Monthly Archives: January 2017

“Inauged”: My New Word for “Now We’ve Been F**ked by You Know Who”

Well, it’s done. He is the President. Yup. Trump and his coterie of billionaire country rapists are now our official leaders. How does it feel? Like you could benefit from several hours on a bidet? I feel your pain.

As most of my readers know, especially if they’ve clicked on the “Books by” link on my Facebook site, I write and have two published works of fiction, Zendoscopy (a serio-comic coming-of-age tale) and Spacebraid and Other Tales of a Dystopian Universe (sci-fi fantasy stories). What many may not know, however, is that I’m a retired M.D. An ob/gyn, to be precise about it. I spent 16 years in clinical practice, and then segued into administrative medicine, taking on several roles during the balance of my career: senior health plan executive, market medical director for a large health plan and, ultimately, heading up physician, hospital, and ancillary provider peer review (medical quality of care management) for 13 western states for a very large insurance company. Along the way, I also did some teaching in a university-affiliated ob/gyn residency program. Having worked in these several sectors of our health care environment, I’ve developed some pretty strong opinions about where health care should be heading. And folks, lemme tell ya, it ain’t a goin’ in that direction today.

At first, I thought I’d provide you with a historical review of how we got to where we currently find ourselves but, as I began to write, I realized I could fill far more paragraphs than anyone would want to assimilate on the subject. So, instead, here’s a considerably shorter review with my take on it all.

The pre-mid-1980s 80/20 insurance plans and employer-based health care model provided coverage that encouraged people to ask for everything and physicians to provide it…and more. This led to uncontrolled costs and opened the door for so-called “managed care”, a model that promised evidence-based health care with cost controls and some inevitable loss of choice for patients. Big business saw an opening and stepped in to run it, leading to substantial abuse in the name of bolstering corporate profit. The promise of better care at lower cost was sacrificed on the altar of stratospheric executive pay. Health care, quite simply, became an immoral, profit-centered business.

The Affordable Care Act (the “ACA”, or “Obamacare”) was an attempt to deal with the problem and provide coverage for the millions of Americans who lacked health insurance. It is important to remember that the basic idea from which grew the ACA was, in fact, a Republican plan and was even implemented in Massachusetts by then-governor Mitt Romney. But the version known as the Affordable Care Act was the specific plan promoted by our nation’s first black President, and as Senator Mitch McConnell famously articulated, nothing proposed by President Obama would ever be approved by Republicans, including the formerly articulated Republican health care plan. The racism inherent in the Republican position was obvious and odious.

President Obama’s offering included a “public option”, essentially a program of universal coverage provided through an alternative that would, in effect, compete with the private health care system. This was a non-starter for business-protectionist Republicans, who screamed “socialized medicine” and forced Obama to drop it. As a result, the ACA ultimately passed on a straight party-line vote without the one component that would have led to truly comprehensive coverage availability for everyone. The ACA as enacted was far from perfect but it was a compromise that Republicans could at least say didn’t eliminate the insurance companies from the health care market, and it did allow more than 20 million people who formerly lacked insurance to gain coverage. Other benefits of the ACA are well known and I won’t take time to delineate them here.

Now, the Republicans, who’ve tried some sixty times without success to dismantle the ACA, see their chance finally to kill it. But as in all the years since its adoption, they have been unable to present a viable alternative. What they’re learning is that health care does not operate according to simple market-based supply and demand rules. Demand for health care is relatively inelastic – everyone needs it eventually and, often, unpredictably. To drop 20 million or more from the insurance roles will only cause them to delay care, become sicker, and then seek care in emergency rooms, where treatment is outrageously expensive and, to a great extent, paid for by taxpayers in the form of government expenditures and increased direct health care costs. It isn’t more cost effective than covering people through insurance and, being wasteful of resources and inefficient, it makes no sense to abandon the ACA with this as the inevitable result.

What is the answer? No matter how distasteful it is for the right wing, the ONLY viable answer is universal coverage, sometimes referred to as “Medicare for all”, although it would likely differ in some respects from Medicare. It would, in essence, be a federally funded program that could use private insurance companies as fiscal intermediaries under contract for reimbursement. Everyone would be covered by a safety net assuring a basic standard of care. Those who could afford it could purchase upgraded levels of coverage from the insurance companies, say, for cosmetic or advanced infertility treatment. We would abandon the dysfunctional employer-based health care model, with funding (as now for Medicare/Medicaid) coming from tax revenues. It would not be more expensive per capita than what we are paying now in premiums.

That’s a somewhat oversimplified view of what needs to happen, but I’m confident in predicting that it won’t happen anytime soon. Entrenched interests will see to that. But how long will we be able to justify our present system or whatever the Republicans may try to implement when we’re confronted by the well-functioning universal coverage systems of other Western, developed nations? Our present system, with its fragmented incentives of patients v. doctors v. hospitals v. insurance companies v. drug companies is an utterly unnecessary disgrace with higher costs and worse health outcomes than most if not all Western European countries. But we won’t get what we need until we all stand up for it. This will take a degree of political awareness and activity sorely lacking today in the American public, many of whom voted against their own best interests in the recent Presidential election.

