Best fix: No corporate hospitals or clinics. Independent doctors only, with public references. No CEOs or other non-medical administrators. Complete public disclosure of costs for both hospitals and more minor procedures.
And what we call medical insurance today was created as and referred to as "Hospitalization Insurance."
What was it? You got a yearly benefit of 7 days for free, full coverage? That was the era of inpatient physicals. Bizarre. It was a gateway drug for the abject madness the legacy system is presently addicted to.
I certainly agree with your sentiments here. Just look closer at the problem illuminated in the COVID fiasco. Here we find unconscionable things being done by medical administrators, and other medical professionals who say little or nothing. Whether they are powerless or complicit, the result is the same.
Further, every modern hospital is a form of corporation doing business as a hospital. Many practicing physicians will also practice in commerce as a corporate species.
The greater issue turns on First Principles and the structure of power, primacy and liberty to practice.
Consider this approach:
1) No corporate entity should be able to dictate patient care in any manner and should not be allowed as a lawful interloper in the performance and practice of the individual licensed physician mutually attending a patient in their care.
2) Only the patient and the physician of their choosing should determine was is medically necessary for the said patient. No other 3rd party, clerk, non-physician, non attending physician or physician not of the patient's choosing should determine what is medically necessary, except in instances of extremis, emergent circumstances or incapacitation.
3) Remove the traditional exemption from consumer protection statutes provided for medical services and related product. They are in the channels of trade doing commerce. Regulate that commerce like ever other industry, especially when the consumer is also a patient.
4) Issue medical insurance to the human individual only. Prohibit different prices for the same coverage. The insurers may compete among themselves, but among their customers everybody pays the same premium for the same product. All coverages must pay claims for what the patient and the physician of their choosing have determined to be medically necessary. The primary servicing insurer marketplace remains intact and become increasingly competitive based upon the quality of claims services provided. This is not a single payor approach.
5) In further consideration of (4) end all group and family policies. No interlopers. No more clerks and medical persons dictating medical necessity to patients they have never attended nor have permission to attend. The contractual and administrative clarity will make it easier to focus upon and identify criminal racketeering and illegal reimbursement schemes. This will help the primary insurer more profitably evolve into an expert and efficient medical claims management contractor, which will be an essential service in the anticipated model being considered here. This is something the government has no business doing. This is not what they do well. Large blocks of public works capital formation is their thing; that and large scale regulatory operations. They may do it ugly, but they do it, and endure a scale and scope of operations where no other corporate entity could possibly survive. This is not a single payer approach. There is no way a single payer approach can effectively administrate the volume and velocity of incoming claims on such a massive national scale. It will need an vibrant industry blessed with adroit management, or they too will perish or be consumed by their competitors who can.
6) Capture the entirety of the medical reinsurance and stop loss market and remove it from the profit sector as such is economically counterproductive and transnational capital interests reap the gain, not the American citizen. Pour that into a government treasury/trust structure and require all primary medical insurers to buy stop loss insurance from the treasury/trust entity, and all at the same rates. Medical insurance premium prices are in large part a result of the stop loss reinsurance premium paid by the primary servicing insurer to the reinsurer. If you think about it, we are sovereign American citizen with unalienable rights. It is fundamentally not reasonable to expect a corporation to pay the costs of our unalienable rights, such as the right to determine with the physician of our choosing what is medically necessary. We mutually can and should be together paying the costs of our unalienable rights as citizens in the most direct and efficient way possible. Such measures will bring the sea change needed to be radically transform the current system away from decades of racketeering, predation and the plague of ritual stupidity that dominates its commercial culture.
7) Elevate the sanctity and primacy of the mutual physician/patient relationship to at least the equivalency of the lawyer/client relationship. How barbaric and indefensible that such is not already this way. The sanctity and primacy of the relationship between the patient and the physician of their choosing... well, without that, just look around at the tragedies, heartbreak, predation and institutional stupidities that have become normalized in the absence of that.
The mutual physician/patient relationship is everything. Its quality and primacy are the object of the entire exercise of what we call human medicine.
Nothing can replace that unique trustee relationship. Nothing else should.
Dr. Malone thank you for writing this and sorry for blasting your comments section with my links. This was just too perfect. You are so good at explaining the problem - one which I have recognized for almost a decade now. So lately I have been working with a think tank of like minded people thinking about solutions. And we have been tackling this problem with several recent articles. We are trying to discuss what can we do to fight back that is both VERY EFFECTIVE and SAFE. No one wants violence if possible. But governments and power structures tend to get violent when attacked.
So we have a plan that we believe will work: radical transparency and decentralization. We don't need government's permission. All we need is some open sourced tech built and a new agreement between all people that focuses on one thing - our biggest issue: ENDING CORRUPTION IN THE SYSTEMS THAT GOVERN OUR LIVES.
All of our problems are because we are running our software on a bad system. It just needs a few tweaks, and the system can be great again.
If this interests you or anyone else at all I beg you to at least read some of the ideas. To change this we will need a movement. Either that or we can just sit here and wait for everyone else to save us.
My husband was in the hospital and I had an itch on my arm (from trapping cats in the brush) and I asked a nurse for some H2O2. She said they didn't have that. I asked for some -OH. She said they didn't have that either. (WT...?). She then said she had some anti-itch cream (pharmaceutical), but she couldn't give it to me because I wasn't a patient.
What is wrong with this picture? Other than that we began the story with being IN the hospital in the first place.
I also think all malpractice and catastrophic adverse medical events and disability claims should be paid from the same reinsurance fund so they can be cost averaged and absorbed across the national population. Medical malpractice would become a no-fault system with amnesty in the absence of criminal acts. There could then be complete transparancy. Essential high-quality data would be gathered without penalty to improve the systems and practices of medical treatment. Physicians would self-report to better inform the loss control data set gathered on a national scale. The statistic value of such data is enormous in both human and actuarial terms. Further, the immediacy of the data would be equally beneficial. Those patients suffering harm would find their physicians as advocates rather than defendants.
This reinforces the wisdom, utility and value of capturing the reinsurance component as it preserves competition and naturally selects for improved quality and efficiency in the servicing of of claims made while rescuing the underwriting capital and profits arising therefrom for the benefit of all American citizens, instead flowing cross border to elite offshore or transnational financial interests as our present system has been created to allow.
If I may elaborate on another point. The single payor approach will never work as the granular point of service for claims processing is simply too massive and dynamic. It must be distributed across competing entities freely developing and adapting expertise, molding human abilities and administrative performance to meet the unforgiving, complex demand and incredible velocity of filings.
