If I Am In Jail By The End Of Today…

…it will be deemed justifiable homicide. It will, I promise you. Let me explain, your honour.

So the Twitterverse knows that a little while ago I had to complete a 120+ page project in a week. Additionally I kept getting emails & phone calls via the underwriter for weeks after, all of them stupid questions a brain dead squashed monkey would be ashamed to ask. This thing has set me behind quite a bit, and since the loss of my glorious assistant, I am on the verge of a psychotic break as it is.

The project was malpractice insurance applications for all my surgeons, plus the entity. We were promised a $10k reduction in premiums. I was assured this would not be a waste of my precious, sanity clenching time. Today they came back with a quote not only without the discount, but also another $50k higher. We opted, naturally, to stick with our old carrier.

I was told this by my surgeon friend because he thought it would give me a good laugh. Here is what actually happened. I believe I endured an aneurysm. I got a shooting pain up my left leg, which may or may not be a sign of heart attack, dysentery, and stroke combined. Maybe even sarcoidosis. I then immediately had the urge to grab a machete & run through the office, challenging anyone with the cajones to a duel. I was then going to fly to Iowa and possibly blow up the company building with my mind.

I told he surgeon this. He thought I was kidding. See, I’m so cute when I’m angry.

My docs have no pending suits, so what’s up with the shite quote? I have two words for you that I like, and then many that I don’t.

First: tort reform. It’s effing awesome.

Second: Bernie Anderson, the demmycrat from my bleedin’ district, introduced a bill to the Nevada assembly last year that sought to emasculate our precious tort reform by adding in damages for “gross negligence”. That, folks, can mean anything.

So because a digestive health center or two decided not to clean their instruments one day, every doctor in Nevada gets punished with soaring premiums? Really, Nevada? Oh wait, the same sort of nonsense reasoning is what made the Nevada medical board become what I affectionately term The Absurd Reich.

I don’t have time on my lunch to explain any of that. Thankfully, the Nevada senate let that assembly bill die. However, we’re facing an election and all that happy horseshit could come back to play another day. SO, insurance companies are preparing. More defensive medicine, here we come! If we had accepted that quote, we might have had to cut two jobs. So way to stand up for the working class, ya bastards.

Ok, venting over. Me goes back to being sweet cute girly girl nao. Mew.

*stabs a puppy*

Can You Feel The Love?

Several of you have not quite understood what I mean when I say that the current health care bill up for debate before the Senate is not the change in which you want to believe. The reason for this is because you haven’t read it, & in fact have not even skimmed any summaries of it. Many of you have heard the words “health care reform” & assumed it was all faeries, sweetness, light, lollipops, gumdrops, bacon, sparkly vampires, cuddles, and wonderful scrummy health & vitality for all mankind.

You, sweet reader, are smoking crack. I’m sorry. You are. I’ve tried to take the crack pipe from your hands. After all, I feel partly responsible as I seem to have sold you some of the rocks way back when. But if you bothered to look at some of the bill, even just fractions of my blog, you would see that the plan intends to gut Medicare, spank & mangle the truly disabled in America with more difficult to obtain, longer to wait for, more expensive care…so that people like me can get our achy pain medicine? Really? I would rather someone who lost a leg had an untaxed prosthetic limb, thanks.

But since you’ve no interest in reading the bill (and really, at the length of the average Bible, who does?) or even my blog (and really, with all the exasperated snark aimed at you, who would?), here is an article about THIS VERY THING. From a doctor instead of the crazy, overstressed person who bills for them & tries to keep them out of jail whilst attempting to keep up with rapidly shifting, arbitrary government guidlines. Enjoy.

Is Medicare the Real Target of ‘Health Care Reform?’

by Dr. Jane Orient

Nobody outside the inner halls of Congress really knows what’s going on in the negotiations on health care “reform. Every now and then, someone emerges from the formerly smoke-filled rooms and throws another 2,000 or so page “bill” out into the public and then disappears to continue talks to carve up one-sixth of the nation’s economy.


But we do know some of the critical unforgiving numbers. And we have strong reason to suspect that radical changes to Medicare Part E (as in Medicare for Everybody) is the real endgame, whatever the interim steps are called: public option, cooperatives, or mandated Insurance Exchanges.

We have the unmentionable truth that Medicare is insolvent. And the common dogma that Medicare is efficient, popular, and impregnable. Is it a Hegelian thesis and antithesis? With the synthesis being to throw the whole rest of the system, which is also allegedly bankrupting the country, into Medicare?

Are our leaders stark, raving mad? Or diabolically clever?

The on-the-books public debt is around $12 trillion, and Congress needs to pass still another law to increase the debt limit. The annual deficit is close to, or even exceeds,  40% of expenditures, the point that some call the tipping point for hyperinflation.We’re not going to grow our way out of this, not with GDP already down 25%, compared to 2000, if calculated in euros.

Then there are the unfunded liabilities of Medicare and Social Security, about which former U.S. Comptroller General David Walker has been sounding the alarm for years. Estimates are as high as $100 trillion or more—orders of magnitude greater than any conceivable ability to pay.

So here we have a legal obligation to pay back the $12 trillion we have loaned out, much of it to Chinese, Saudis, and other overseas investors. And the moral obligation, backed by politicians’ full faith and credit, to soon-to-be-retiring Baby Boomers.

The Chinese and the Saudis have the industry and the oil we absolutely need to live. Not to mention the Chinese army, nuclear weapons, and missiles. American seniors have—the vote.

It is incontrovertibly true that seniors, especially of the Baby Boomer generation, have been taxed all their working lives to pay for their medical needs in retirement. Their money has gone—into the “lock box”? Wherever it is, it is in the form of IOUs. Whose IOUs will get paid first?

Americans have been robbed by the Medicare system, just like Bernie Madoff’s investors were, only in vastly greater amounts. And they are just as likely to get their full benefits from Medicare as investors are to get their money back from Madoff’s prison cell.

No politician, however, wants to default openly, not on his own watch. There’s the danger to his career, from a voter revolt. And when voting doesn’t work, and peaceful demonstrations don’t work, people could become very surly indeed—and worse possibilities loom.

So here’s the con: We put everybody into the comprehensively reformed system. We suck in huge amounts of new revenues, not called “taxes” but rather “premiums,” “penalties,” “fees,” “surcharges,” or “shared responsibility payments.” Since the thresholds aren’t indexed for inflation, the “responsibility” to “share” the load for other people’s needs migrates down the social scale as the dollar deteriorates. Remember, also, that current health care proposals envision the government collecting new revenue for several years before full benefits–i.e. costs–kick in. Its health care on a layaway plan. A neat trick to plug some budget holes without admitting it.

