Reflections on a Medical Career
(And The Collapse of Health Care)

Dateline: 20 February 2014

When I was between 12 and 14 years old, I thought I wanted to be a doctor (like my grandfather and my father) and I fully expected to be a doctor. In fact, I remember being very focused on being a doctor during those years. But, as is the case with many youthful aspirations, that changed, and I'm glad it did. 

I don't think being a doctor is all it's cracked up to be. It's a demanding profession that can take a heavy toll on the doctor's family. A lot of people begrudge doctors the money they make, but I don't. There is a price tag that comes with the financial success. I wouldn't want to pay that price. And I don't have a problem with anyone who expends time and effort (a.k.a., work) in making their money, especially when they are in a profession that helps other people. I don't care how much money a good doctor makes. I'm not into class envy like that. Now, if we were discussing bankers… that would be different.

Well, anyway, I'm pretty sure that any doctor in America, who has "practiced medicine" for thirty years or more, will tell you that the medical profession isn't what it used to be. Not hardly. And I've read the opinions of several doctors that are saying that the American health care system is near collapse; that Obamacare will bring the death knell of this country's once-remarkable health care system.

A recent example of this is Dr. Robert S. Dotson, an opthamologist, who has written Reflections on a Medical Career. That link will take you to Dr. Dotson's essay posted at the web site of Paul Craig Roberts. 

As an aside, if you have not heard of Paul Craig Roberts, I suggest that you check out his bio and listen to some of the interviews at his web site. Mr. Roberts is an economist and former establishment insider. Among many accomplishments, he was Ronald Reagan's Assistant Secretary of the Treasury.

Paul Craig Roberts has some amazing insights into this time in our history. His economic and political analysis does not conform to any "party line." He strikes me as a credible and brave voice in a world of government-and-corporate media disinformation and mind-manipulation.

Now, back to the essay of Dr. Robert S. Dotson. I encourage you to read it. If you don't have time, I'll give you a couple of excerpts…

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 $1200. 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 $2600 for both eyes!” At the time, Medicare was paying about $1400 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.

Near the end of his essay, Dr. Dotson advises

Avoid contact with the existing health care system as far as possible. Yes, emergencies arise that require the help of physicians, but by and large one can learn to care for one’s own minor issues. Though it is flawed, the internet has been an information leveler for the masses and permits each person to be his or her own physician to a large degree. Take advantage of it! Educate yourself about your own body and learn to fuel and maintain it as you would an expensive auto or a pet poodle.

Dr. Dotson then lists 17 things a person can do to avoid as many medical encounters as possible. If nothing else, go to the end of his essay and read his 17 suggestions.
On a related note, another essay worth reading is Paul Craig Roberts' Obamacare: The Final Payment—Raiding the Assets of Low Income and Poor Americans. In a nutshell,  many more low-income people in this country are going to be herded into medicaid by Obamacare, and when they die, their assets will be taken by the state. This "estate recovery" already happens to some degree (that's how I ended up buying my late step-father's home the state was going to take it if I didn't), but it will now happen on a much larger scale, or so Paul Craig Roberts says. Is anyone else talking about this?

Also, I'm wondering. does anyone reading this have personal experience and opinions about the decline of health care in recent years, and/or with the implementation of Obamacare?


Sheila said...

I can tell you from my own experience, that no one has a clue about how the health care system really works today. It is way beyond your wildest fears.
Extreme, doesn't even begin to set the record straight.
The story is too long, so I will leave you with one of the last things I had to deal with, before the loss of my darling husband, back in July 2013.
Because my husband had used all of his Medicare coverage, and they would not allow him to come back home, they would let him back into the "Rehab-Home" and just take his Social Security as payment!!
Wen I said no, they said I had to. They did not care that, that would leave me with no income at all, a handicapped son to care for, and with no income, only a car to live in. I would be homeless.
The true irony of all of this is, he was only in the hospital because he got several diseases from being IN THE HOSPITAL!! Eventually losing both legs too!

They can, and will take anything from you they can, to pay for any bills not paid, and will take any social security you are qualified for too.

That's only the beginning, so I will leave you with that to chew on. Believe me, that's not even the worse of it.
Start praying now, and pray every day that you never have to go into a hospital. I know I NEVER WILL, and my children know to never let that happen to me too.