Think of IRS. Think of the incredible administrative load they process, then think of what happens to the quality and continuity when they start talking to individual taxpayers. Now think of the medically served. Think of the numbers of medically served. Maybe 40% file taxes annually? That means medical claims processors will churn 2.5 times the number of annual IRS filings and some patients will have multiple filings per month. That is a massive and complex administrative engine that churns at high velocity. That must be managed with nuance and distributed authority and special process. That can't be administrated effective by fiat of checklist. Humans must be free to manage at will as a special process on behalf of the claimant lest they become sausage. If you want sausage, government does a great job making sausage but who wants that? The present system is already turning into a sausage factory and that is the cardinal problem that most threatens us today.
We need to use our mutual large-scale wealth in ways that simplify and create operational ease amidst some of the most difficult work that humans do on behalf of other humans. We must do a much better job of creating competent liberating structures for these professionals to do their thing with immediacy, less agonism and less fear. Literally, our very lives depend on it.
Yes. That is the problem. In the end it's all a form of self government, whether by ignorance, abandonment, abdication, the ambitions of some, the involvement of all, or the tyranny of a few.
The treacherous truth? When it comes to human affairs, there is always government, and there are many species of government, and many temperaments.
There is no escaping the timeless burden between self government and government of the self. If that doesn't bring one to prayer, nothing will.
The big question is: "What government do we have?"
The big problem is: "What government do we need?"
We don't just need good government. We need government to be good.
Some people get in the way of the good. That is the hard problem.
Like it or not, we are our brother's keeper. Best to always be ready to wash some feet as there are always feet to wash. We know when it's our turn. There is no escape, only forgiveness and redemption.
There was also an old chinaman, Lao Tzu, who commiserated about the great dilemma of governing many centuries ago. He wrote the ancient book of 5,000 words. He only wanted to leave the city to go the the mountains and die a peaceful death, but his reputation preceeded him. The guards at the city gate refused to let him leave. As the old story goes, Lao Tzu pleaded to be allowed to go and die in peace, but the guards would not relent. They were terrified everything would turn to sh*t if Lao Tzu was allowed to go. That was when he agreed that he would write his book. And so he did, and so he traded the book for his passage to escape the grip of his government and live out his last days free of them. There is always government. It always seems to be waiting at the gate.
Our imperfect human nature is such his mortal observations and playful admonishments about governing, government and its place in the universe remains ever true in our times, as so it also has been across the arc of human history:
Yes. Single insurer through the 50 states. Fuck CMS. States allowed to contract through competitive payment systems (CMS, BCBS, Humana or any other administrator interested in the business). State laws prohibiting the payers from dictating protocols to providers. (Ie, no "death panels.")
Dr. Malone thank you for writing this and sorry for blasting your comments section with my links. This was just too perfect. You are so good at explaining the problem - one which I have recognized for almost a decade now. So lately I have been working with a think tank of like minded people thinking about solutions. And we have been tackling this problem with several recent articles. We are trying to discuss what can we do to fight back that is both VERY EFFECTIVE and SAFE. No one wants violence if possible. But governments and power structures tend to get violent when attacked.
So we have a plan that we believe will work: radical transparency and decentralization. We don't need government's permission. All we need is some open sourced tech built and a new agreement between all people that focuses on one thing - our biggest issue: ENDING CORRUPTION IN THE SYSTEMS THAT GOVERN OUR LIVES.
All of our problems are because we are running our software on a bad system. It just needs a few tweaks, and the system can be great again.
If this interests you or anyone else at all I beg you to at least read some of the ideas. To change this we will need a movement. Either that or we can just sit here and wait for everyone else to save us.
This reminds me of my son's experience when he was visiting us. (He lives in Texas, I am in North Carolina.) He began to have some very bad pain in his side and back. His wife had no idea how to get to a hospital, so I drove the two of them. There, my son paced back and forth in excruciating pain for several hours. He could not get comfortable either sitting or standing. We asked several times at the reception desk if he could be seen soon, as he was in agony. Finally, we decided to take him to another hospital. Lo and behold, when we informed them we were leaving, they were suddenly able to take him back to be examined. He needed gall bladder surgery. I am still angry when I think about how many people went back before him, seemingly with minor problems; certainly not in obvious pain. No one cared.
I don't live in America, but in Canada instead, but I wanted to share my experience with our healthcare as I feel there is a huge misconception in the world about how "amazing" it is.
I am bipolar, but that diagnosis was only given after 15 years of misdiagnosis and being an involuntary guinea pig for greedy doctors who perscribed me insane medications. I trusted them, I had no choice. The antipsychotics, benzodiazepines, mood stabilizers and antidepressant salads I was given for years never worked, they always made me worse, but they just gave me more and more meds. Multiple doctors over years. I was told the physical side effects like rapid weigh gain, twitching, and being zombified to name a few were a "benifit outweighed the cons" situation, though its funny how no one seemed to ever care about my opinion of that.
Obviously the medications were terrible for me and often resulted in my having emergency room hospital trips for suicidal thoughts or self harm or just a general psychotic break. I would wait for 8 to 10 hours sometimes in emergency for some white coat doctor to ask me some questions about my mental state and then always, ALWAYS, they would dismiss me and send me on my way. They would tell me I "didnt seem suicidal" and that they weren't to concerned about me. I would beg them to keep me there for further assessment, for help, for anything, as I was terrified of myself, and they would say they only keep people who are "actually a danger to themselves". I have a strong will to live apparently, and even when ever cell in my body wanted to die, and i would always manage to find a way to hold on for another day. But I often wondered how many people were turned away, like me, but couldn't hold on.... and how many people even know they had gone to the hospital for help first only to be turned away?
Unfortunately, one fateful day, I couldn't hold on anymore and I did attempt to take my life. I went to the hospital in an ambulance, they stitched me up, and then they sent me home. Yep, thats right. I cut my wrists so deeply i needed stitches and they didnt feel I was at risk enough apparently to keep there for further assessment. I was flabbergasted. Oh, and lets not forget the wait periods to see a psychiatrist. Were talking years sometimes.
Our country has an opioid crisis. Mental health issues are running rampant. People are dying by their own hand every day. And our political leaders are more concerned with 10 dollar-a-day day care, virtue signaling, and blaming eachother for l these issues than actually offering compassionate care for some of the most vulnerable people in our society. I survived my ordeal, and after my suicide attempt I finally was given a Lithium and wouldn't ya know it, I haven't had a single hospital trip since.