Now comes the allocation part. We make everybody dependent on the system: patients for their care, doctors for their livelihood, so everybody is in a cooperative mood. An inspiration from a consummate politician named Bismarck, also implemented by Lenin and Stalin. Is there any other way than promising “universal care” that politicians could get away with cutting hundreds of billions from expected Medicare expenditures?

We let politicians off the hook by delegating the key decisions to an appointed Federal Reserve-like agency.

We set up a “fair,” “evidence-based” system, with the apparently laudable goal of improving the overall health of society. No discrimination of course—“disparities” are to be eliminated.

Remember, however, that age discrimination is not “invidious.” Every 60-year-old was once 20. The “complete lives system” (a.k.a. “Reaper Curve”) favored by Ezekiel Emanuel is by this logic completely fair.

Here is what it means: people over age 65 would get 3.4 times less care than a 50-year-old. At present, however, spending on people over age 65 is about 3.1 times higher than for 50-year-olds (Uwe Reinhardt, Health Affairs November/December 2003). Under the Emanuel system, older people would get only about one-tenth as much care as they do now [1/(3.4 x 3.1)].

The elderly would not all be cut off at once. They would simply be placed in an overloaded boat with everybody else, with lower-priority people pitched overboard—one at a time.

No death panel is needed. The system simply ratchets down doctors’ pay to the minimum they will tolerate, then punishes those on the top end of the spending curve. It will know who they are because of intense electronic monitoring of everything. Rational rationing—“equitable redistribution”—will occur.

Key words include “universal” and “consensus.” With “everybody in, nobody out,” social hydraulics will occur. Pull one lever at the top, and everybody beneath it is complicit in the “hard” decisions.

Default? No, no. Just a change.

From: http://biggovernment.com/2009/11/22/is-medicare-the-real-target-of-health-care-reform/

Don’t forget, the elderly aren’t the only people who get Medicare. It’s also people with Down syndrome, post traumatic stress, MS, ESRD, ALS, and a host of other chronic, debilitating illnesses. So please, for the love of humanity, stop thinking that supporting THIS health care reform bill makes you a caring, loving liberal. It doesn’t. It makes you unwilling to read. Call your senator. Tell them this is bullshit. Tell them you DO NOT WANT. Tell them to chuck it & do something better.

“When do we want it? NOW!” doesn’t work if we what we get causes suffering.

If you want to do something really wild & crazy, call your Senator & tell them to not only chuck the bill, but do nothing at all regarding “health care reform”. Government has just made it worse. If you are feeling particularly impish, throw in a shout out for tort reform. That would make my wee little icy heart sing.

Please Understand

Here is another clever article about why private, individual health care is a more palatable answer than the alternative. It rants less than me, isn’t funny, & has no swearing. So, if you’re into that, I’m sorry. If you just want a concise additional explanation of how government has already screwed up health care spending & costs in America, check this out:

“Obama’s Flawed Prescription for Health Care

By Jeff Scialabba

The House of Representatives has already passed its health-care bill and now the Senate is preparing to vote on its own. Should it pass, the largest new entitlement program since the New Deal will be a reconciliation process and a President’s signature away from being enacted. This is Congress and President Obama’s proposed cure for the ills of our health-care system. But are we sure they have properly diagnosed the disease?

In his speech before Congress in early September, Obama noted that “more and more Americans worry that if you move, lose your job, or change your job, you’ll lose your health insurance too,” and that “buying insurance on your own costs you three times as much as the coverage you get from your employer.” The obvious implication is that government must do something.

But missing from the speech were answers to the following questions: Why is individual insurance so pricey? And why are so many Americans–over half the population, including more than 90 percent of the privately insured–chained to their employer for health insurance?

The answers implicate government. Government policy has favored employer-based insurance through tax breaks dating back to WWII. Together with coercive labor laws arm-twisting companies into providing health benefits, these substantial tax breaks, which have never been extended to individuals purchasing insurance on their own, have distorted the health-insurance market. Employer-based plans now outnumber more limited and more expensive individual plans 10 to 1.

Obama also decries “the problem of rising costs,” which is crippling businesses and pushing the federal deficit to stratospheric highs. But again, he fails to identify the real factors at work.

Health insurance in America is typically comprehensive, intended to cover almost any medical expense, including routine care. This would be like using car insurance to pay for tune-ups and oil changes, and history has shown that this model increases (marginal) demand for medical services. But government interventions have favored the comprehensive model for decades, beginning in the 1930s with the granting of nonprofit status to Blue Cross and Blue Shield, which pioneered the model. Comprehensive coverage was further entrenched by Medicare and Medicaid in the 1960s, as well as by the imposition of more than 2,100 federal and state mandates dictating who insurers must cover and what services they must pay for.

As a result of these distortions, 95 percent of insured Americans–some 240 million of us–have comprehensive insurance paid for by a third party, either our employer or the government. As consumers of medical services we are cut off from their costs. When we go to the doctor, we don’t even see the price until it shows up on the invoice–with all but a small co-pay or deductible (relative to the total bill) paid by our insurance. When the cost to patients is low, we view any test or treatment as “necessary” no matter how minor the benefits. This apparent free lunch has led to the exploding spending we see today.

Because Obama fails to grasp the cause of our problems, his proposed solutions will fare as badly as every previous “reform.”

Past attempts to limit the expenditures of Medicare and Medicaid by lowering reimbursements to physicians and hospitals, for instance, have left medical providers loath to take on new Medicare and Medicaid patients and forced them to make up the losses by raising prices on private consumers. These “cost-cutting” measures have also done little to stop the hemorrhagic spending–Medicare alone is expected to consume nearly 50 percent of all federal income tax revenue by 2040.

Similarly, the use of mandates to increase coverage has had disastrous results. While state mandates have benefited special interest groups, they’ve raised the cost of basic coverage an estimated 20 to 50 percent. Moreover, in order to prevent the skirting of state mandates, federal law prohibits insurance companies from offering plans across state lines–effectively banning competition and prohibiting market forces from driving prices downward.

No honest observer of our health-care system could deny it is in need of reform. But the basic question is: Have existing government interventions proved positive? Obama and his supporters on both the left and the right answer “yes”–but the facts say otherwise. Rather than trying to expand government control over health care–as Obama would do–we should be working to eliminate it.”