I can honestly say that the horror is real, and people need to know what the new rules are. They will shock you.
God's grace to us all, we will need it.

Anonymous said...

While I am thankful that the medical professionals were able to "fix" my husbands heart with bypass surgery and valve replacement (also an aneurysm), my general opinions of the "healthcare community" were formed after my poor dad's lung cancer had spread to his brain. With as many tumors he had, there really was no hope at all - and everything I read said death within 6 weeks. But the greedy cancer industry decided to give him WHOLE BRAIN RADIATION! Please look that method up - cut, burn, poison - his brain and head was burned! Even the skin on his ears was fried! And this "treatment" accomplished NOTHING! He died right about 6 weeks, just like everything I read. Not only did my sister have to drive him 60 miles away for each of these burns, but the entire time the quacks were telling my parents that is would help him!! HELP HIM??!! He had NO hope at that point. After he died, my sister and I confronted his doctor about how they were not honest with my parents. His lame excuse was that he hated to give old people bad news!! Oh, but it's ok to rob them of their money! And not to mention the false hope they gave to my parents - and torturing my dad in his last days by frying his brain!
I made up my mind right then, that I would NEVER go to a doctor ever again! My husband and my kids know my motto is "I will either live with it, or die from it"!

Herrick Kimball said...

Sheila and Anonymous,

Thanks for taking the time to post your experiences.

Very sobering.

"I will either live with it or die from it" is a phrase I've not heard and will remember.

Anonymous said...

Thank you for publishing the links to Paul Craig Roberts. I went and read the articles you quoted from and a few more.
Very scary. Very terrifying. I don't like the part how they just sign you up for Medicaid based on your income. I went and read my state's position on the "estate recovery." They'll take it all. My husband and I need to have some serious discussions, since he just turned 55. Our home still isn't all ours (making payments still) but it is all we have.
We are going to have to make some changes. There is No free lunch.

Anonymous said...

I work in a hospital as a medical lab technician, my mother in law is an RN, my sister in law is an RN. They do not go to doctors and take care of their own ailments and their family members. Remember this - social workers are not your friend, nor are they there to help you. Any suggestion of assisted living, rehab in the nearby nursing home etc. oh my, please rethink your strategy. Once they get ahold of you, your health and assets will circle the drain. Might as well die at home like people used to do. Nursing homes are big business now because of ailing baby boomers. They are a gold mine to confiscate assets. Any recommendation for hip replacements, knee replacements etc. for anyone over the age of 60 look for doctors to be smacking their lips over the complications that will go with it. And, the infections acquired in rehab, you will not recover from. Knee replacement and early death vs cane and long life, give me a cane, I have seen so many worthless surgeries for nothing, money wasted, death, etc. Medication side effects, worse than the disease etc. Doctors and social workers are not God and to those who the social worker intimidates into being herded into a nursing home, hire a lawyer for senior citizens rights. A home health aid is much cheaper and family members taking turns will save dignity and assets. That's what people did decades ago. No one should forfeit their home for the crap care in todays nursing homes where you lie helpless in your own urine for hours, dirty, alone etc. and we pay for that? Why you can do that at home for free!!!

Anonymous said...

Mr. Kimball, you hadn't heard that phrase before because it's my own. LOL
But feel free to use it, pass it on, etc. I spat that phrase out in the midst of my grief and frustration, but never truer words have I uttered. I feel exactly the same today as I did nearly 8 years ago when I first said them...and I've repeated them often enough that as I said before, my kids and my husband know that's my motto. They have strict rules that I have laid out regarding my coming elderly years, potential illnesses, and even funeral - I don't believe in "viewing" dead bodies - after all, it's only a shell - the soul is not there anymore. As we gathered around my dad when he was dying, I turned away from him at his last breath and never looked back. I refused to look at his body without him in it. I certainly did not want my last image of him to be his body with no soul. Sorry for the rant, but this is something that hit me hard. I miss my dad EVERY single day, and I look forward to seeing him again someday.

Herrick Kimball said...

I hope a lot of people will read these comments. The perspectives expressed here are valuable contribution to the discussion.

I hope more people will read Paul Craig Robert's article on estate recovery with Obamacare. The whole law is so convoluted and difficult to understand but that part of it is certainly understandable.