I can't speak for everyone of course. Not every one is bipolar and was used as a drug tester for greedy doctors, but I can say beyond a doubt that our systems are deeply broken, and I fear people die every day unnecessarily and thinking that they aren't worth the care or time of our doctors and health care systems, because quite frankly, that's how they make you feel. Like you're a burden.
Thanks for posting from a fellow Canuck. I am glad you survived. Healthcare in both our countries is quite atrocious but mental healthcare is especially so. A lot of homeless people are on the streets for that very reason.
And thank you for sharing it. You’re in my thoughts. I’m struggling with my niece with bipolar and way too many medication so it’s just a nightmare so I hear you
It is very difficult for both the person and all involved. I hope your niece is able to find a medication that works well for her and that things get better!
It was perscribed, I dont believe its available here over the counter. I was put on 900mg, but had it upped to 1200mg 4 months later and that seemed to be the perfect dose. I had been on Lamotrigine with antipsychotics prior to Lithium, and they left me on it, but removed the antipsychotics. So I take 1200 mg of Lithium and 100 mg of Lamotrigine and have done so for 4 years now and finally get to experience a "normal" life for the most part.
Thank you for your kind words. I am grateful every day, and believe me, I really simplified the years of ridiculous stuff I went through, so it makes me even more grateful.
Dr. Malone thank you for writing this and sorry for blasting your comments section with my links. This was just too perfect. You are so good at explaining the problem - one which I have recognized for almost a decade now. So lately I have been working with a think tank of like minded people thinking about solutions. And we have been tackling this problem with several recent articles. We are trying to discuss what can we do to fight back that is both VERY EFFECTIVE and SAFE. No one wants violence if possible. But governments and power structures tend to get violent when attacked.
So we have a plan that we believe will work: radical transparency and decentralization. We don't need government's permission. All we need is some open sourced tech built and a new agreement between all people that focuses on one thing - our biggest issue: ENDING CORRUPTION IN THE SYSTEMS THAT GOVERN OUR LIVES.
All of our problems are because we are running our software on a bad system. It just needs a few tweaks, and the system can be great again.
If this interests you or anyone else at all I beg you to at least read some of the ideas. To change this we will need a movement. Either that or we can just sit here and wait for everyone else to save us.
Yup, when Hillary tried pushing her healthcare thru when Slick Willy was Prez, many argued that her plan would change health care into a very profitable business at the expense of patient health. Since the Affordable Care Act my insurance costs have tripled.
Fixing the U.S. system is a tricky one. The greek and euro systems seem to often combine a socialized NHS component with private insurance. The U.S. has something similar with Medicare/Medicaid and private insurance but it is a big messy ball. We also have 50 state regulations on top of federal. If I were to start somewhere it would be to blow up all regulations to get more innovation and competition and start over. There are just too many vested interests to get any meaningful change. Which brings us back to the fact that our government is hopelessly broken.
Our family uses a faith based health care sharing service instead of insurance. Our experience in the American health care system is much closer to your friends Greek experience. The lightening of the medical staffs countenances when we tell them we are cash pay is very noticeable. Generally, we pay a bill and before the credit card payment is due, fellow sharing members pay us the refund in multiple little checks..and often also attach get well notes and cards. Gone are mountains of “insurance” paperwork and the headache they cause to the medical establishment. I helped my wife through cancer with this and found better, cheaper doctors that did not work in hospitals that were happy to have us. The United States has far too much liability induced fear in its institutions. This has created mountains of paperwork. Our system eliminates much of that..and our doctors felt freer to use the protocols they thought best. BTW- I bet that the “free” hospital would have been a very different experience with more than a “little” more of a wait. Social medicine is not the answer, especially with the controls organizations like the WHO have over these government organizations.
Are you able to tell me the name of your healthcare sharing service? I’ve been wanting to look into this option, but could find no reviews on the ones I am aware of.
We use Samaritan. There are others and some that are secular. Unfortunately Samaritan has restrictions on preexisting conditions. Other may not if you fall into that category. These health care sharing organizations have a bit of a target on their back from certain sectors of the political “leadership”. While they last, I would recommend utilizing one if you can.
I was working in Nigeria for an oil company when my wife developed Deep Vein Thrombosis.
Making a long story about arguing with the insurance company short, we air-ambulanced her to South Africa for medical care. It was great. The care was great, and after being in the hospital for about a week, her bill was the equivalent of ~$3,000 US.
One of the ironies is I wanted to take her to Europe. The insurance company argued, a jet to Europe would be almost $100k, the limits of the policy. There wouldn't be any money left for her care when she arrived.
Later, when I'm telling this story to Europeans, they laughingly said, "Why did you want to bring her to Europe? She got better care in South Africa. " And I see now, they were right.
I also had a medevac experience in South Africa (from East Africa) in 2018. Didn't need air-ambulance was stable enough for regular flight - there was a driver waiting at the airport to take me straight to hospital in Johannesburg (they thought I couldn't handle another ride to Pretoria). 2,5 days in hospital and then discharged until 5 days later when follow up appointments were scheduled. Total cost - $5k which I paid then passed onto insurance company for reimbursement.
Nurses were very caring and made me rooibos tea whenever I wanted it. My chart was old school paper chart, not electronic one. Main doctor in charge of me spent time to explain what's going on and what the next tests would be (CT, MRI). Phlebotomist was so gentle and even offered to do butterfly needle vs regular one for less pain given how many vials they were doing. Most importantly, I was listened to as a patient and not dismissed.
Until COVID I trusted our Canadian health care system, though I had a few less than positive experiences with my first oncologist. My family doctor has been amazing for over 15 years. He even, off the record, recommended against the jab. I was so relieved but sad that he couldn't be more open.
My daughter-in-law was a nurse until last fall when she had to make the decision between the jab or her job. She'd been getting increasingly disillusioned with the medical system. Several years ago her hospital fired the floor secretaries, saying that the nurses could answer the phone and do all the paperwork. Fast forward a couple of more years and the hospital fired all of the LPNs, saying that minimum wage "techs" could do the LPNs job. Wasn't uncommon after this for my daughter-in-law to come home upset because her tech would only work with a certain number of patients then sit the rest of shift at the nurses station. Eventually her 12 hour shift became 14 or 15 because she didn't have time to chart until after her shift was over. She was a compassionate nurse who cared but was burned out.
I think the medical system has many issues like too many regulations, insurance companies controlling treatment, burned out staff, and too much pharmaceutical company influence. Those who work in the system could list many more.
If one drives around the US and is paying attention, one notices the absolute explosion in brand new, increasingly large, “healthcare” facilities. And more and more specialized “institutes” that promise super high expertise in leading edge “procedures”.
