So You Want A Government Run Health System: Me and the VA

This is not a “trash the VA” piece by any stretch of the imagination. It is, however, a reality of a centralized medical system be it governmental or any other that is very large in nature. I am one of those folks that recognize very early on that having a “shrink” was a good idea. I will not bore you with the details of my background that convinced me it was a good idea but for well over 25 years I have found that better living through properly administered chemicals was a good thing. I started going to the VA here in Tuscaloosa a little over ten years ago primary for cost considerations in terms of the co pays of both the medications and the doctors. I like many others had heard horror stories of how bad the VA was and how you could never get to see a doctor , etc. To my surprise the VA Hospital here in Tuscaloosa was better run than the local hospital, the people working there treated you much nicer, and the waiting time was minimal. I was really impressed. I was assigned to a specific treatment team for my medical problems and while they had no emergency services, I could call if I had any questions about my medications. If I had an emergency I had to go to the local hospital ER. I saw my medical doctor every 6 months or every three months if necessary and my prescriptions were mailed to me in a timely fashion. The one thing I did not care for was that there was a significant turnover in medical doctors. I might see the same doctor twice but the third time it may be a completely new doctor and a completely new nurse. That did not bother me too much because I had good insurance and I was also still going to my personal private physician as a backup.
The other positive thing about the VA was that they cover just about everything else. When I needed glasses my primary care doctor made an appointment for me and my eyes were checked and I got new glasses; not top of the line, but serviceable and they were free. When I had sleep apnea problems they arranged for me to be tested by a private specialist and VA furnished me with a CPAP machine. The unique part of this was that all of my records were there for any of my healthcare people to review where I was in the facility. It was a bit disconcerting that so many people from secretaries to lab techs to nurses to doctors everywhere in the hospital could pull up my records at any time if they chose to find out what was going on with me. Then, the bottom fell out. I don’t know why or how it happen, but it happen.
From the first day I had gone to the VA I had been assigned to a particular psychiatrist, whom I will call Dr. B. Over a period of ten years Dr. B and I had developed a very good working relationship. As I was supposed to do I had come to trust her a great deal and had told her a lot more about me and my problems than I had ever told anyone. In return Dr. B had worked with me and had carefully adjusted my medications to the point where I was feeling better about myself and life in general than I had ever remembered feeling before. It was to the point that for the last four years before the incident that my appointments with her were fairly short checkups and “how are you doing?”, “I am doing great.” type meetings. I had my alcohol problem well under control, had re establish solid contacts with my kids and grandkids, and my work was going well. Everything was absolutely great, Then, I went to my last appointment only find that Dr. B have been transferred to in patient only and I had been assigned a temporary psychiatrist. Now, I am not sure if any of you can relate to this but it was as close to ripping my guts out as it could get knowing that this ten confidential relationship with Dr. B had been, without notice or warning, jerked away from me.
As I sat in the hallway waiting to meet my new Doctor I thought I needed to calm down. She had all of Dr, B’s notes so there should be no big changes. I was WRONG! As I entered Dr. W’s office she was sitting at the computer and without looking up she told me she was concerned about my medications. I asked her why and she looked at me over her professorial looking reading glasses and said that they did not coincide with the new VA protocols. Trying to stay as calm as a nut case can I said again that didn’t understand. She said that the VA had established certain medication protocols that had to be followed under certain conditions and that Dr. B was not following them and that she was going to have to change them. And, then, what can I say, the red eyed, fire breathing dragon came out of his cage. I launched into a tirade about how in the h___ could she or any other pinhead develop protocols which would over ride a doctor’s treatment plan that had been treating me for ten years. I, in no calm terms explain how bad it had been and how much better it was now (not that my behavior was showing it). Her response was simply that was the protocol. I then ask her what if her protocol didn’t work would she change me back at our next appointment and she said she would not me again because she was a temporary fill in until they could hire someone permanent. At that point I am really surprised that they didn’t lock me up somewhere. To think that they had run a substitute in for one meeting who was going to completely change a treatment plan that was ten years in the making and was working fine and then take off for somewhere else was completely beyond my ability to comprehend. I think she finally got frightened (her chair was pushed as far in one corner as it could go) and Dr. B’s former nurse came and calmed me down and assured me that my treatment plan would stay the same until a permanent psychiatrist had been hired and had conferred with Dr. B.
I guess the point of this is that within any large healthcare organization the doctors and nurses work at will of the organization. While you may be their patient today, tomorrow the organization may need them elsewhere. I still go to the VA but I am far less enthused about it because they are undergoing a lot of transition and changes. I still keep my personal doctor as my primary physician and I am undecided about my psychiatrist. An additional problem at the VA is that the generic co pay on medication is $8 while the generic co pay from my personal physician at Walgreen’s is $5, $4 if I go to Wal Mart. This last point I will make here is that the VA in Tuscaloosa runs a very tight ship. I have heard from other vets that it is the exception to the VA hospitals rather than the rule. This I cannot speak to, but I will continue to go to the VA if for no other reason, as a back up to my private care system.

