to Wake You Up

The announcement of the Supreme Court's decision this Thursday past was a surprise to everyone:  conservatives, the political Left, the news media, and Washington politicians, the President included.  Unfortunately no further clarification has been forthcoming; this massive, secretly written, never-explained and still-understood law.  Titled the Patient Protection and Affordable Care Act, (PPACA), it is neither protective of patients nor financially affordable for the country.  How, or even if, the law will ever be implemented is a mystery to all involved.

What's Not to Love?

Only politicians as cynical and deceitful as our President and his cronies could have designed such a large law completely under wraps and presented only as a Universal Good for All.  Seemingly sensible provisions are heralded, such as the elimination of pre-existing conditions as a barrier to obtaining health insurance, "free preventive services" for both young and old, ranging from contraception and abortion to cancer screening and colonoscopies for elders, expansion of the Medicaid rolls to cover tens of millions more Americans.  But like eating a huge and rich meal for free, but suffering endless and painful indigestion later, Obama arranged for all of the goodies to be delivered to the voters up front--but the massive tax increases and budget deficits that will be caused by the bill don't start coming home to roost until after 2014.  By then his last election will be long past--pretty clever move, wouldn't you say?

Some Bends in the Road

Two of Obama's most prominent lies that were told during the Congressional writing of Obamacare were his famous and often-repeated "guarantees"--that if you have an insurance policy you like, you will be able to keep that policy; if you have a doctor you like, you will be able to keep that doctor".  These two whoppers are already being shown as blatant untruths:  nationwide, employers are dropping health insurance coverage, and most doctors, like herds of lost sheep, are being forced into "Accountable Care Organizations (ACOs)" so that the government can efficiently tell them what to do, what tests and treatments may be ordered, and monitor them for "compliance" to make sure that nobody is getting out of line and giving more treatment than is allowed or will be paid for.  Most doctors will agree to this government control, because they have never "grown a pair" and it's tough to swim against the current of government management of all things medical.  Other physicians will simply retire or go to work in other careers.  A brave few will continue to soldier on as "private physicians" using the "direct care model"--which means they will work outside of the insurance company/government medicine mandate, and provide care directly to individuals who are willing to pay for this personalized medical care.  This is sometimes referred to as "Concierge Medicine", and has been working well across the country by a few enterprising physicians for ten or fifteen years.

But Why Won't Obamacare Work?

It can and will work--but not as advertised,  and probably not in a way that anyone in Texas will like.  The "care" that will be provided will be a far cry from what everyone has grown up with and gotten used to.  Think about it:  President Obama said that his plan would provide health coverage for millions more people--and would also save lots of money.  More services for more people for less money.  Where have you seen that work before, ever?  There's no free lunch; everything has to be paid for.  Despite Obama's assurances, and the glitzy ads the government is running on TV, all of these new "free" services will need to be paid for by someone, unless they turn out to be empty promises, kind of the medical equivalent of a prize in the Cracker Jack bos--it's there, but it's not worth much.  So to bring this all about will require more money (TAXES), lower quality services, or fewer people eligible to receive services, which is where the DEATH PANELS come.  Yes, there will be death panels; we've had them before in the United States and we will again.

Death Panels--wasn't that just Sarah Palin's scary talk?

I'm afraid not.  We had death panels and treatment selection panels as recently as the early 1970's.  Before renal hemodialysis (kidney machines) were widely available, panels would meet to decide which patients would be fortunately enough to live with a kidney machine or die without one.  How else will you decide who gets a scarce resource?  If you have one machine and fifty people need it you can probably only treat about a third of them--so someone gets to decide.   Happily more machines and goverment funding came available in the mid- to late-1970s and the death panels no longer had to meet.   But it's a fact of reality.  And the Obamacare law provides for at least two different types of panels that perform this cost-saving work.

As many of you know, I was recently hospitalized with a severe diabetic foot infection--it might have been more "cost effective" to cut off the foot that provide the extensive treatment I required.  Believe me, I was thinking of my future and what could happen under Obamacare some years down the line.  President Obama has already addressed this question quite frankly in a very public setting, and his answer was not pretty:

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So Sarah Palin was thinking about her mentally challenged son; I am thinking about me and my family and our medical problems.  How will we fare with the treatment decision panels?