The underlying assumption in the US is that everyone is Ill or afflicted with a multitude of diseases/conditions, all requiring multiple drugs and ultimately specialized “treatment or procedures”
Go into a CVS in a relatively small town and take a look at the thousands of prescriptions filling up the bins.
Clearly, there is so much money in our “healthcare” system that they literally don’t know what to do with it.
Little known secret. Use an Urgent Care in the US. 1/10th the cost of an emergency room. Rented ebikes in Newport Beach, CA. Front tire came off my son's bike leaving him in a heap. Once the tire stopped rolling 100 yards away, he was left with a gash on his chin. You know it is bad when the second comment out of witness' mouth after "is he ok" is... "Oh that's going to need stitches." Being insured by Kaiser, we were dreading the ER experience. We found an Urgent Care in the area, but after 30 minutes and a newbie doctor saying it's too deep, she said she could not handle it and ER was required. Glad she declined it, not being confident in her ability. We researched another Advance Urgent Care. This was where the A team resides. Receptionist was awesome, said she had seen a lot of traumas come through that office and if there is no neurosurgery required or major vascular involvement, they can take care of it. If they can't, no charge. Cool sign me up. Got there after a 20 minute ride, checked in, in a room in 5 minutes, 3 of us, no masks...doctor walks in, she looks at the gaping wound and manipulates it to assess the damage like it wasn't her first rodeo and says, "Get the prep tray I got this". Wow, she was a stud!!!! Stitched it up, in and out in 40 minutes with care and follow up instructions. $400 out the door. Amazing service and beyond reasonable for minor surgery. Guarantee Kaiser ER would have done the same (maybe) for $5000, my out of pocket (partial) deductible. Total deductible is $7500 before they start to pay a dime.
Urgent Care name: Med Hero San Clemente CA True Professionals.
My youngest child has special needs and needed to be seen in the emergency room. She cannot say much and particularly not when she is in pain or discomfort. We went to a children's hospital in Westchester NY, where I was repeatedly asked what was her pain level- I said it was high as she needed a catheterization (but when they asked her she obviously could not answer), but they continually let in other kids who were clearly not in great discomfort. When we went to the bathroom, they literally erased her name from the waiting list and after every other child was let in but her, they said, they were too full and I would need to be patient. Well, that was when I began to talk very loudly about "discrimination" against children with special needs and needing to see a supervisor. (At this point we had been over 6 hours in the waiting room). After getting into the back area, we waited another 2.5 hours without seeing a single person. We ended up not needing the catheterization because she suddenly could urinate after more than 28 hours had passed. But I left a lengthy complaint letter (literally, a child with a scratched knee got in)and I think I managed to get children with special needs to be triaged slightly differently. Just because they aren't crying out in pain doesn't mean they aren't suffering.
I think the only way we will ever begin to scratch the surface will be if all hospitals are forced to publish ALL (every procedure, every item) of their prices online. I know Trump had an order requiring this, but most hospitals have the prices hidden on their websites or tell you to call for a price.
Sad, awful truth is that in the US today the majority of hospitals are owned either by giant corporations or (more recent development) giant private equity funds. There is also a hot trend for Emergency "Provider" groups to be bought out by large private equity funds. Both corporations and equity funds have fiduciary duty only to their investors. This helps to explain the replacement of ER physicians with Nurse Practitioners and Physician Assistants (cheaper), along with paring overall staffing down as far as they can get away with legally. Most minor things treated by NPs and PAs do just fine, but I shudder to think of NP or PA management of major medical or trauma cases without having an experienced physician for backup. I've seen it evolve before my eyes (I'm a retired ER physician with 30 years full time experience in high volume ERs). The American people are being used as cash cows, with no real options till maybe after the fact, trying to negotiate an exorbitant bill down to something realistic (good luck). Your story about the injured knee and treatment via private physicians/hospitals holds the key to bringing American medicine back down to earth, but the corporations and private equity funds play hardball and have made it exceedingly difficult for private practitioners. Majority of physicians have had their practices bought out by giant corporate hospitals/private equity funds, and they become "employees" rather than independent professionals. They discover that they must "follow the narrative, follow the algorithms" or be out of a job and maybe rendered unimployable. That's a big part of the reason so many physicians stayed silent or just went along with the fatally flawed "vaccine"/lockdown regime. I'm retired now, but just doing a little light part time work doing mostly physicals, and don't care if I get fired at this point. We got a taste of "single payor" with the vaccine mandates, and a bigger vicarious taste of "single payor" medicine witnessing the outrageous new reality in Canada during and after the truckers' protest. Don't fall for "single payor". If "single payor" enacted, only a matter of time till rigid algorithms will be imposed, including "ineligibility" for this or that treatment with no chance of appeal.
The right to die could ever-so-easily become "duty to die". I could write more, but this is enough.
Private equity has gotten into insurance as well. Quit a company that had been backed by PE last year because EBITDA is the overriding concen. Clients and employees take a very distant 2nd and 3rd.
...teared up when reading about the frog... so well written... so relatable... shocking relatable... even though or maybe just because I see a lot who do not have the courage to go through the open door and work hard to find freedom, friends and health... will read the next chapter of your story now...
Best fix: No corporate hospitals or clinics. Independent doctors only, with public references. No CEOs or other non-medical administrators. Complete public disclosure of costs for both hospitals and more minor procedures.
And no more "for profit" hospitals. The very idea of a "for profit" hospital is obscene.
Originally, hospitals were for the poor who could not afford care.
And what we call medical insurance today was created as and referred to as "Hospitalization Insurance."
What was it? You got a yearly benefit of 7 days for free, full coverage? That was the era of inpatient physicals. Bizarre. It was a gateway drug for the abject madness the legacy system is presently addicted to.
I certainly agree with your sentiments here. Just look closer at the problem illuminated in the COVID fiasco. Here we find unconscionable things being done by medical administrators, and other medical professionals who say little or nothing. Whether they are powerless or complicit, the result is the same.
Further, every modern hospital is a form of corporation doing business as a hospital. Many practicing physicians will also practice in commerce as a corporate species.
The greater issue turns on First Principles and the structure of power, primacy and liberty to practice.
Consider this approach:
1) No corporate entity should be able to dictate patient care in any manner and should not be allowed as a lawful interloper in the performance and practice of the individual licensed physician mutually attending a patient in their care.
2) Only the patient and the physician of their choosing should determine was is medically necessary for the said patient. No other 3rd party, clerk, non-physician, non attending physician or physician not of the patient's choosing should determine what is medically necessary, except in instances of extremis, emergent circumstances or incapacitation.