The downside of Streamlining the Healthcare System

While I am in favor of President Obama’s plan to overhaul America’s healthcare system and in particular the health insurance system, my experience shows there are limitations and exceptions which should be accounted for in the new system. The system proposed by the President’s cost containment seems to indicate that all medical personnel are equally competent. The following is my dark comedy of unequal’s in the medical community in Tuscaloosa, AL.
On a Friday evening in 1999 I was ending the week as usual by stopping by my haunt for a couple of drinks before going back to my apartment. Surprisingly, after the first drink I didn’t feel well so I left and went home and lay down thinking I was just tired. Later that night I felt worse, bad enough in fact, that I called my son to take me to the emergency room. I have only vague memories of getting to the emergency room but apparently was immediately admitted to the hospital. When my personal doctor came out and was putting together my “treatment team” I remember insisting that a friend who was a surgeon be assigned to the team. I am not sure this would be allowed under the new plan but he became a critical part of the team as time went on.
At some point the team had determined that the problem was caused by my liver shutting down. A radiologist was called in to take a biopsy of my liver to determine the problem. He inserted a needle into my right side into my liver, and through my liver, into my right lung causing it to collapse. Now I had a problem I didn’t have when I went in the hospital. Fortunately, my surgeon friend was standing there and heard the air rush from my lung and got me into immediate surgery to put in a chest tube.
After that I lingered in the hospital in another week being treated by an internist with antibiotics for a strep infection and not getting any better. I had gotten to the point that I told my children that I had made my peace and was ready to die because I felt pretty sure I was going to die. The internist, over the week I was there, insisted that the antibiotics would work if given enough time. His time frame was six to eight weeks in the hospital though he did not know if there was any malignancy or not. I vaguely remember calling him some less than polite names and calling my personal physician and my friend. My wife had been arguing all along that I needed to leave Tuscaloosa and go to the University of Alabama – Birmingham hospital. My surgeon friend agreed with her and made the referral. I left for Birmingham that day. To make a long story short, after two surgeries; one to repair my lung and another to insert tubes into my liver to drain off the infection, and four more weeks recovery time I came home with a new appreciation for second opinions.
The point of this is that all doctors and hospitals are not created equally. Streamlining the healthcare system to cut cost is a great idea as long as it accounts for the previous sentence. I tend to have a great deal of confidence in my personal doctor and the doctors I choose, however, I even ask to get a second opinion on their decisions from time to time. I think it is a wise thing to do since everybody has an off day now and then. I also think that any doctor should have the right to redo tests if there are reasons to question the first tests.

THE OBAMA PRESS CONFERENCE: THE POLICE ACTED STUPIDLY?

I listened carefully to our president's press conference held at 8PM ET on the topic of health care. I was impressed by his attention to detail and his careful and compassionate analysis of the American health care crisis. He had me. He captured my attention, until the end. He had me until the last question which [seemed designed] dealt not with health care but with an isolated incident that spoke to the arrest of a Harvard professor named Henry Gates, or "Skip" as the president calls him.

I was astonished when the President of the United States criticized the Cambridge police, calling them "stupid" for arresting "Skip." He said he was not there, so he really does not know what happened. The fact is Professor "Skip" forgot his keys, and had to "jimmy" his way into his house. A neighbor called, and cops responded, as they should. They confronted "Skip" and he provided identification. Well, so far so good, but it didn't end there. On the contrary, "Skip" chased the officers, who were satisfied that he was not a burglar, out into the yard and continued to scream at them accusing them of being racists, bigots, and etc. He was out of control, and he was playing the race card. It had nothing to do with race. The police were doing their job and the situation got out of control through no fault of their own. The only party acting "stupidly" here was "Skip" Gates. He should have been shaking the hands of the cops who risked their lives to protect people and property; in this case his property.