But Won't Romney and the Republicans Get This Repealed?

More than 50% of Americans oppose Obamacare.  That's a fact.  But there is another fact that reminds me of an old saying we used to hear, "Possession is 9/10 of the law"--meaning that once a condition is in place it is pretty hard to dislodge it.  Maybe it will be repealed.  Maybe it will be modified.  Maybe it is here to stay.

The Conclusion of the Matter

There is a lot more to consider and discuss.  But the lesson I'd like readers to think about right now is this:  More changes are coming than any of us can really anticipate.  But anyone who thinks Obamacare is going to bring gold-plated health care like we are used to is in for a rude awakening.

Your comments are invited.

A [Very] Little More on Peterson

Outpatient Services

Monday's long blog post was intended to be entirely about my hospital stay.  Since discharge I have had daily care in the  IV therapy department, where they hook up new bags of antibiotics which run into my arm through two small portable pumps.  These are worn around my neck in a nifty brown-and-orange bag!  On weekends this care is delivered through the heart catheterization lab.  All of the nurses who've cared for me there have been absolutely and totally wonderful, and do their work with excellence.

I also visited the Wound Care department, headed by Lori Gagnon, MD, for followup on my foot.
Doctor Gagnon was interested, intelligent, pleasant, comforting and reassuring.  She really made me feel good about how well my foot was improving.

I hate to be perceived as a shill for PRMC but I have honestly been very pleased with the critical aspects of care that I received there.

A Doctor looks at Peterson Regional Medical Center

With Eyes Wide Open

On Saturday June 9, a serious medical condition--a severe diabetic foot infection--required me to be hospitalized for intravenous antibiotics.  My physician and I discussed treatment options.  My physician said, "Well, you can go to Peterson or Fredericksburg.  You know, we really hear a lot of bad things about Peterson--but it's up to you.  Kerrville is a lot more convenient, and since  you are a doctor and you are thinking clearly, you will be able to watch them and will know if anything is a problem."  Convenience rules.  I elected to go to Peterson.

Now, along with lots of other folks in Kerrville, I had heard my share of "horror stories" about our local hospital.  Let me hasten to say that these were stories from "regular" lay people, not from anyone in the medical community.  Bad results.  Unexpected death.  A whole range of stuff.  I can't say I was scared to be there; I felt that I was capable of monitoring my own care.  I expected problems.  I expected to "go AMA"--medical jargon for leaving "against medical advice".

I was loaded for bear!

What I Experienced

Arriving at the Emergency Room around 10 AM, I was greeted courteously and promptly "taken back" and placed on a stretcher in an exam cubicle.  A covey of nurses quickly came in and gathered some medical info and made sure I wasn't dying (I wasn't).  It was then over an hour before I was seen by a physician--not a good start, I thought.  When the ER doctor finally arrived, he introduced himself and looked at my foot.  I explained what had happened, how I had failed outpatient therapy, and why my physician and I thought I needed IV antibiotics.  He agreed with us (smart guy) and ordered some lab work and an x-ray.  These were normal (good news, but not unusual) and started some IV antibiotics.

About a geological age later he returned and stated that I should probably stay in the hospital (D'oh).  I asked him about hospital care and he told me that he was a "locum" (a temporary, fill-in physician) and that he really did not know anything about the doctors here or how the hospital worked.  I told him that I expected to be admitted by a hospitalist (a primary care physician, usually from Internal Medicine as a discipline, who only handles patients while they are in the hospital).  The ER doctor did the paperwork to get me admitted and up I went to unit 3-West.

The nursing care I received ranged from good to excellent.  Admittedly I was perhaps the "wellest" person in the hospital, but my nurses were attentive, efficient,  pleasant, and just positive in every way.

Food service.  The food service was very persistent in always getting an order from me, but alas, their offerengs I found to be absolutely awful except for the fruit bowl.  Then again, it is hard to mess up some cubes of cantaloupe and a few red grapes.   But then nobody goes to a hospital for good food.