3) Remove the traditional exemption from consumer protection statutes provided for medical services and related product. They are in the channels of trade doing commerce. Regulate that commerce like ever other industry, especially when the consumer is also a patient.
4) Issue medical insurance to the human individual only. Prohibit different prices for the same coverage. The insurers may compete among themselves, but among their customers everybody pays the same premium for the same product. All coverages must pay claims for what the patient and the physician of their choosing have determined to be medically necessary. The primary servicing insurer marketplace remains intact and become increasingly competitive based upon the quality of claims services provided. This is not a single payor approach.
5) In further consideration of (4) end all group and family policies. No interlopers. No more clerks and medical persons dictating medical necessity to patients they have never attended nor have permission to attend. The contractual and administrative clarity will make it easier to focus upon and identify criminal racketeering and illegal reimbursement schemes. This will help the primary insurer more profitably evolve into an expert and efficient medical claims management contractor, which will be an essential service in the anticipated model being considered here. This is something the government has no business doing. This is not what they do well. Large blocks of public works capital formation is their thing; that and large scale regulatory operations. They may do it ugly, but they do it, and endure a scale and scope of operations where no other corporate entity could possibly survive. This is not a single payer approach. There is no way a single payer approach can effectively administrate the volume and velocity of incoming claims on such a massive national scale. It will need an vibrant industry blessed with adroit management, or they too will perish or be consumed by their competitors who can.
6) Capture the entirety of the medical reinsurance and stop loss market and remove it from the profit sector as such is economically counterproductive and transnational capital interests reap the gain, not the American citizen. Pour that into a government treasury/trust structure and require all primary medical insurers to buy stop loss insurance from the treasury/trust entity, and all at the same rates. Medical insurance premium prices are in large part a result of the stop loss reinsurance premium paid by the primary servicing insurer to the reinsurer. If you think about it, we are sovereign American citizen with unalienable rights. It is fundamentally not reasonable to expect a corporation to pay the costs of our unalienable rights, such as the right to determine with the physician of our choosing what is medically necessary. We mutually can and should be together paying the costs of our unalienable rights as citizens in the most direct and efficient way possible. Such measures will bring the sea change needed to be radically transform the current system away from decades of racketeering, predation and the plague of ritual stupidity that dominates its commercial culture.
7) Elevate the sanctity and primacy of the mutual physician/patient relationship to at least the equivalency of the lawyer/client relationship. How barbaric and indefensible that such is not already this way. The sanctity and primacy of the relationship between the patient and the physician of their choosing... well, without that, just look around at the tragedies, heartbreak, predation and institutional stupidities that have become normalized in the absence of that.
The mutual physician/patient relationship is everything. Its quality and primacy are the object of the entire exercise of what we call human medicine.
Nothing can replace that unique trustee relationship. Nothing else should.
Dr. Malone thank you for writing this and sorry for blasting your comments section with my links. This was just too perfect. You are so good at explaining the problem - one which I have recognized for almost a decade now. So lately I have been working with a think tank of like minded people thinking about solutions. And we have been tackling this problem with several recent articles. We are trying to discuss what can we do to fight back that is both VERY EFFECTIVE and SAFE. No one wants violence if possible. But governments and power structures tend to get violent when attacked.
So we have a plan that we believe will work: radical transparency and decentralization. We don't need government's permission. All we need is some open sourced tech built and a new agreement between all people that focuses on one thing - our biggest issue: ENDING CORRUPTION IN THE SYSTEMS THAT GOVERN OUR LIVES.
All of our problems are because we are running our software on a bad system. It just needs a few tweaks, and the system can be great again.
If this interests you or anyone else at all I beg you to at least read some of the ideas. To change this we will need a movement. Either that or we can just sit here and wait for everyone else to save us.
#TransparencyMovement
https://joshketry.substack.com/p/what-we-need-is-a-transparency-movement
My husband was in the hospital and I had an itch on my arm (from trapping cats in the brush) and I asked a nurse for some H2O2. She said they didn't have that. I asked for some -OH. She said they didn't have that either. (WT...?). She then said she had some anti-itch cream (pharmaceutical), but she couldn't give it to me because I wasn't a patient.
What is wrong with this picture? Other than that we began the story with being IN the hospital in the first place.
The nurse didn't know what hydrogen peroxide was.. happens all the time.. YEP.
Beautifully said.
I also think all malpractice and catastrophic adverse medical events and disability claims should be paid from the same reinsurance fund so they can be cost averaged and absorbed across the national population. Medical malpractice would become a no-fault system with amnesty in the absence of criminal acts. There could then be complete transparancy. Essential high-quality data would be gathered without penalty to improve the systems and practices of medical treatment. Physicians would self-report to better inform the loss control data set gathered on a national scale. The statistic value of such data is enormous in both human and actuarial terms. Further, the immediacy of the data would be equally beneficial. Those patients suffering harm would find their physicians as advocates rather than defendants.
This reinforces the wisdom, utility and value of capturing the reinsurance component as it preserves competition and naturally selects for improved quality and efficiency in the servicing of of claims made while rescuing the underwriting capital and profits arising therefrom for the benefit of all American citizens, instead flowing cross border to elite offshore or transnational financial interests as our present system has been created to allow.
If I may elaborate on another point. The single payor approach will never work as the granular point of service for claims processing is simply too massive and dynamic. It must be distributed across competing entities freely developing and adapting expertise, molding human abilities and administrative performance to meet the unforgiving, complex demand and incredible velocity of filings.
Think of IRS. Think of the incredible administrative load they process, then think of what happens to the quality and continuity when they start talking to individual taxpayers. Now think of the medically served. Think of the numbers of medically served. Maybe 40% file taxes annually? That means medical claims processors will churn 2.5 times the number of annual IRS filings and some patients will have multiple filings per month. That is a massive and complex administrative engine that churns at high velocity. That must be managed with nuance and distributed authority and special process. That can't be administrated effective by fiat of checklist. Humans must be free to manage at will as a special process on behalf of the claimant lest they become sausage. If you want sausage, government does a great job making sausage but who wants that? The present system is already turning into a sausage factory and that is the cardinal problem that most threatens us today.
We need to use our mutual large-scale wealth in ways that simplify and create operational ease amidst some of the most difficult work that humans do on behalf of other humans. We must do a much better job of creating competent liberating structures for these professionals to do their thing with immediacy, less agonism and less fear. Literally, our very lives depend on it.
That being said, we should start with getting rid of the Federal Government.
Yes. That is the problem. In the end it's all a form of self government, whether by ignorance, abandonment, abdication, the ambitions of some, the involvement of all, or the tyranny of a few.