From http://www.istockanalyst.com/article/viewarticle/articleid/3651940

Keep thinking about it, kids! Keeping thinking about your position. I did. It lead to a reversal. It may not for you, but critical thinking will make YOUR argument sharper. Take emotion out of it & make a real case. We can do better than any of these yahoos in Congress, fo sho.

Yes! THIS!!!

Ok, so you know how I’ve been posting bits & bobs here, there, & everywhere about health care & why the current plan up before the Senate is not an option? I mean, aside from the fact that it requires us to buy insurance, but apparently has a loophole so insurers don’t have to insure us…HUH? WHAT? Yeah, my law people (ok, person) is working that one out as I swear & stomp maniacally. I will update yall as I learn more.

In the meantime, someone calmer, whom I imagine swears & stomps less, wrote it all down in one place. Read this, then talk to me.

“The Problem with Our Health-Care Debate

By Alex Epstein

Everyone seems to have a different take on how to solve America’s health-care problem. But notice that every solution offered involves some elaborate new system of government controls. Different proposals include a “public option,” mandatory insurance for individuals, government-supported health-care exchanges, government-sponsored “efficacy research,” government-supported co-ops, and as many other ways of dictating consumer and producer behavior as can fit in a 1,000-page bill.

More government controls, we are told, are necessary to solve problems such as skyrocketing health-insurance prices, lack of competition among insurance companies, the inability of workers to keep their insurance policy when switching jobs, etc.


Then why do giants of the computer industry like Google, Microsoft and Apple compete vigorously without a “public option”? Why do we have such plentiful, affordable food without a government “food insurance mandate”? Why does laser eye-surgery, which is not covered by Medicare or government insurance laws, get better and cheaper all the time, while the price of health services the government is most involved in, skyrockets?

The answer is that these other markets are (comparatively) left free–while health care has been manipulated by government “solutions” for decades. Thus, our health–care discussion should focus, not on how government controls can solve our problems, but on how government controls have caused our problems.

Take for instance the common complaint that individuals can’t keep their health insurance when switching from one job to another. The only reason so many individuals can’t keep their insurance in the first place is that they get it through their employer–a phenomenon that was institutionalized by the government post-WWII through tax laws that make individually purchased insurance far more expensive. We don’t face the same problem with car or home insurance when we change jobs because we don’t buy it through our employer.

Or consider the general phenomenon of skyrocketing prices for health insurance. The ways in which the government drives up prices are many and gory, but here are a few.

State insurance-mandates force companies and individuals to buy policies covering all sorts of expensive treatments they wouldn’t otherwise buy coverage for: chiropractic care, psychiatric care, prenatal care. Every such “benefit” means higher costs. Those who would prefer just to purchase insurance against medical catastrophe and pay for everything else out of pocket are prohibited from doing so.

More broadly, since the 1940s, on the idea that health care is a “right” that others must provide, the government has made Americans collectively responsible for each other’s health care, whether through collectivized employer plans or through Medicare; thus, on average, “every time an American spends a dollar on physicians’ services,” explains health economist John Goodman, “only 10 cents is paid out of pocket; the remainder is paid by a third party.”

People consuming medical services on other people’s dime consume a lot more. Prices are further driven up by numerous restrictions on the supply of medical professionals, such as protectionist licensing laws that prevent doctor’s assistants, nurse practitioners, nurses, and paramedics from competing with doctors on services they are well qualified to perform (fixing minor bone breaks, diagnosing the flu, etc.).

When supply is artificially limited, and demand artificially increases, prices explode. (Any system promising “universal care” experiences this–the much-vaunted “affordable” European system just deals with it by severe rationing.)

This is just a fraction of the story of how government has mangled the market for health care–a story any honest discussion of health care needs to study and learn from.

Then we will start to hear proposals for a truly progressive idea: a market in health care where the individual is responsible for his own health, the medical profession is truly free to compete for his dollars, and the government has been removed from the equation–the private option.”

From: http://www.northwestgeorgia.com/opinion/local_story_321102325.html

If you’ve been reading my blog, you know I have MOAR MOAR MOAR about why I have turned my back on any public option. Because it turns its back on the public. Yes, it does. If you have not been reading my blog, go back past photos of my more recent hair colour & cute kitty cat stuff & you’ll start to find things of varying degrees of livid angry-girlness. The more I tried to defend the concept of the public option, the more I realized I was defending a system that cannot help but be inevitably corrupted by special interests & personal agendas of politicians. In addition to that, the private sector has far more useful solutions.

Remember, we didn’t start freaking out about health care coverage until…well…we started getting it. Hmmmm.


Disclaimer I seem to have to post repeatedly, since you all think I’m 12: I started billing medical insurances, including Medicare & Medicaid, in my father’s cardiology practice. That was 19 years ago, & I am still in medical administration, including billing. I’m not just some button-nosed girly girl all stompy for no reason. I fight with these jerks every single day of my life. Yes, I am also talking about private insurers. That’s why it behooves us to be able to buy our own plans, regardless of our employer. We can vote with our dollars.

The Easy Feel Good Nothingness

I demand you read this: http://online.wsj.com/article/SB10001424052748704795604574519671055918380.html I’ll wait. It’s much shorter than 1,900 pages.

Done? Ok. I’m going to ignore your multicultural tizzy, as you are entitled to your opinion. That’s a feelings issue, & I can’t argue with feelings. However, I am going to give you some facts based on my experience in medical billing and patient care.

Of particular alarmingness to me, the thing making me scream NO NO NO NO NO NO NO NO NO NO this CANNOT HAPPEN into a pillow repeatedly:

• Sec. 1302 (pp. 672-692) moves Medicare from a fee-for-service payment system, in which patients choose which doctors to see and doctors are paid for each service they provide, toward what’s called a “medical home.”

Now this is EXACTLY my problem with Medicare Advantage on the Part B level! We will have to hire staff just to take care of the auths portion…

• Secs. 1158-1160 (pp. 499-520) initiates programs to reduce payments for patient care to what it costs in the lowest cost regions of the country.

…and this will make it so we can’t pay that staff.

Holy Christmas trees. If this passes, forget everything. Your health care experience will decline rapidly, dramatically, and not just because the staff you will be dealing with will be insane with rage and stress. We won’t be able to afford to care for you the way we want to, it’s that simple.

I understand that you think you are caring & kind because you are on the side of insuring everyone. You want to feel good about yourself, so why not go with the first promise to make everybody happy?