The police should not be expected to tolerate behavior that goes beyond the extreme. It matters not to me that Professor Gates is a black man. I am neither a racist or a bigot and my writings will reflect that sentiment, however, this is a case of Professor Gates being black. It has nothing to do with a fair assessment of the facts. The fact is if Gates were white this would not have been news. That is what bothers me about America. There is discrimination on both sides of this fence and in this case the Cambridge police were doing their job. The president should never have commented on an isolated case such as this. It does nothing but feed the right wing crazies in the country and alienate our first responders. I am disappointed in our president. This question should never have been raised and certainly should not have been answered in a forum that spoke to health care and the economy....MM

Health Care is Like a Locked Cadillac for the Rich

One must admire the panache of the Republicans and others who loudly boast that America has the best health care system in the world. Raising their well dressed arms and pointing in no particular direction with their manicured nails attached to fingers cared for by one of the best heath coverage systems in this country they shrilly tell all who will listen about the poorly run systems in Canada, France, and the United Kingdom under government control. Not that any of them have ever tried any of those systems because they are all well covered by the Federal employee health insurance plan, not to mention the fact that there are usually paramedics and physicians hanging around the congressional sick rooms anyway. Additionally, we should not forget that these poor souls were well covered, well insured and well heeled people before attaining their offices to begin with; after all, the idiocy of a poor man running for political office is no longer a pipe dream, it is simply a pipe probably filled with crack or some similar substance. But, alas, I digress. The question is do we have this great and wonderful health care system? The answer is a resounding yes, if you can afford it. Therein lies the rub and it is not just the 47 million without any health insurance. Oh nooooo! We must also consider those who could only afford marginal insurance and are nothing more that one catastrophic diagnosis away from homelessness, food stamps, and the welfare line. It would be well for most everyone to read the fine print on their health insurance policies and see who really makes the decisions and what their real maximum limits are, ... and of course how easy it is for the insurance company to walk away.
Yes, here in America our great health system may well be the Cadillac of Health System in the World. The problem is, the car is locked and only the rich and the powerful have the key and seem to have no intention of sharing. All the rest of us can do is sit around it and say... "Ain't That Great"!!!!!!

PALIN A "LITTLE SHOP OF HORRORS" SAY AIDES

It is a given that I suffer from Palin Derangement Syndrome (PDS). Then again so do millions of Americans. The fact that this incurious, cluelesss, amoral woman could be a VP nominee, much less a governor, is frightening in what it says about our country.

It's well known that there were tensions between Arizona Sen. John McCain and Alaska Gov. Sarah Palin last year during their presidential run, but a new article in Vanity Fair magazine sheds light on just how serious the rift between the two camps was.

According to the article, former McCain campaign staffers suffer from a collective "survivor's guilt" over the problem-plagued choice of Palin as vice-presidential candidate. The friction between the McCain and Palin was so intense that it carried right on into election night, when Palin wanted to address the Arizona crowd to whom McCain was to give his concession speech. After much back-and-forth wrangling, Palin didn't speak that night.

But trouble had been brewing long before that. Over the course of the campaign, one close adviser to McCain "was heard to refer to Palin as "little shop of horrors'" during the campaign.

McCain campaign members, in a series of conversations, told the magazine that "no serious vetting had been done before the selection (by either the McCain or the Obama team), and there was trouble in nailing down basic facts about Palin’s life" -- an omission that would cause immediate trouble as details of Palin's sordid family life began to emerge.

Palin's lack of aptitude in her new starring role as V-P candidate became obvious quickly. At times, it seemed as if Palin was more concerned with her popularity back home in Alaska than with the national presidential campaign that she was now a central part of.

"By all accounts, Palin was either unwilling, or simply unable, to prepare," the piece says. "In the run-up to the Couric interview, Palin had become preoccupied with a far more parochial concern: answering a humdrum written questionnaire from her hometown newspaper, the Frontiersman ... At the same time, she grew concerned that her approval ratings back home in Alaska were sagging as she embraced the role of McCain’s bad cop."