The treacherous truth? When it comes to human affairs, there is always government, and there are many species of government, and many temperaments.
There is no escaping the timeless burden between self government and government of the self. If that doesn't bring one to prayer, nothing will.
The big question is: "What government do we have?"
The big problem is: "What government do we need?"
We don't just need good government. We need government to be good.
Some people get in the way of the good. That is the hard problem.
Like it or not, we are our brother's keeper. Best to always be ready to wash some feet as there are always feet to wash. We know when it's our turn. There is no escape, only forgiveness and redemption.
There was also an old chinaman, Lao Tzu, who commiserated about the great dilemma of governing many centuries ago. He wrote the ancient book of 5,000 words. He only wanted to leave the city to go the the mountains and die a peaceful death, but his reputation preceeded him. The guards at the city gate refused to let him leave. As the old story goes, Lao Tzu pleaded to be allowed to go and die in peace, but the guards would not relent. They were terrified everything would turn to sh*t if Lao Tzu was allowed to go. That was when he agreed that he would write his book. And so he did, and so he traded the book for his passage to escape the grip of his government and live out his last days free of them. There is always government. It always seems to be waiting at the gate.
Our imperfect human nature is such his mortal observations and playful admonishments about governing, government and its place in the universe remains ever true in our times, as so it also has been across the arc of human history:
What is a good man but a bad man's teacher?
What is a bad man but a good man's job?
If you don't understand this, you will get lost,
however intelligent you are.
It is the great secret.
https://cpb-us-w2.wpmucdn.com/u.osu.edu/dist/5/25851/files/2016/02/taoteching-Stephen-Mitchell-translation-v9deoq.pdf
Yes. Single insurer through the 50 states. Fuck CMS. States allowed to contract through competitive payment systems (CMS, BCBS, Humana or any other administrator interested in the business). State laws prohibiting the payers from dictating protocols to providers. (Ie, no "death panels.")
Absolutely!!!
Dr. Malone thank you for writing this and sorry for blasting your comments section with my links. This was just too perfect. You are so good at explaining the problem - one which I have recognized for almost a decade now. So lately I have been working with a think tank of like minded people thinking about solutions. And we have been tackling this problem with several recent articles. We are trying to discuss what can we do to fight back that is both VERY EFFECTIVE and SAFE. No one wants violence if possible. But governments and power structures tend to get violent when attacked.
So we have a plan that we believe will work: radical transparency and decentralization. We don't need government's permission. All we need is some open sourced tech built and a new agreement between all people that focuses on one thing - our biggest issue: ENDING CORRUPTION IN THE SYSTEMS THAT GOVERN OUR LIVES.
All of our problems are because we are running our software on a bad system. It just needs a few tweaks, and the system can be great again.
If this interests you or anyone else at all I beg you to at least read some of the ideas. To change this we will need a movement. Either that or we can just sit here and wait for everyone else to save us.
#TransparencyMovement
https://joshketry.substack.com/p/what-we-need-is-a-transparency-movement
This reminds me of my son's experience when he was visiting us. (He lives in Texas, I am in North Carolina.) He began to have some very bad pain in his side and back. His wife had no idea how to get to a hospital, so I drove the two of them. There, my son paced back and forth in excruciating pain for several hours. He could not get comfortable either sitting or standing. We asked several times at the reception desk if he could be seen soon, as he was in agony. Finally, we decided to take him to another hospital. Lo and behold, when we informed them we were leaving, they were suddenly able to take him back to be examined. He needed gall bladder surgery. I am still angry when I think about how many people went back before him, seemingly with minor problems; certainly not in obvious pain. No one cared.
I don't live in America, but in Canada instead, but I wanted to share my experience with our healthcare as I feel there is a huge misconception in the world about how "amazing" it is.
I am bipolar, but that diagnosis was only given after 15 years of misdiagnosis and being an involuntary guinea pig for greedy doctors who perscribed me insane medications. I trusted them, I had no choice. The antipsychotics, benzodiazepines, mood stabilizers and antidepressant salads I was given for years never worked, they always made me worse, but they just gave me more and more meds. Multiple doctors over years. I was told the physical side effects like rapid weigh gain, twitching, and being zombified to name a few were a "benifit outweighed the cons" situation, though its funny how no one seemed to ever care about my opinion of that.
Obviously the medications were terrible for me and often resulted in my having emergency room hospital trips for suicidal thoughts or self harm or just a general psychotic break. I would wait for 8 to 10 hours sometimes in emergency for some white coat doctor to ask me some questions about my mental state and then always, ALWAYS, they would dismiss me and send me on my way. They would tell me I "didnt seem suicidal" and that they weren't to concerned about me. I would beg them to keep me there for further assessment, for help, for anything, as I was terrified of myself, and they would say they only keep people who are "actually a danger to themselves". I have a strong will to live apparently, and even when ever cell in my body wanted to die, and i would always manage to find a way to hold on for another day. But I often wondered how many people were turned away, like me, but couldn't hold on.... and how many people even know they had gone to the hospital for help first only to be turned away?
Unfortunately, one fateful day, I couldn't hold on anymore and I did attempt to take my life. I went to the hospital in an ambulance, they stitched me up, and then they sent me home. Yep, thats right. I cut my wrists so deeply i needed stitches and they didnt feel I was at risk enough apparently to keep there for further assessment. I was flabbergasted. Oh, and lets not forget the wait periods to see a psychiatrist. Were talking years sometimes.
Our country has an opioid crisis. Mental health issues are running rampant. People are dying by their own hand every day. And our political leaders are more concerned with 10 dollar-a-day day care, virtue signaling, and blaming eachother for l these issues than actually offering compassionate care for some of the most vulnerable people in our society. I survived my ordeal, and after my suicide attempt I finally was given a Lithium and wouldn't ya know it, I haven't had a single hospital trip since.
I can't speak for everyone of course. Not every one is bipolar and was used as a drug tester for greedy doctors, but I can say beyond a doubt that our systems are deeply broken, and I fear people die every day unnecessarily and thinking that they aren't worth the care or time of our doctors and health care systems, because quite frankly, that's how they make you feel. Like you're a burden.
Anyways, thanks for reading!
Thanks for posting from a fellow Canuck. I am glad you survived. Healthcare in both our countries is quite atrocious but mental healthcare is especially so. A lot of homeless people are on the streets for that very reason.
I started bodybuilding in my teens and vacuumed up nutrition science and the latest studies. 30 years later still lifting, eating well and on no meds.