Torture, or What Things were Bad?

There is an amazing lack of coordination of services in the hospital. Nurse visits.  Vital sign checks.  Lab draws. Blood sugar checks.  Dietary delivery.    Why can't all of these things be done at the same time?  During the day it is not too much of a problem, but at night being awakened every five to ten minutes for a series of tasks with questionable importance is pretty irritating.   But this is an age-old complaint about hospitals--nothing new here.

Poor, Late, or Erroneous Communication

By far, my main complaint in the hospital was lack of communication.  You just could not find out what was going on.  It started upon admission--when I first got to my room I was told "the doctor will be here in a few minutes"; later, "the doctor is here and he will see you soon"; a few hours later, "we have called the doctor".

It was five or six hours after I was admitted before the doctor saw me the first time.  I thought this was a bit slow; of course the ER doctor had seen me, but he was not in charge of my care.  Since I was in the hospital for an infection, I thought it was pretty important for the internal medicine specialist to see me soon to evaluate and assess the treatment I was to receive.  This was a frustration for me each day...I never knew when--or if--the doctor was coming around.

When I did hospital practice myself two decades ago I was probably guilty of some of this too.

But the thing that bothered me the most was that after the end of the third day, when I was to be discharged for at-home intravenous antibiotics--the instructions I was given by the hospital were totally wrong.  I was pretty upsest to be told by the RN that I would have to return to the hospital several times daily for doses of IV antibiotics, that I would not be able to receive these at home "because these are very powerful medications".  I argued that it made no sense for me to have "at home antibiotic therapy" if I had to return to the hospital several times a day to get medication.  Rather than continue to battle, I decided to straighten it out the next day as an outpati  ent.  Happily,  the next morning I was happy to find out that everything the discharging RN had told me was incorrect.  I was also not told, by nurse or doctor, what meds I'd be receiving or what to expect for followup.  The printed instructions I was given at discharge were either wrong or inaccurate on several issues.

This morning--one week after my discharge--I was called by a physician office wanting to know why I missed my appointment.  I had not seen this physician and my hospital discharge papers said nothing of my having such an appointment.

Communication problems  never build confidence in anyone.  Since I am a doctor I was able to "fill in the blanks" pretty easily even though I was not given some very vital information.  Other patients might not be so lucky or as familiar with medical care.

So What did I think of Peterson Regional Medical Center?

On balance I was very pleased with the care I received at PRMC.  The nurses were nice and good and, hey, I still have my foot--which was the main goal.  But I did encounter several irritating and troubling inefficiencies in the care that was given--most critically the all-important lapses in correct discharge information.

So What should a Kerrvillian Do?

I think PRMC is an excellent facility and you can get good care there.  Unfortunately, like any hospital whether it be PRMC or Methodist or North Central Baptist, you can also get bad care there.  But I think the problems that we find in Kerrville are the same problems that you can find at any hospital or town.  No place is exempt.  Much of it is just a product of the mess that healthcare is in in the United States today and there are no easy fixes.  so, in the meantime, we should:

1.  Support PRMC.  It's a good facility, and a community of this size needs a good facility.
2.  Be very vigiliant if you or a loved one is a patient.
3.  If something seems wrong...ASK ABOUT IT.
4.  Question all tests and treatments.  This allows a double-check and can reduce unnecessary tests and expenses.
5.  Don't suffer in silence...you will be popular if you don't bother the staff, but it is not in your best interest to be popular.
6.  Above all, STAY OUT OF THE HOSPITAL!!!  Follow good, healthy "clean eating" practices, be safe, and take care of your health.  It's your responsibility.

Commissioners Anticipate More Rain

Rainwater catchment system added to Ag Barn Project

An eye-catching article in today's Daily Times tells us how a rainwater catchment system has been added to the Ag Barn project.  The article does not carry a figure for the cost of the system, but explains that the system is quite sophisticated and will add the water to the plumbing system of the barn for non-potable uses such as toilet flushing, dust control and irrigation.