Well, what you are effectively promoting, the change you want to believe in, is screwing the disabled. You want to punish the disabled and the elderly so that people who are already getting free health care (as doctors and hospitals are obligated to treat emergent conditions regardless of your ability to pay) can be “insured”. Insured crappily and expensively, I might add (go back & read the article again if you didn’t catch that the first time).

In order to have pre-existing conditions like mine covered, you are willing to put truly disabled people through hell?

Heck, maybe you’re just a run of the mill selfish ass like most people. Well, the amount of strain this idiotic travesty of a “health care reform” bill would put on the health care industry would make your 30 minute to two hour wait for your doctor, even with your spiffy private insurance, potentially much longer. Why? Because of the added rigamarole we’ll have to go through for our Medicare patients. Who, remember, are getting screwed by the good intentions of liberals.

I’m going to throw up.

YES I’m pissed!

One more question: Why does everybody have to have insurance? How does someone’s choice to not have health insurance, which is their right, hurt you? It’s not like they’re hitting you with their body like they would with their car. This is a non-pissed question. I am genuinely curious.

When Do We Want It? NOW! Unread! Not Understood! But WITH FEELING. TODAY.

Many of you whom, you must admit, do not work in the patient care industry have been plying me with “it’s not fair” questions lately regarding pre-existing conditions. “But the Pelosi Plan is sound, as it forces insurers to cover pre-existing conditions! Therefore, it’s good! Good, good, good! And you’re a big meanie for not trusting it immediately even though not one person in this country could possibly have had the time to read all 1,900 pages of it. Meanie!”

Newsflash: I HAVE FOUR PRE-EXISTING CONDITIONS AND I STILL DON’T THINK THE PELOSI TOME HAS THE ANSWER. Why? Because I actually work in health care. I have worked in health care for 19 years, mostly in billing, and I can tell you several other ideas just off the top of my head today, during a really fruitful discussion I had with a reasonable person, that have nothing to do with universal health care.

I was going to post a giant rant, citing a number of postings I’ve made on this subject over the past three weeks, but instead I figured, for now, since I am tired, it would be easier to post just my half of today’s conversation. If you have questions or comments, I am happy to elaborate in coming days, but I warn you, I can go on about this for weeks. And have.

The challenge was basically to defend the GOP health plan since it doesn’t touch pre-existing conditions. My response is below, but I’ve modified it a little for clarity to a wider audience:

I’ve been thinking about this since I actually have pre-exes. It makes sense to me instead that these either be covered by specific insurance groups willing to offset the risk with other ventures, charity, self pay clinics that specialize in certain chronic conditions at low cost (like my “special” doctor), HSAs (which are saving my arse right now) or a combo. 

The argument for not forcing insurance companies to cover pre-ex is because it would drive costs up for everybody, including regular old healthy folks unlike me, across the board (I’m healthy, but I have to take measures other people don’t to stay that way). 

If companies are allowed to come up with innovative ways to serve the pre-ex community, the market can better serve them, more cost effectively, than the government, without imposing on everybody. I know I have fibromyalgia and am perfectly willing to pay into an insurance group willing to offer fibromyalgia coverage. However, if you take for example your employer’s insurance (ours just got crappier with the rising costs), you are having to pay for the gal who can’t say no to a doughnut even though she has diabetes & heart disease. You are taking on her risk (which is why I think we should scrap employer insurance altogether and be allowed to purchase our own plans, just like car insurance). 

I have other friends in health care with chronic pain conditions or other illnesses who are also opposed to the Pelosi Plan. They want to pay for their illness, not a drunk driver who got in an accident and now has chronic back pain (or several hundred thousand of them). 

Even if something is not a lifestyle choice, there’re better ways to handle it than letting the government step in to control it. For example, my condition is just something that happens to you. I wouldn’t feel comfortable going on government care, because what is currently approved by the FDA (the government) to treat my condition is not only the most expensive drug to treat my condition, it’s also NOT the best! 

Now I pay cash to see a no-insurance doctor who treats a lot of people with FMS. He’s had me change my diet & take supplements to deal with my condition, and it’s improved dramatically. I take a third of the FDA approved rx than I used to, and I can exercise, think more clearly, and lift more than I was able to on the full dose of the meds. 

My neurologist, who is beholden to insurance rules as she bills my plan (which, like all private plans, is now influenced almost entirely by CMS guidelines), can’t go off label with my rx. She has a limited amount of time to see me since she contracts with Medicare & HMOs, & needs to get a certain amount of people in per day to make up her overhead. 

My cash pay doctor does not. In addition to this, although my out of pocket for him is way over my co-pay for my neuro, I spend anywhere from 1 hour to 3 hours with him. With my neuro, maybe 30 minutes if we get gossiping. Because he spends more time with me, he notices things I can tweak to make my life easier & more pain free. 

With my HSA, my cash pay doctor becomes 30% less expensive. 

So there are lots of alternatives to a big, expensive government health plan, even more than I’ve mentioned this evening. But keep throwing situations at me; I will try to think of ideas where a private solution could be better.

In addition to this conversation, I have to throw something else out there. Many of you might not realize that the Pelosi Tome also pays for abortions under a variety of conditions that you might not feel terribly comfortable with, and in fact, you might not feel comfortable paying for other people’s abortions at all. I do not; it goes quite vehemently against my religious beliefs. So the health plan is going to violate my first amendment rights because someone who was not raped or not in danger of losing their life didn’t use birth control? Really?

No, I can’t do that. You can make that choice. You can’t force me to pay for it. That’s not American.

Common Sense Ain’t

What do 19 year olds, little teapots, & doctors have in common? The ability to make me go *headdesk* ALL DAY.

Sorry, that was redundant. Many 19 year olds and doctors ARE little teapots. “When I get all steamed up, hear me shout!”

New Rule: You don’t get to argue with me about ANYthing unless you A. think and B. know what the fuck you’re talking about. Also, if you suspect for even 3 seconds that I do not know what I am talking about, you need to call me on it. Deal?

By “call me on it”, I do not mean “You’re mean!” and “I like you better when you’re cute & girly!” I mean you have to say something constructive, like, “My dear, I believe you are mistaken, because…” You don’t even have to put in the “my dear”, it’s just what I tend to get from some of you of whom I’m more fond.

Recent knock down drag out with an MD boiled down to: “My claims must not be getting paid because of something you’ve done wrong,” and then “I have to explain why a patient is having a repeat procedure done every time they’re having it done?! But I mentioned why the first time they came in!”