From Vanity Fair:

As Palin has piled misstep on top of misstep, the senior members of McCain’s campaign team have undergone a painful odyssey of their own. In recent rounds of long conversations, most made it clear that they suffer a kind of survivor’s guilt: they can’t quite believe that for two frantic months last fall, caught in a Bermuda Triangle of a campaign, they worked their tails off to try to elect as vice president of the United States someone who, by mid-October, they believed for certain was nowhere near ready for the job, and might never be.

The Vanity Fair piece asks some poignant questions about the significance of Palin's vice-presidential bid last year. "What does it say about the nature of modern American politics that a public official who often seems proud of what she does not know is not only accepted but applauded?" the article asks.

"What does her prominence say about the importance of having (or lacking) a record of achievement in public life?" the piece continues. "Why did so many skilled veterans of the Republican Party—long regarded as the more adroit team in presidential politics—keep loyally working for her election even after they privately realized she was casual about the truth and totally unfit for the vice-presidency?"

AMERICA'S HEALTH CARE CRISIS

America is reeling under the weight of health care as it exists today with millions of people rolling the dice and not carrying insurance due to its high cost and restrictions.

The mostly Republican supported corporate fat cats and the insurance companies are making money hand over fist while sentencing thousands to death because of their poor decisions. These decisions are designed to save them money and deprive Americans of decent health care. Even today, when faced with overwhelming evidence, the vast majority of Republican legislators are opposed to providing health care for all Americans, knowing that any government supported program would cost their wealthy constituents.

To read some of these horror stories check out this link:

Health Care Horror Stories

Where Are The True Visionaries

In all my years of studying, listening to lectures, researching, lecturing to students and pondering the concepts of administration and leadership I have wondered when people with these great qualities were going to appear. After all Douglas McGregor developed his "theory x - theory y" concept in the 1950's and Maslow identified man's hierarchy of needs 10 years before that. We were teaching these ideas in the 1970's, the 1980's and it is not unusual to find some of these relatively simplistic ideas around in today's management classes. However, after all reading and listening to all of these seemingly great ideas it appears that no one has been paying attention. At least no one with enough clout to make the world sit up and take notice and apparently this is not going to change. And, now it seems there is scientific reason for the world not to change and it isn't just about money. In a National Geographic Special entitled "Killer Stress" on the PBS channel Neurobiologist Robert Sapolskyhas discovered that the higher one is up on the ladder of hierarchy the less chance he or she has of dying of a heart attack. Sapolsky's study of baboons in South Africa confirmed that the lower people are in the hierarchy the greater their chronic stress level and thus the greater their systems are taxed which lowers their imune systems and creates higher blood pressure. This, in turn, leads to those in the mid and lower levels of the hierarchy being subject to more chronic illnesses, high blood pressure, obesity, and diabetes.
So, despite the fact that, on an intellectual level we may know that our companies can run better, more efficiently, more effectively, and probably with less health care costs the "haves" have chosen to not let it be so to protect not only their bundles of cash, lives of luxury, multiple mansions, and other perks which keep the stress level down, they are also insuring that they maintain the healthy positions on the planet. As long as they can maintain a stranglehold on how the systems are going to work with their clout, spelled dollars, they keep the stress level pushed down to the lower levels. Perhaps that is why the elitism of the Replublican party and their backers seem to always keep pushing against any type of level playing field.
The irony of it all; Sapolsky's study showed an interesting twist which indicated it does not have to be that way. The baboon cohorts he studied were all dominated by the larger more aggresive males who constantly harassed all of the other baboons who were below them in the pecking order. This kept the lower baboons in constant stress and thus they lived much shorter lives than the dominant males. The twist came when he found the very first cohort he had studied 30 years earlier had been decimated by disease. It seems that the cohort had discovered a trash dump left by humans and began raiding it and of course the dominant males had taken over and got most all of the food, which had been tainted by tubercliosis. This in turn killed off the dominant males and left primarily females and the less dominant males. Suprisingly, this cohort began to thrive without dominant members and the other members being more concerned about each other. In fact, as other males joined there cohort they were pushed into the go along get along mode of living. One wonders if baboons can thrive in that kind of environment why can't man.
If you have read this far and haven't fell asleep you you may be wondering ... WTF. Well here it is; It seems that we get two kind of leaders in this country. One fits the mold of the past administration who are saying one thing but are pretty well winking directly in your face so you know they are lying and you can't do anything about it. They are those that say we are the greatest country in the world, but who have never lived anywhere else. They don't care about facts and truth, they only get them irritated. Kind of like Iran. You remember. Anyone who questioned the last administration was a traitor.
Then there are the other kind. Someone like the present administration. Prior to taking office they have their hearts and minds in the right place but they run into those whose loyalty remains with the similarities of the dominant baboons. People like Obama had a good plan but he finds that the true terrorists are not always the ones with bombs and guns but those with money and media access to a fearful block of citizen blockheads. In the old days the establishment would have called them rabblerousers but now the old establishment are the rabblerousers. They have just enough brainless, greedy, power hungry, or all of the above mouth movers to keep people fearful. So the visionary of the campaign who sees the greatness of the of the future so clearly over the horizon suddenly begins to run into the haze drifting out of the smoke fill rooms of the wheeler dealers and the nay sayers trying to protect their power, money, and yes; their health.