A neighbor of mine has a catchment system.  It's a thing of beauty.  But in these dry years it is difficult to see how it has made a significant contribution to her garden irrigation.

The system at the new ag barn will be large and quite sophisticated...quite a step up from putting a barrel under your gutter downspout.  How much cost will it add?  How much maintenance?  How many years in drouth or low-water conditions will be needed to recoup the cost?

I fear that, as with most "green" projects, we are expected to give credit for good thoughts and intentions rather than for economic viability.  Like Solyndra and electric cars, we're supposed to feel better because we use them, not because they save us money.  But maybe I am wrong.

They're Coming for your Money!

Tax and Spend isn't always the answer

Two above-the-fold items in today's Daily Times caught my attention and interest.  The first, "Split Council Reaffirms support for River Trail" explains new Mayor Pratt's sensible hesitancy to spend tons of money on the River Trail project, while current and past council members say "full speed ahead"  to spending on the project, invoking talk of what a positive economic effect the trail would have on the city.  Really?  A nice thing to have, yes.   A business generator and tourist magnet...not likely. 

The second item,"Conference Center could get local tax incentive" resurrects the idea of a hotel and conference center for Kerrville, an idea rising from the grave with the stake still through its heart.  Such ideas hold endless appeal for daydreamers, but if such an idea were economically viable, private industry would have pursued it 25 years ago.  Now we have the same "stimulus spending" members of our local leadership still pushing the idea.  Great.  Just what we need.  A tax-supported white elephant.

It's true that our hotels have become seedy.  Moving here in the mid-1980s, I found the "YO Ranch Hilton and Conference Center",  shiny and new, and the Inn of the Hills,  bright and popular and booming.  Likewise the Sunday House.  Obviously some of the shine has gone off of these, and I also don't feel like we see as many small-to-medium conventions and other gatherings here as we did.  But there are lots of reasons for this--not the least of which is the national economy--I don't think it is lack of a convention center and hotel complex. 

The National Debate becomes Local

The Tea Party Movement favors sensible government spending, if not "austerity".  The Liberal Left favors heavy involvement of government in all aspects of the economy.  This argument is currently being played out on the national stage.  Perhaps the River Trail idea and the Hotel and Conference Center idea, both supported at least in part by our tax dollars--represents the Kerrville division of this national debate.   Good minded people can disagree on these issues; indeed, some of those that I describe as "stimulus spenders" are friends whom I support in general.

When I drive over a pot-holed or curbless street, and talk with friends and patients who are our of work and short on funds, it is difficult for me to understand how these problems--that are very real in the here-and-now of our community, will be helped by projects such as those under discussion now.

Let private industry move the economy.  Let the government-at all levels--just stand out of the way.

On the bench

Out of the game and on the bench

Stepped on a nail the other day and got a foot infection!  Haven't felt like posting...will get back at it in a few.  Thanks to all readers!

On, Wisconsin! Implications of the Walker Victory

The Best Shot Didn't Penetrate the Target

Governor Scott Walker defeated the attempt to "Recall" him by a 53% to 48% margin.  The man who took the best shot of the national Democrat party and nationwide public employee unions watched the bullet fall harmlessly to the ground.  Lieutenant Governor Kleefisch also defeated her recall effort.

The Wisconsin Recall Election was the most important electoral contest in the country this year except for national elections in November.  It bodes well for conservatives and Republicans this fall, since even the most concentrated efforts of the Liberal Left, Democrats, and labor unions fell far short of victory.  I hope that this proves that the fiscally wasteful, unsustainable, redistributionist efforts of those groups will be similarly routed in November.

Those who voted for President Obama in 2008 can be forgiven using the "Fool me once, shame on you; fool me twice, shame on me"doctrine.  But a successful re-election of Obama this year would be devastating to this country, allowing him and his socialist fellow-travelers to continue their possibly  mortal damage to our country.

The failed Wisconsin recall gives us objective reasons for hope, since even in this extremely "blue", progressive state, there are enough people with good sense to oppose liberal government policies.  President Barack Obama and his foolish, destructive policies must be defeated and utterly repudiated this November.