ARE YOU FUCKING KIDDING ME?!! *headdesk* *headdesk* *headdesk*

Thanks to Medicare, every time you visit a doctor, you’ve bought a product that gets its own ICN (individual claim number). That ICN represents one encounter note out of your medical record. To Medicare, & hence to all private insurance, that’s the product it’s buying on your behalf. So yeah, you might be coming in for treatment of the same thing over & over, but Medicare doesn’t care about that. They want to know what they’re buying today. So yes, doctor, you have to take an extra seven seconds to say, “Patient returns for continued treatment of her whateverosis.” Which, DUH, is good record keeping.

The next person who comes to an argument with a machete & sweeps it across the necks of all participating with a giant emotional, hand wringing accusation of “The world is unfair!” gets shot down. Never bring a machete to a gun fight, babes.

I love yall, but some of you really want the the world to be fair. I have news for you. It ain’t. It will never be, so you have to make the most with what you’ve got. Also, your version of fair & right is not everybody’s, so forcing it upon other people is NOT cool.

People get very emotional & hand wringy about health care. I do, in a more “clubbing baby seals over the head” way. I’m sick of it. I’ve been doing this for 19 years and I’m over it. No matter what the government does, they make it worse as is evidenced by how poorly they are handling “new” (10 year old) procedures we are now doing for patients. Baby seals are cute & cuddlesome, but not if you flood the waters with them so that they are choking out the ecosystem. The health care plan I was excited about, the change I tried to believe in, is a 2000 page partisan document of redundancy document that makes the Federal Register look positively brief by comparison (the Federal Register, for those who won’t google it, is NOT brief). But I’m not just bitching. I have alternate ideas.

Scrap it all; let charity sort it out!

I have an idea, and like most of my ideas, I have the name before I have it fully fleshed out (as I’m good at brainstorming, but not planning). It’s called Passport, and anybody better than me at planning is free to steal it. Passport would be a nationwide health care charity, but it would not be applied for by patients. Herein lies disaster, because patients do not have the time, energy, or knowledge to take care of this crap (yet Medicare & Medicaid expect them to, sometimes with the help of underpaid, overloaded social workers).

Passport would be very simple. If a doctor had a patient that wasn’t paying their bills, for ANY reason, they would just submit the HCFA (CMS1500 to you newbies) to Passport. The doctor would determine if the patient was truly unable to take care of the claim, because the doctor & his/her staff see the patient every day, & have access to the patient’s information. The doctor’s staff can smell that the patient is homeless. That way, nobody is working the system. Doctors who erroneously or falsely submit claims to Passport would get in trouble, NOT the patient. The onus would be on the professional, not the sick person.

AND because there’d be no federal fee schedule, RVUs would stop being so ridiculously low & doctors could universally lower their charges, even out the rates, & actually cover their costs! My God, common sense! (Assuming the private plans followed suit, that is.)

Peeps donating to Passport would get fatty tax breaks. Super fatty.

Hmm? Hmm?

Also, those of you clamouring for free health care, let me let you in on a little secret: it already exists.

Exhibit A: If you show up to the ER, you cannot be turned away if you are truly sick. Most ERs won’t turn you away even if you are kinda sick.

Exhibit B: If you can’t pay your bill, no law enforcement officer is going to come after you. Your hospital or doctor will try to get you state or federal aid. If you don’t qualify, & you still can’t pay, your doctor will have to jump through hoops to get your bill written off if he/she participates with Medicare, because if you take Medicare patients, IT IS AGAINST THE LAW TO GIVE FREE CARE. What?! Yes, THE FEDERAL GOVERNMENT DOESN’T LET US GIVE FREE CARE because of kick back laws. Because it’s caring like that. Innerestin’, huh? Hospitals also have to prove it with tons of paperwork, but unlike doctors, they have armies of staff to do this paperwork.

Exhibit C: If you still can’t be written off for some reason, you will just be sent to collections. Sure, your credit score will go down, but you can always file for medical bankruptcy and be good as gold in 7 years. If you think a person cannot live or function in collections AND get continuous, uninterrupted, high quality health care, boy do I have proof to the contrary (that I can’t share because of HIPAA).

America already HAS free health care. It is not perfect, it is not equally applied, but that is due to misinterpretation of confusing laws. It is not due to cruelty or greed.

You can watch all the soppy TV & listen to all the politicians you like. You won’t know the truth until you talk to human beings in the field, read things your government publishes. Or, y’know, just listen to crazy bitches rant.

Gimme Gimme Gimme

Do you have Abba in your head now? Good. You now have a modicum of the pain I have endured today thanks to California’s glorious state Medicaid fund, Medi-Cal.

If you are still a proponent of state run health care after this, I’m guessing you probably could not wait for ‘Survivor’ tonight, & you are really concerned about whether Paula regrets leaving ‘Idol’. Pat pat.


As I have ranted before, Medi-Cal is the Three Stooges of all the state run health plans, and I am not sure how the Sovereign Dimension of California got it that way, but it must have been a magical process involving Shriners in those little cars, shrooms, that weird speech impaired kid down the street who kept saying he was gonna beat people up, and lemmings. Here is what got my hard earned goat today.

A few weeks ago, Medi-Cal discovered that one of our patients had Medicare primary. Our patient apparently did not know this, either, as she neglected to tell us. No matter, Medi-Cal, like all Medicaid programs, is supposed to cover the disabled & look out for them. How it does this from riding on the short bus itself is a mystery for the ages, but ya know. Medi-Cal, obviously by some administrative screw-up, had already paid our claim, so the letter telling us that the patient had Medicare primary was also requesting a refund.

What did we do, as a compliant practice? We cut an effing check, didn’t we? We sure did. We also mailed it immediately to the address indicated on the letter.

Yeah, so, today…we get the check back. WE GET THE CHECK BACK. With a letter. There was a lot of Medi-Calese on this letter, so I will translate for you what it said:

“You don’t get to give us money back, even when we ask you for it. Instead, we get to take it out of future payments, even though we won’t send you any future payments, as we send you maybe $47 out of the $14,789 you bill us a year.”

Yes, California, which is broke, is not accepting MONEY IT ASKS FOR.

Are you making the “I would so, could so kill a goat” face yet? (see psychotic photo below from the last #wtfwednesday)

Wait. It gets SO much better.