With the American middle class dwindling, more and more will be automatically enrolled into medicaid via Obamacare, and what assets they have will be confiscated by the state when they die. There is no choice with any of this.

It is a wicked scheme. More people need to understand the ramifications of this.

Anonymous said...

yes, a wicked scheme indeed, but how do we get out of Obamacare unless we are Amish, etc.? After reading the article on estate recovery anyone 55yr and over who loses their job will be FORCED to take part in Obamacare and forced onto Medicaid until they get in a position to pay their own benefits - and this will come out of their estate when they die? How do we avoid this? If anyone can get Paul Craig Roberts to write an article on how to get out of that lets get the ball rolling. This has got to stop and I can not believe the people of the United States has let this happen. No one in our government cares one bit about the people, the working, honest people who have followed the rules all these years. We have been set up to fail on purpose. Look around your at all the entitlement mentality - they are not gonna fight for what they have worked for, because its free because they have not worked, but those who have are so disrespected and almost spat upon by this awful horrible scheme. I would rather have a Hurricane Katrina blow away all my assets, house and everything than this. Evil and Satan now rule the United States.

Herrick Kimball said...

I don't have answers when it comes to asset protection in the face of this kind of government oppression. I'm trying to figure it out for myself. I think an irrevocable trust, made 60 months prior to any need for Medicaid, may be the only way to keep the government from taking what they want. But I'm not an expert on this by any means.

Herrick Kimball said...

Here is a link to another article that talks about medicaid asset recovery via Obamacare….

Fine Print: State Can Seize Your Assets to Pay For Care After You're Forced into Medicaid by Obamacare

david kaiser said...

Just been going to several specialists for a health problem. Specialists are just hammers looking for nails. They want to try to fix everything and don't care what the side effects will be of their fixing. Many times a natural remedy will either cure or alleviate the symptoms. But the specialist is out to "fix" you, so he can pay his bills and take him his salary. I wish I had not listened to the specialist and undergone the knife. Please learn from my mistake. Look for alternates, get a second and third opinion, and just stop and think.

Jon Compton said...

I am a physician and have spent considerable time researching "obamacare" and what it means.... even taking an online course to better understand it. I have also attended lectures about the history of american healthcare. Even so, I feel barely adequate to offer opinions about what is wrong with our healthcare system or how to fix it. I am therefore frequently surprised at how confident I find others are with their opinions about what is wrong and what should be done.

That being said, I do think Obamacare is a valiant effort to reduce costs and provide better and more affordable healthcare.... it is a mess agreed! but I do appreciate the efforts being made in the bill.

Here are a few things to think about...

1. Is healthcare a privilege or a right?....meaning should it only be provided to those that can afford it out of their own pockets?
2. Do you think that the amount of money you pay into a health plan usually covers the costs of the care you receive? Keep in mind that in many cases one day in the hospital costs $15,000.... and most of your expenses come from the last few weeks and days before you die.
4. Do you think you have reasonable expectations? nobody wants to be sick or to die.... but caring for you is not free. Who is supposed to pay?
5. Do you think a system exists that is fair, just, affordable, and offers full access to modern medical treatments?

Anonymous said...

Jon Compton - why does one day in the hospital cost $15,000? Same reason 1 Tylenol tablet costs $30.00 in the ER. Why is that? It did not used to be that way before medicare and Medicaid. I know because my grandparents could afford to go to the doctor and self pay before medicare came along and they were lower middle class to almost poor. How old are you anyway? Please review history and do your homework. Who is gonna pay the bill? Really? Obamacare is not going to pay the bill, the working poor are going to pay the bill and get no care in return. We have already considered everything that you listed and it is out of control and if you are really a doctor you already know this. you should be ashamed.

Anonymous said...

Five things.

1) Insurance does not equal healthcare. Nor is it necessary for healthcare. People forget that.

2)Health insurance is shared risk for unexpected events. Like car insurance it is not a maintenance plan, nor should it be. People forget that.

3) Insurance drives UP the cost of medical care - it is why one day in the hospital could cost $15,000+

4)Government meddling ALWAYS increases the cost, and so it is with medical care and consequently insurance to cover that care. People forget that.

5) The more intrusive the government the higher the cost - look at the increases in "education", health care, government - all are LEADERS in cost escalation. People forget that. Government is pleased.

A well stated problem suggests the solution.