The Irony of Ironies

As I should have expected a number of the Republican senators who voted against the stimulus bill are now out and about in their states telling their constitutes how much money they are bringing into the state from the stimulus. There are times I get really sick of the people in this country. Sure there are a lot of good people, but there are also a lot of ignorant ones also. There are are also a whole bunch of people whose sole concern is "me, me, me". The self serving and greed of many people in country make me sick. To call them hypocrites would be a disservice to hypocrites everywhere. We have stupid people voting for stupid politicians who feed those stupid people with more stupid ideas so those stupid people will vote for them again. It is no wonder that America, and most of the industrialized world are bound to continue making the same mistakes over and over again. The real scary part is that as technology speeds up the world moves faster which means the repeated mistakes are coming with less time to recover between debacles. This probably means that, where at one time we may have had 50 - 75 years to recover between screw ups, now we will be down to 25 - 40 years. And that number will continue to decrease. In other words we will be screwing up with such rapidity that there be no time for recovery. At that point we will, just like every other world power in the past we will implode.
Americans have this notorius habit of saying that this is the greatest country on earth. I guess that is a good propoganda belief but keep in mind that the vast majority of Americans have never been out of this country so they have no basis for comparison. At one time as a result of the result of the industrial revolution we were considered the world leader in many areas. Now, just check where we rank educationally, the number people incarcerated, the length of our prison sentences, the number of state executions, our number underage pregnacies, our national trade deficit, and our industrial output. Thanks to the Bush Administration we have lost the respect of much of the world because of our foriegn policies and our torturing of prisoners. We are now fighting now to just regain some of our respect in the world.
This is one time I hope I am completely wrong at least for the sake of my children and grandchildren,

THE REPUBLICAN RANT

Far be it for me to suggest that those who have risen to such powerful seats of government such as the United States Senate and House of Representatives do not understand the fundamentals of how money must flow in order there precious capitalistic system to work. While it is true that there is an old axiom which holds that you must have money to make money. However, that holds true only it one enter a business where is customers have the money and desire to purchase goods. If there is a hesitancy on the part of the consumer to purchaser to spend money because he or she does not know if their job will still be there in the morning, or if they are already unemployed then the manufacturer would be foolish not to at least cut back on production. Then of course at the point of sale fewer people will be needed to sell the product..
So here I arrive at my point. The Republicans ranted and raved about insufficient tax cuts for businesses. This argued John McCain was the only way to grow the economy. This clearly showed why McCain was confused during the last election campaign. If you give tax breaks to the businesses, most who are hurting because they are not moving enough product at a profit bearing price, where is the incentive to hire more employees. Are the going to make more products which are not selling. Nope, they are going to pay down there debts and hoard the cash until times improve. This is the same practice the banks were using with the first TARP money; that and figuring out to glean as much as they could for their executives. In other words they are willing to throw more money at business and let them hold onto it hoping that at some point the banks start lending again and the average American wage earner is again starting off behind the proverbial "8" ball. However, these same naysayers are speaking with forked tongues when they are right there in line to get their states share of the stimulus money on the one hand, while they all voted against it and are hoping it fails. Had they done that during the past 8 years Cheney would have probably labeled them unpatriotic. The bill is past now. Isn't their job to try help make it work if possible to improve the well being of all Americans. Ideologies should be left for the next bill to come through but it seems as if Rush "pop another pill" Limbaugh has them marching lock step to his cadence of "I hope this fails." In other words he wants things to get worse for Americans only for his ideological demigods.

Laser