In addition to returning our check and then telling us they were not going to pay us for whatever the amount in the check was for however long it would take to make up the amount of the check, they also sent a form. “When Medicare pays you, complete the following form to retrieve your secondary payer funds.” REALLY? Really, Medi-Cal? Knowing full well that you nearly always allow 50% LESS than Medicare, you want us to fill out a freaking form that violates MMA & completely flies in the face of the simple act of sending the claim with the Medicare EOB attached like EVERY OTHER FUCKING SECONDARY PAYER IN THE COUNTRY??!!!”

REALLY?!! How stupid I are!

I advised our intrepid state plans gal to check the allowables and, should they teh sucks, kindly introduce that fucker to the shredder. Which was of course taken on with delirious glee. I’m pretty sure the whole rest of the office thinks billing is on drugs now.

Anywho. If this is the mentality of the people running the medical funding for persons who are the sickest, weakest, and most defenseless people in society, how in the hell are they going to treat the REST of us? Like one more bleedin’ pot hole, that’s how. Ignore, rinse, repeat.

What else is wrong with gimme gimme? It cripples us. Shut up. If you’ve even babysat a child, let alone raised one, you know what spoiling does. Sure, you can have a pop. Sure, you can have a lollie. Sure, you can have a Little Debbie. Sure, you can stay up and watch T2 on HBO while I talk on the phone with my boyfriend. Wait, why am I surrounded by children stained various shades of purple, wielding knives & crying? I can has headache! I can has fired!

Oh, but we’re not children! We can has thinkings! No, we cannot. Observe, my sweet little friend who believes in the inherent intrepidness of the human spirit <snicker>.

When I was feeling particularly martyr-y and decided to leave private practice to do hospital work, I at one point did a stint in customer service. Customer service plain blows everywhere, but customer service for sick & dying people that you just sent a $400k bill to is not anybody’s idea of a career high. Here’s one of the lows of that stint.

Girl calls me. She was about my age, which at the time was 25 I think. She is furious. “Why you guys keep sending me this $70k bill? I don’t got $70k.”

“I’m sorry, ma’am, let me check that for you.” After the unholy torment of trying to get her account number out of her (anybody who’s been on that side of the phone knows what I’m talking about), I finally find her account & within 3 seconds  of reading the notes, ask, “Ma’am, I show you probably qualify for Medicaid. Did you take your application in to the Social Security office?”

Big dramatic sigh. “Yah, I did, but there was a line. It was like a 5 hour wait. Can’t you just write it off?”

*aside: You pay your fucking credit card bills for your goddamned Nascar tickets, people, but somebody saves your LIFE, delivers your CHILD, and you want us to write it OFF? Pri-ori-fucking-ties!*


I say to her, “Ma’am, I don’t understand. Why couldn’t you wait 5 hours to get free health care?” You could HEAR the blinking.

I continued. “Ma’am, I sit at this desk 50 hours a week, and it would take me something like 3 years to make $70k. I strongly suggest that you go to the Social Security office, wait the five hours or more if it takes that, and get the free health care. It will last you until you are able to get your own health care.”

She was approved within two weeks. It was paid two weeks after that. The bill had slid 120 days, though, so it was in danger of going to collection. REALLY?

So that’s part 1 of why Gimme Gimme fucks you over by turning you into a whiny child.

Part 2: The Plucky Pole. I am well known to folk in the Depeche Mode/Recoil online circle, as is The Plucky Pole. She is a dear girl, beautiful, vivacious, adorable, completely insane like most Depeche Mode fans (particularly the kind that glom on to Martin), and she appalled half the DM mailing list by announcing that Poland was better with Communism.

I defended her, stating that she grew up with everything being given to her, and it’s not her fault that at 18 she was now at an American university on scholarship, but having to buy her own concert tickets, food, $15k Gibson guitars…anyhow this did not go down well. She did not understand why we did not understand why she was not dropping to the floor in front of a tapestry of Reagan every day praising his name. Didn’t she like being able to say what she felt about the government?

“I always said what I felt about the government.The government was great.” *headdesk*

My immature 14 year old boy response is always to go “The Whatever is Your MOM” and in this case, it would have been appropriate to scream “THE GOVERNMENT IS YOUR MOM!” because it WAS. The government was her overburdened, highly stressed mom who had no dad in the house to help, way too many children, and had to lay down a strict code of behaviour or kill ’em all (as any sane mom would snap in that situation). The Plucky Pole didn’t know any better because Mom = love & that’s all she knew.

Cold, horrible, “You have to buy it” America was expecting her to pick her clothes up off the floor, do her own laundry, make her own lunch, and walk to school. As she had never done this, she was horrified. She was ill equipped to deal with the basics of survival. It was awful to read in her emails. Her priorities were, to put it mildly, whack.

Part 3: Overheard today: “Unemployment pays me more than a full time job at Starbucks would. Why would I go off unemployment?”



*kicks a puppy*

Hey Mr. President, Tally Me My Health Plan (repost, but yeah)

Reposted from July 11. Because yall seem to enjoy this one (& only this one). 😉

Health care. It affects you even if you think you are the healthiest little creature in the whole widely world, because even those of you in high school will be working soon, & will be paying into a system that could collapse in on itself like a giant achey souffle full of boomers.

First I have to say I am terrified that my stupid blog may be the only source of non-popstar-death related news or commentary in the world for a while, so I am sorry I have not paid it more attention for you. The amount of press this nonsense has been given is not worth even an ounce of commentary, so I.

[That was me, dramatically cutting myself off at slightly less an ounce. Did you catch that? You probably did. You are much smarter than I am.]

Anyhow, today Rick was suggesting that in order to prop up Medicaid (whoo boy, more on that later), the rich, who do not like paying taxes (because, you know, the poor line up for it, it’s more fun than fire eating all nude strippers at Disneyland), should be asked to “make a donation” of a million dollars or more to Medicaid every year, & hence have their taxes reduced in that fashion.

I said, “Dude, that’s a tax.”

“No it’s not,” he said. “It’s a donation.”

“Dude. A forced or even suggested donation is a tax.”

“Oh. Well, can they be asked to consider donating…”

“Ok, let me explain the free market economy to you from the rich person’s standpoint. Hi, I am Richy Wigglebottom McHumphries the Third. I have a million dollars. It’s my money. I want to donate it to the charity I choose. I, Richy Wigglebottom McHumphries the Third, happen to want to save abandoned long haired teacup Pomeranians. I like them better than I like little children of races that are not my race. So I am not donating that money to Medicaid.”

“Races that are not my race?”