Im still shocked how the system as is feeds us crap and makes us sick.
But it’s too lucrative so it rolls on and on.
And thank you for sharing it. You’re in my thoughts. I’m struggling with my niece with bipolar and way too many medication so it’s just a nightmare so I hear you
It is very difficult for both the person and all involved. I hope your niece is able to find a medication that works well for her and that things get better!
May I ask… What dose of lithium you were or are taking? Was it prescribed? Or over-the-counter as it is here.
It was perscribed, I dont believe its available here over the counter. I was put on 900mg, but had it upped to 1200mg 4 months later and that seemed to be the perfect dose. I had been on Lamotrigine with antipsychotics prior to Lithium, and they left me on it, but removed the antipsychotics. So I take 1200 mg of Lithium and 100 mg of Lamotrigine and have done so for 4 years now and finally get to experience a "normal" life for the most part.
Thank you so very much. I recognize that that is private information and I appreciate so much that you gave it.
An interesting video I saw recently, do a YouTube search for bipolar research Korea. There’s a few different videos. Interesting. About dendrites
Dr Malone, I’m aware that our conversation took quite a side road here. But thank you 🙏 for providing this road.
I’ve always heard that government healthcare is great, as long as you’re healthy.
That is some truth right there if I have ever heard it!
I have started to listen to Praying Medic. See if he might be of some help. Good luck to you.
My heart goes out to you. I am grateful to read that you finally were given a way out of those hellish years.
Thank you for your kind words. I am grateful every day, and believe me, I really simplified the years of ridiculous stuff I went through, so it makes me even more grateful.
I pray that you are remaining well. You are brave to share your ordeal. Thank you and God bless.
Dr. Malone thank you for writing this and sorry for blasting your comments section with my links. This was just too perfect. You are so good at explaining the problem - one which I have recognized for almost a decade now. So lately I have been working with a think tank of like minded people thinking about solutions. And we have been tackling this problem with several recent articles. We are trying to discuss what can we do to fight back that is both VERY EFFECTIVE and SAFE. No one wants violence if possible. But governments and power structures tend to get violent when attacked.
So we have a plan that we believe will work: radical transparency and decentralization. We don't need government's permission. All we need is some open sourced tech built and a new agreement between all people that focuses on one thing - our biggest issue: ENDING CORRUPTION IN THE SYSTEMS THAT GOVERN OUR LIVES.
All of our problems are because we are running our software on a bad system. It just needs a few tweaks, and the system can be great again.
If this interests you or anyone else at all I beg you to at least read some of the ideas. To change this we will need a movement. Either that or we can just sit here and wait for everyone else to save us.
#TransparencyMovement
https://joshketry.substack.com/p/what-we-need-is-a-transparency-movement
The demise of the American health care system was totally avoidable.
Yup, when Hillary tried pushing her healthcare thru when Slick Willy was Prez, many argued that her plan would change health care into a very profitable business at the expense of patient health. Since the Affordable Care Act my insurance costs have tripled.
Oh, you're not happy with Romney-care?
Can’t stand Romney or his Care.
An overview of the Greek system. https://healthmanagement.org/c/imaging/issuearticle/an-overview-of-the-healthcare-system-in-greece-1
Fixing the U.S. system is a tricky one. The greek and euro systems seem to often combine a socialized NHS component with private insurance. The U.S. has something similar with Medicare/Medicaid and private insurance but it is a big messy ball. We also have 50 state regulations on top of federal. If I were to start somewhere it would be to blow up all regulations to get more innovation and competition and start over. There are just too many vested interests to get any meaningful change. Which brings us back to the fact that our government is hopelessly broken.
Our family uses a faith based health care sharing service instead of insurance. Our experience in the American health care system is much closer to your friends Greek experience. The lightening of the medical staffs countenances when we tell them we are cash pay is very noticeable. Generally, we pay a bill and before the credit card payment is due, fellow sharing members pay us the refund in multiple little checks..and often also attach get well notes and cards. Gone are mountains of “insurance” paperwork and the headache they cause to the medical establishment. I helped my wife through cancer with this and found better, cheaper doctors that did not work in hospitals that were happy to have us. The United States has far too much liability induced fear in its institutions. This has created mountains of paperwork. Our system eliminates much of that..and our doctors felt freer to use the protocols they thought best. BTW- I bet that the “free” hospital would have been a very different experience with more than a “little” more of a wait. Social medicine is not the answer, especially with the controls organizations like the WHO have over these government organizations.
Are you able to tell me the name of your healthcare sharing service? I’ve been wanting to look into this option, but could find no reviews on the ones I am aware of.
We use Samaritan. There are others and some that are secular. Unfortunately Samaritan has restrictions on preexisting conditions. Other may not if you fall into that category. These health care sharing organizations have a bit of a target on their back from certain sectors of the political “leadership”. While they last, I would recommend utilizing one if you can.
Thank you very much! May I ask what state you reside?
California, sadly.
😢
The AMA is run by the medical mafia. Shoot them all. It's a start.
I was working in Nigeria for an oil company when my wife developed Deep Vein Thrombosis.
Making a long story about arguing with the insurance company short, we air-ambulanced her to South Africa for medical care. It was great. The care was great, and after being in the hospital for about a week, her bill was the equivalent of ~$3,000 US.
One of the ironies is I wanted to take her to Europe. The insurance company argued, a jet to Europe would be almost $100k, the limits of the policy. There wouldn't be any money left for her care when she arrived.
Later, when I'm telling this story to Europeans, they laughingly said, "Why did you want to bring her to Europe? She got better care in South Africa. " And I see now, they were right.
I also had a medevac experience in South Africa (from East Africa) in 2018. Didn't need air-ambulance was stable enough for regular flight - there was a driver waiting at the airport to take me straight to hospital in Johannesburg (they thought I couldn't handle another ride to Pretoria). 2,5 days in hospital and then discharged until 5 days later when follow up appointments were scheduled. Total cost - $5k which I paid then passed onto insurance company for reimbursement.
Nurses were very caring and made me rooibos tea whenever I wanted it. My chart was old school paper chart, not electronic one. Main doctor in charge of me spent time to explain what's going on and what the next tests would be (CT, MRI). Phlebotomist was so gentle and even offered to do butterfly needle vs regular one for less pain given how many vials they were doing. Most importantly, I was listened to as a patient and not dismissed.
Until COVID I trusted our Canadian health care system, though I had a few less than positive experiences with my first oncologist. My family doctor has been amazing for over 15 years. He even, off the record, recommended against the jab. I was so relieved but sad that he couldn't be more open.