Maybe those folks will eventually wake up and realize they’ve been conned. If so, I hope it happens before the suffering becomes too severe. Say, in time for the next midterm elections.

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Buy a Binky for Donald!

OK, the truth is that I, as a one of those elitist, left wing liberal, rational secular humanists, am as dismayed as every other one of my similarly minded friends over the election of Donald Trump as our 45th President. But I’ve got an idea to express our huge sense of foreboding about what’s coming while maybe effecting some positive change in the man’s abysmal behavior..

Let’s start with a description of he who would be our fascist leader. Supremely experientially and temperamentally unqualified for office, racist, anti-immigrant, willfully ignorant, lacking of any understanding of the country’s founding principles, pandering, mendacious, misogynistic, loaded with conflicts of interest, amoral, and, to the point of this little essay, drowning in infantile narcissism. Yup, that’s most of it.

Trump reminds one of a spoiled, bullying brat with a skin so thin (and orange, apparently) that he cannot tolerate even the slightest criticism without lashing out like a petulant, infantile  adolescent  with unrestricted access to social media. Nothing escapes his tweeted outrage. Most recent example: Meryl Streep at the Golden Globes, eliciting this rude imbecility, “…a Hillary flunky who lost big,” and  the gratuitous dig, “…one of the most over-rated actresses in Hollywood.”

So, what do we do with an oversized, whiny, bullying pea-brain whose tantrums seem uncontrollable? Well, I’ve been a pretty good parent in my lifetime, if I do say so myself, and I’ve learned that when babies get really irritable and can’t be otherwise controlled, all that nervous energy can usually be dissipated by sucking. And based upon all the available evidence, Donald Trump is a baby who sucks big. Ergo, my new campaign, which I’ve chosen to call “Buy a Binky* for Donald”.

Given that the guy’s lack of self-control is a manifestation of extreme immaturity, excess nervous energy, and deeply seated insecurity (not uncommon in bullies), why not let him stuff a Binky into his pie hole to suck his way into more socially acceptable behavior? To accomplish this, we should, each and every one of us, send him a pacifier so he’ll have a “huge” supply, say, enough to carry him through his impeachment. After all, if he’s going to act like an out of control and immature sociopath, let’s treat him like one. You can send it to him at Trump Tower. I’ve given the address, below.

BUY A BINKY FOR DONALD!

Send a Binky to Donald at:

President–Elect Donald J. Trump, Trump Tower, 721 Fifth Avenue, New York, NY  10022

* Binky is the registered trademark of  Edgewell Personal Care Brands, LLC.

 

President Elect Trump’s Inaugural Address

I am pleased to announce that an unnamed and highly disloyal source close to President Elect Trump has hacked into his laptop and discovered a draft of his inaugural address which, as a public service, I reprint below.

INAUGURAL ADDRESS: DONALD J. TRUMP (“I wrote it and it’s HUGE.”)

My fellow Christian Americans. I stand before you today as the forty-somethingeth (shoulda taken those briefings – they’d a told me) President of the United States. To those of you who voted for me, I express my deep gratitude. To those who didn’t, F you.

My agenda for the next four years is an ambitious one, one that bears little resemblance to anything I promised during the campaign but, I can assure you, it’s gonna be great. Just to name a few things, I’m going to radiate goodwill toward all by lowering taxes on the upper 1%. These are the job creators of our economy and deserve to be rolling in dough. And in fairness, the rest of you will continue to pay and pay to support those creators. Remember, taxation of the 99% is a privilege. It’s the American way. Or at least, the Republican way.

For another example, I offer my version of the gutting of Obamacare, the worst social program ever devised by an Afro-American Muslim Kenyan terrorist sympathizer. You know what I mean. First, we kill the mandate. Then we kill preexisting conditions. Then we kill keeping dependents on until age 26. Then we kill taxation on medical devices. Yes, I know I promised we’d replace it with something great, but, hell, I haven’t got a clue what that would be. And as everyone knows, health care isn’t a right. It’s for people who can pay for it, and if 20 million people can’t pay the freight, well, screw ‘em.

We need to improve our relationship with Russia. Vlad and I are buddies, and continuing to nurture that relationship will help me financially and only marginally destroy American security. Which leads me to comment on that whole hacking thing. There’s no way that Vlad would do that just for me – to us, I mean. And actually, I’ve heard that the hackers were actually based on Nauru, with plans to invade the West Coast after bringing us to our cyber-knees. Some guy named Assange told me that.

Finally, let me say that I truly respect all people. Excluding, of course, Muslims, blacks, Mexicans, Jews – except for my son-in-law, and I’m not too sure about him  — and most anyone else who isn’t either Christian, white, male, or Ivanka. Ivanka. My little vixen!

So, my fellow Americans, let us move backward to a better time, the days of Jim Crow, no reproductive rights, and pussy grabbing without fear. After all, we are Americans, and we are going to make America great again!