“Teacup Pomeranians?”


“Did that just come off the top of your head?” Rick asked, laughing.

“Of course it did,” I said, serious as all hell, “Because this shit is always at the top of my head. I am always thinking about this conundrum when I am at work,”

How DO we get everybody to want to pay for other people’s healthcare? Other nations seem to enjoy doing this, enjoy reaping the benefits of it, and don’t really bitch about all that much, These nations are all very cold, populated by hot blonde people, and their dearest ambition in life appears to be getting to the next coffee-oriented mixer. So that might have something to do with it.

People from these freezing cold countries ask me, “Kay-lee, how come in Amereeka, nobody wants to buy me an Einsterzenden Neubauten CD?” Ok, so that’s just one guy. His name was Jan (pronounced Yahn) and he was from Norway, & he called me a fascist because I would not spend every dime of my babysitting money on his CD collection & M&M addiction. But he is a perfect example of how people in America, including English people like me in America, are not into subsidizing everybody else’s wants & needs.

In cold countries, it’s hard to survive. Those people have Viking survival genes where sharing is caring & huddling around the fire (or in the nekkid hot tub) and hacking up a reindeer & roasting it over a spit (nekkid) and forcing guests to drink unholy quantities of coffee (nekkid or otherwise) is extremely important in order to live in those ridiculously cold ass countries. It is now hardwired into their genes to fork over 70% of their money to pay for everyone ever.

Now let’s look at America, a people that, a little over 200 years ago, were being oppressed by a king who had syphillis. There was a lot of unfair taxing, and now American people are predisposed to hating all tax ever for any reason whatsoever. I actually worked with a woman who said to me, and I quote, “I am at the tail end of the boomer generation. I better get my damned social security money & I better get full Medicare benefits,”

I responded, as any sane person would, “Well, barring a plague that only strikes people born between 1945 & 1960, they’re going to have to raise taxes to make all of you happy.”

“Raise taxes?!” shouted the sun spotted, gap toothed, rural Nevadan. “Raise taxes on ME?! I’ll bet them Demmy-crats would like that, them fat cats in Washington.” Because I swear to you, all rural Nevadans talk like Grandpa Simpson.

I said to her, “Wait, you want your benefits, but you don’t want the government to get the money to give you your benefits?”

“Well, they can’t take it from ME!”

And that, right there, folks from other countries, is the problem. Americans are so vehemently opposed to taxes, even the kind that pay for stuff we actually do badly need in this country, that they fail to apply logic to the situation. Tax everybody but me & my kind. Tax Mexico. Tax them fat cats. Um, there’s more of you, moron, than there are fat cats, and the fat cats have better lawyers who find all the loopholes. Lots of morons, so let’s just tax the morons. Well, nobody thinks they’re the moron, do they?

Sigh. So first, you are dealing with a populace that doesn’t want to pay for squat. Living in America, I can kinda see their point. In Nevada especially, paying taxes does not necessarily mean that the canyon that has developed in your street will ever been repaired, nor that literate people will teach at your kid’s school, nor that Medicaid claims will be paid. In fact, it seems to us in the health care industry that Nevadans pay tax specifically so the state can hire people who spend all day denying Medicaid claims for weirder & more frustating reasons.

So Americans don’t necessarily get a lot of bang for their buck. Californians, who are suffering so violently from this economy, are actually getting gigantic state sponsored funeral processions for PRIVATE CITIZENS (ok, just the one) with their tax dollars, so they have every right to be extremely confused as to why they are paying over 10% in sales tax. And MediCal (California Medicaid) fucking blows. I can say this from vast experience with the program. I live ten minutes from California, so we get a lot of MediCal patients. I am happy to explain why MediCal is the 3 Stooges of Health Care if you are willing to read a rant.

How can I put this? When The Governator was running for office, I wrote him a letter. I said I was not an American citizen & couldn’t vote, but I would urge everybody I know with my various powers of persuasion to vote for him if he would just reform MediCal. It is a gigantic money wasting behemoth of nonsense that virtually guarantees no doctor wants to take Cali state aid patients, meaning these people can’t see anybody. What good is free heatlh care if nobody participates? Why don’t we want to participate?

1. The phone books every month. It’s not as bad as it was before Governator took office, but once a month, MediCal sends what is basically a yellow pages to every single MediCal provider. They have a website, but they send the paper updates. That are as thick as a phone book. Is this to prop up the federal economy with postage payments? Is this because the California Department of Healthcare hates trees & wishes upon the world a nice crusty carbon monoxide death?

2. Failure to comply with MANDATORY FEDERAL MODERNIZATION & STANDARDIZATION ACTS. Believe it or not, the federal government has actually done a lot in the past few years to make federal health programs like Medicare & Tricare faster, cheaper, and better. And it’s WORKING. Even reluctant doctors’ offices that bitched & moaned about the upgrades we all needed to make to our systems are now realising that it is actually better in the long run. But MediCal, while paying lipservice to the MMA by adopting NPIs (but still having their own weird PINs, rendering the convenience of NPIs useless), still makes up and enforces their own modifiers. WHY? TO WHAT END? There is no REASON for it except to delay payment, but in the meantime they are wasting even more money mailing out denials, and asking providers to submit appeals ON SPECIAL FORMS THEY PRINT AND MAIL YOU TO…with carbons! Like you can’t do this shit online with Medicare & print as many copies as you need!

Some of you are confused. Medicare is a federal program. Medicaid is a federally FUNDED program, but it is state run. Each state has its own Medicaid guidelines & sometimes calls it a different name. California Medicaid is called MediCal. Nevada has TWO. Southern Nevada calls their Medicaid program SAMI. We’re just good old Medicaid in Northern Nevada.

MMA = Medicare Modernization Act, which dragged Medicare kicking & screaming out of IRS land & into high speed internet wonderfulness. NPI = National Practitioner Identifier. Before NPI, all the Medicaids in the country, Medicare, & all the private insurances all had separate provider IDs. There was no good reason for this except that everyone in the insurance business is a prick. True fact, cannot be disputed. So the federal government actually had the ganas to say, “You know what, this is stupid. Let’s give each doctor in the United States one 10 digit number that works for everything. The doctor must update the NPI database with new info any time it changes, & that will be that.” Well, in theory. NPI is my friend, I love it. I adopted NPI immediately. I was actually the NPI touchstone in town because other offices in town were calling me to ask how to get one & how to use it (which was silly because the website takes you through the whole process easily, but I like to help so whatever).

