Is Medical Care Doomed?

"BAIL'EM OUT!!! ???? Hell, back in 1990, the Government seized the Mustang

Ranch brothel in Nevada for tax evasion and, as required by law, tried to
run it. They failed and it closed. Now, we are trusting our economy of
our country, our banking system, our auto industry and possibly our health
plans to the same nit-wits who couldn't make money running a whore house
and selling whiskey?!"

 "What the Hell are we thinking?"

 One of my colleagues noted that I was Nostradamus-like in predicting that
Panetta was brought in to gut DoD.  (I don't think Panetta does this
willingly.  He is a skilled bureaucrat and is one of the few people around
that could take on the task though and he is a "good soldier."  That may
seem a paradox but I think it is true.  Panetta will save what he can but
Obama et al are hell bent on gutting the US Armed Forces to pander to their
leftist base.) It gives me no pleasure to be right on this.  What this
administration is about to do to the DOD is reckless endangerment and what
it is about to do to soldiers and dependents is unconscionable.  So much for
the integrity of the US on its promises to its warriors.

 What hasn't hit home to all yet is that there is going to be a downsizing of
the military and return of many soldiers to the workforce in an abysmal job
market.  Many of these folks will need specialized care for things 
and as we've already seen the VA is not able to get the job done timely or
competently and it is getting worse exponentially.  What you see now is
going to get worse quick as the VA budget takes a nose dive.  

I just talked to a VISN Director who told me they just started implementing budget cuts

and that VISN Director had to take the majority of the Hospital Directors to
task in the network and realized that they had little idea how to deal with
and a strong denial component to even begin to deal with budget shortfalls.
Most had never experienced a declining budget!  This is a disaster in the
making.  Not only will returning soldiers have a hard time getting jobs,
employers that provide healthcare plans are fewer ever day and if they have
a vet with any problems they are not going to hire them and see the company
healthcare premium escalate if they can avoid it.  This will coincide with a
VA struggling to stay within a declining budget and a VA management
hierarchy that couldn't manage a 7-11 well.   

 Add to this the numbers of MDs that are beginning to retire early or quit
private practice and go to hospital and group based practice (in these
positions, MDs work for a salary for a defined work week as opposed as
working longer hours as needs be-this in effect with decrease the number of
work hours for MDs.  They will accept a smaller and fixed salary but like we
saw in the VA this quickly leads a strong incentive for doctors to
"organize" into Unions.  Beyond 8 hour days and 40 hour weeks you must pay a
premium that rapidly costs more that what the MD income was before.  It is
frustrating in the least and dangerous in the main when you find physicians
walking off the job at 4:00 PM leaving patients partially worked up because
their shift has ended.  Primary care MDs and surgeons are simply not going
to work 100 hour weeks for $85-100K/annum.

 This is happening in an environment which is slated to get 30+M
more patients in a few years!  I know I sound like a broken record but we
are watching the unfolding of an unmitigated disaster in American medicine.
I just spent days with hospital based folks and they are laying off nurses
and support personnel due to falling compensations in the face of burgeoning
workloads!!  Many are dropping expensive programs because the
Medicare/Medicaid compensation is falling-if they don't have the program the
government can't force them to take the patients.  We're talking bread and
butter care like hips and cataract surgeries!

 Our soldiers, retirees and dependents are a subset of the groups that are
going to need care but resources promised to care for them are going to get
hammered.  Turning to the VA for help is turning to a system which has been
lacking in leadership and accountability for a decade and it is a system
that is about to come under major fiscal duress.  

This will unfold over the next few years, but even with a change in the 

White House and a functioningCongress, if that is possible, 

the impacts on health care due to what is already in motion and the paralysis 

of health care organizations due to current uncertainties this is a runaway train 

that is going to take years to put back in order if it ever can be restored to reasonable function.

         Medicine is just a microcosm within a much bigger environment."

by Dr. Ted Galey, a Pathologist and is the former Pacific Northwest Director of the VA