Thanks, Wisconsin.

Shall We Gather at the River?

Goodbye to Innocence

We buried Clarissa Menchaca today.  I say "we" advisedly, for since our son was a passenger in the car when she was taken from us, our lives are inextricably linked with the Aguirre/Menchaca families and shall remain so forevermore.

Clarissa was only thirty, beautiful, a loving mother, and in the full flower of young womanhood.  Having graduated from the Christian Womens Job Corps, she was well on the way to a brighter life and future for herself and her children.  Clarissa was not perfect.  She made mistakes but tried to do her best.  The Bible tells us that all of us sin and fall short of the glory of God, not just some people.  That is why none of us is in a position to cast the first stone.

Innocence is lost and knowledge of the reality of life is gained.  As I sat in the chapel and looked at the many twentysomethings and thirtysomethings who were her friends and relatives, I knew that another hole had appeared in their armor of indestructibility.  Though she was not the first of their number to be claimed by disease and accident, her loss brought continued emphasis on the fact that bad things do not happen only to other people.  They can happen to you too.

Pastor David Danielson's comforting message of salvation reminded us all that Clarissa is in a better place, praising God continuously around the throne of His Grace.  By accepting Him into her life on Earth, she gained Life Eternal.  We are invited to do so as well.

Shall we gather at the river

Where bright angel feet have trod

Where the crystal tide forever

Flows by the throne of God.

Contributions for the support of her children are being accepted at Wells-Fargo bank.  Donations may be made to the Children of Clarissa Menchaca.

Not So Fast, Buster!

Is another taxing entity the answer?

A lead article in the weekend Daily Times proclaims that newly re-elected Commissioner Buster Baldwin wants to pursue a new taxing entity, an Emergency Services District, to fund and direct emergency medical services in Kerr County outside of Kerrville.  It states that emergency services are already funded by city residents in Kerrville, and by separate ESDs for Ingram and Mountain Home.

New taxes = bad.  ESD = good.  What's a voter to do?  The newspaper article raises several questions.

First, popular support.  Baldwin, a long time ESD supporter, considers his re-election to be a confirmation of public will to create an ESD.  Post hoc, ergo propter hoc:  after the fact, therefore the cause of it.  Not so fast, I say.  There are plenty of reasons for an incumbent to be re-elected, and I doubt that the majority of primary voters were even aware of the ESD issue.  So I doubt that Baldwin's re-election indicates a groundswell of support for a new tax district.

Second, coordination.  How would a new district coordinate with the other authorities such as the City of Kerrville and the already existing West Kerr County districts?  Would there be one "super district", or a total of four separate ones?

Without coordination, confusion.  It's not explained how the districts would work together, or how money would be saved or provided.   How would the new tax money be used?

Is voter approval in November likely?  With the current appetite for austerity in Texas government, approval of a new district doesn't seem likely, especially in this county.  The commissioners should have their work cut out for them in explaining the advantages and mechanism of a new Emergency Services District. 

Court System Not the Right Remedy

Don't go to court looking for justice

The long, expensive, and very public trial of former Vice-Presidential candidate and Senator John Edwards has predictably ended with a whimper and not a bang.  As many national pundits have pointed out all along, it is really not a crime to be a real dirtbag and loathsome human being, and the Edwards trial was just another attempt to do legally what is best done by a public sense or morality and outrage.

It is instructive to remember that the national Democrat party put this man forth in 2004 to be in a position "a heartbeat away" from the Presidency.  [When its Presidential candidate was well known "American Gigolo" and inflated war hero John Kerry]  Edwards' crimes and misdemeanors, along with his odious human nature, were well known to national political operatives at the time of his nomination. 

Legislating or adjudicating morality generally doesn't work.  It didn't work with National Prohibition.  It didn't work with Sunday "blue laws".  It isn't working with abortion and with legally redefining marriage.  It doesn't work with drugs and alcohol abuse which are more medical issues than criminal ones.

What would work?  Returning the country to roots of morality and common sense.  How is this to be done?  Now that is a real question....

In loving memory

Clarissa Marie Menchaca

 1982 - 2012