MediCal has adopted the NPI, but that’s it. And then there’s the stupid PINs, which,again, since they are MediCal specific, renders NPI’s purpose impotent with that program.

Part of MMA was to make sure everybody in the insurance industry was using the same modifiers on codes. For example, if you have an office visit with me (99214) and we do a study on you on the same day, because during the visit it seems like a good idea (93880), we get to add a 25 to the visit so that your insurance knows the visit is separately payable from your carotid ultrasound. It is billed out as 99214-25 & 93880. We are telling your insurance company “Mrs. X came in with headaches & intermittent left sided weakness. After taking a history & physical, we thought she might have some carotid stenosis. Our tech was available, so we had him do a carotid study & we found that she has 80% & needs to be managed to prevent a stroke. You will pay us for both services, please.”

A normal insurance company says, “Ok. That makes sense. Here’s 25% of what you billed. Muahahaha! There’s nothing you can do about it! Muahahahah!”

MediCal says, “Oh no, here is your claim back. 25 is not a valid modifier in the Holy Sovereign Dimension of California. It is not even a number here. In California Medicaid World, it goes 23, 24, BoomBoomPow, 26, 27. Also you need to add ZA and &!# to your carotid study, whatever that is. We’ve never heard of a carotid & we are pretty sure you are making that up. Also people don’t have strokes. You stroke the kitty cat. You do not HAVE a stroke.”

Commence ME having a stroke.

3. DId I mention MediCal’s thing where they have their own appeal forms? They come as a pad. They also have special prior authorization forms but lie about when you need to use them. They also tell you need them after the fact even when they told you that you didn’t need them before. Also, if you want to call their appeals department, you are told they don’t have phones. I shit you not. I actually asked them one time, “What happens if there is a fire? How do they get the fire department to come?” The rep said, ‘Well, they can call out, but they can’t get calls in.” I asked, “What if their child is sick at school, & the school needs to contact the parent, working, I imagine, in your appeals department?” The rep sighed. “We are not allowed to give out the number.” Ah HAH. Fuck me.

4. When you get a denial, it says things like this. “Service is not payable because it is a duplicate of an identical service paid on XX XX XXXX.” It actually says XX XX XXXX. I am not using that as an example. There is no DATE there to take the place of the XX XX XXXX. It’s just XX XX XXXX. Or, you get something like, “Please resubmit claim with an RTD.” This is will be after the NINTH FUCKING TIME YOU’VE SENT THE CLAIM BACK IN WITH AN RTD. Or, you will get this inexplicable charmer: “Claim denied. This provider is not qualified to provide Charpentier services.” WHAT THE FUCK IS A CHARPENTIER SERVICE?!!! And when you call them, WHEN YOU CALL *THEIR* FUCKING CUSTOMER LINE… THEY DON’T FUCKING KNOW!!!!!!

5. Next year, when you DO get a payment, for the 47562 laparascopic cholecystectomy you billed out, that was $2030.00, you get $327.00.


Nevada Medicaid, unfortunately, is going the way of MediCal in this economy. They are pulling the “we don’t recognize that modifier” bullshit & also denying claims but not actually saying why they’re denying them. They don’t even come up with something as creative as a Charpentier service. They just say “Claim denied because: ” and then there’s no “because”.

So Dear Rick, how the fuck do you expect to get rich people to donate $1,000,000 for THAT?! Really?

So Dear Obama, if we’re gonna do a public option, please make Medicare available to anybody who wants it. Medicare only has 2% overhead, opposed to 30% for some private health plans. Medicare patients can see any doctor they like as much as they like for any reason they like. They do not need pre-auths. They do not need permission. They do not have to tell the government what they’re doing (that’s MediCAID, not MediCARE). The only thing Medicare doesn’t cover is cosmetic procedures. And really, duh. Medicare also does not cover drugs well, but I have a solution for that. Get rid of Medicare HMOs. They drain patients dry. They are horrible. They are run by the same assholes that are clobbering you and me with deductibles & copays. Imagine having nice, sensible, nobody-tells-me-what-to-do

Medicare except this time, instead of the patient paying 20% of allowed, add a bigger deductible, and co-pays, oh, and prior authorizations, and have the HMO tell the doctor & the patient that they can’t do a whole hell of a lot.

Stop subsidizing Medicare HMOs. They cripple Medicare. Just abolish them. Completely. Please.

DO NOT put a limit on how much treatment a patient can get, Mr. Biden. You are not a doctor! Medicare does not put a limit on the treatment a patient can get. Medicare has a program for people with end stage renal disease called, you guessed it, the ESRD program. For 31 months, Medicare is secondary to your employer’s insurance, but after the 31 months when you are too sick to work much, Medicare kicks in as primary. People with ESRD sometimes have surgery EVERY MONTH because their dialysis fistulas occlude, they bleed, the caths get infected, whatever. If you limit how often ESRD patients can see their surgeon, you will straight up kill them. It’s that simple.

So those of you Republicanny types that are bitching about one payer healthcare (which the President has NOT endorsed), simmer. Those of you thinking Medicare will be like the government telling you what to do, you are clueless. Medicare is THE most free form plan in America, period. It pays for shit, but doctors sometimes don’t mind because they know they don’t have to argue with a bunch of suits to get a procedure done on a patient. Medicare will deny anything they consider as medically unnecessary AFTER the fact, and NOT ding the patient. It’s true!

So those of you Democratty types that are bitching there’s no one payer healthcare, trust me, that’s ok. Competition IS good, & I have seen shitty HMOs fall apart because employers stop using them & go with better plans. The better plans are like Medicare but pay even better if allowing slightly less freedom of choice. In this economy, however, employers are sticking with shitty plans if they’re cheap, which kinda blows, so @HaemishM ‘s idea about all of us buying our own insurance is a good one.

So Christ. Lemme tell ya. Health coverage has to be more affordable because everybody deserves to be healthy. Everybody. If Americans don’t want to pay for it because they have this knack of dumping things into the ocean when they have to pay too much for it, fine. I don’t want my doctors to get dumped in Tahoe, with the manatees & the Lochness Monsteresses. But that means private plans have to be regulated, which means more government, or maybe less government, but smarter & more direct. Because right now, many private plans are getting away with murder, literallly, because their members are dying from lack of treatment. I won’t name names in writing. Gimme a call if you want me to tell who NOT to send a cheque to every month. And there are some you should avoid like…like a Norwegian who insists you buy him dodgy industrial music on a nigh hourly basis.