My daughter-in-law was a nurse until last fall when she had to make the decision between the jab or her job. She'd been getting increasingly disillusioned with the medical system. Several years ago her hospital fired the floor secretaries, saying that the nurses could answer the phone and do all the paperwork. Fast forward a couple of more years and the hospital fired all of the LPNs, saying that minimum wage "techs" could do the LPNs job. Wasn't uncommon after this for my daughter-in-law to come home upset because her tech would only work with a certain number of patients then sit the rest of shift at the nurses station. Eventually her 12 hour shift became 14 or 15 because she didn't have time to chart until after her shift was over. She was a compassionate nurse who cared but was burned out.
I think the medical system has many issues like too many regulations, insurance companies controlling treatment, burned out staff, and too much pharmaceutical company influence. Those who work in the system could list many more.
Excellent article.
If one drives around the US and is paying attention, one notices the absolute explosion in brand new, increasingly large, “healthcare” facilities. And more and more specialized “institutes” that promise super high expertise in leading edge “procedures”.
The underlying assumption in the US is that everyone is Ill or afflicted with a multitude of diseases/conditions, all requiring multiple drugs and ultimately specialized “treatment or procedures”
Go into a CVS in a relatively small town and take a look at the thousands of prescriptions filling up the bins.
Clearly, there is so much money in our “healthcare” system that they literally don’t know what to do with it.
Little known secret. Use an Urgent Care in the US. 1/10th the cost of an emergency room. Rented ebikes in Newport Beach, CA. Front tire came off my son's bike leaving him in a heap. Once the tire stopped rolling 100 yards away, he was left with a gash on his chin. You know it is bad when the second comment out of witness' mouth after "is he ok" is... "Oh that's going to need stitches." Being insured by Kaiser, we were dreading the ER experience. We found an Urgent Care in the area, but after 30 minutes and a newbie doctor saying it's too deep, she said she could not handle it and ER was required. Glad she declined it, not being confident in her ability. We researched another Advance Urgent Care. This was where the A team resides. Receptionist was awesome, said she had seen a lot of traumas come through that office and if there is no neurosurgery required or major vascular involvement, they can take care of it. If they can't, no charge. Cool sign me up. Got there after a 20 minute ride, checked in, in a room in 5 minutes, 3 of us, no masks...doctor walks in, she looks at the gaping wound and manipulates it to assess the damage like it wasn't her first rodeo and says, "Get the prep tray I got this". Wow, she was a stud!!!! Stitched it up, in and out in 40 minutes with care and follow up instructions. $400 out the door. Amazing service and beyond reasonable for minor surgery. Guarantee Kaiser ER would have done the same (maybe) for $5000, my out of pocket (partial) deductible. Total deductible is $7500 before they start to pay a dime.
Urgent Care name: Med Hero San Clemente CA True Professionals.
Thanks. Going to bookmark their page.
It's worse than just the cost. You need physician level expertise to navigate the US system, and it often bites you anyway. Here is an example from psychiatry, the most corrupt medical specialty: https://robertyoho.substack.com/p/0fba8cfa-8434-4996-be22-0fefe3c0c306
For related material, see https://robertyoho.substack.com/p/antidepressants-are-the-root-cause#details
My youngest child has special needs and needed to be seen in the emergency room. She cannot say much and particularly not when she is in pain or discomfort. We went to a children's hospital in Westchester NY, where I was repeatedly asked what was her pain level- I said it was high as she needed a catheterization (but when they asked her she obviously could not answer), but they continually let in other kids who were clearly not in great discomfort. When we went to the bathroom, they literally erased her name from the waiting list and after every other child was let in but her, they said, they were too full and I would need to be patient. Well, that was when I began to talk very loudly about "discrimination" against children with special needs and needing to see a supervisor. (At this point we had been over 6 hours in the waiting room). After getting into the back area, we waited another 2.5 hours without seeing a single person. We ended up not needing the catheterization because she suddenly could urinate after more than 28 hours had passed. But I left a lengthy complaint letter (literally, a child with a scratched knee got in)and I think I managed to get children with special needs to be triaged slightly differently. Just because they aren't crying out in pain doesn't mean they aren't suffering.
I think the only way we will ever begin to scratch the surface will be if all hospitals are forced to publish ALL (every procedure, every item) of their prices online. I know Trump had an order requiring this, but most hospitals have the prices hidden on their websites or tell you to call for a price.
So sorry to hear your child was treated so poorly.
Sad, awful truth is that in the US today the majority of hospitals are owned either by giant corporations or (more recent development) giant private equity funds. There is also a hot trend for Emergency "Provider" groups to be bought out by large private equity funds. Both corporations and equity funds have fiduciary duty only to their investors. This helps to explain the replacement of ER physicians with Nurse Practitioners and Physician Assistants (cheaper), along with paring overall staffing down as far as they can get away with legally. Most minor things treated by NPs and PAs do just fine, but I shudder to think of NP or PA management of major medical or trauma cases without having an experienced physician for backup. I've seen it evolve before my eyes (I'm a retired ER physician with 30 years full time experience in high volume ERs). The American people are being used as cash cows, with no real options till maybe after the fact, trying to negotiate an exorbitant bill down to something realistic (good luck). Your story about the injured knee and treatment via private physicians/hospitals holds the key to bringing American medicine back down to earth, but the corporations and private equity funds play hardball and have made it exceedingly difficult for private practitioners. Majority of physicians have had their practices bought out by giant corporate hospitals/private equity funds, and they become "employees" rather than independent professionals. They discover that they must "follow the narrative, follow the algorithms" or be out of a job and maybe rendered unimployable. That's a big part of the reason so many physicians stayed silent or just went along with the fatally flawed "vaccine"/lockdown regime. I'm retired now, but just doing a little light part time work doing mostly physicals, and don't care if I get fired at this point. We got a taste of "single payor" with the vaccine mandates, and a bigger vicarious taste of "single payor" medicine witnessing the outrageous new reality in Canada during and after the truckers' protest. Don't fall for "single payor". If "single payor" enacted, only a matter of time till rigid algorithms will be imposed, including "ineligibility" for this or that treatment with no chance of appeal.
The right to die could ever-so-easily become "duty to die". I could write more, but this is enough.
Private equity has gotten into insurance as well. Quit a company that had been backed by PE last year because EBITDA is the overriding concen. Clients and employees take a very distant 2nd and 3rd.
...teared up when reading about the frog... so well written... so relatable... shocking relatable... even though or maybe just because I see a lot who do not have the courage to go through the open door and work hard to find freedom, friends and health... will read the next chapter of your story now...