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06/01/2014

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Joe, I too remember all of the good press the VA got with regards to its electronic medical records system. Of course, as we all know, good press has long been for sale in this area/state/country.

I read Roch's diatribe on Dr. Wolicki's letter (it was an accident, I was surfing the buzz on the Jeff Martin fiasco). According to Smith-Jr., we're supposed to dismiss every doctor who opposes Obamacare - or criticizes the VA/any government program - if they accept Medicare or Medicaid.

But that's crap. (Reading Smith-Jr. again was like watching Bill Maher - the eyes and ears bleed.) Because of the feeding and growth of the monster-known-as-the-welfare state, most of us (especially Pediatricians) have been forced into very tight corners on reimbursement and must accept these programs now to make any kind of living.

It doesn't mean we like it - or approve of what's going on.

Moreover, despite every machination Lord Obama/our government has lately employed to keep us beaten down, silent and submissive, the last time I looked at my passport I was a US citizen - and had the right (some would argue the responsibility) to speak up/out to power.

Most doctors are living in fear these days. Piss off the wrong people and your career/life can be over.

The VA is a mess. It has always been a mess. Years ago, medical students knew it when they did their rotations. The jokes flew (if anyone remembers M*A*S*H, sometimes dark humor is necessary to get you through the day - and at the VA the humor was very dark). Like the NHSC (in which I served and for which I was eviscerated - Smith, Jr. did not care about that), oversight and accountability is non-existent.

Obamacare - "policed" by the IRS (pause for hysterical laughter) - is and will be no different. If nothing is done to fix the fixing, medicine-as-it-should-be-practiced will go the way of the Post Office and Amtrack.

OBTW, the VA isn't the only place were EMR totally SUCKS.

Mary, your comments raise a number of important points:

1. The media/left complex didn't just love the VA's EMR system. They felt the VA was great for quality and preventive health care and all sorts of indicators that were sliced, diced and measured. Somehow, they missed the obvious truth.

2. Do you remember the days when doctors were criticized if they would not accept Medicare or Medicaid? The assumption was that they were cold, unfeeling, only in it for the money. There was societal pressure to participate to help those who are elderly or otherwise disadvantaged. Now, according to the voices on the left, if you participate, you must surrender your right to critique governmental health care systems. And you correctly point out that these behemoths have so heavily penetrated certain market segments to the extent that many physicians' practices cannot be viable if they do NOT participate. It is a sad commentary, but the absolute truth.

3. These voices on the left have utterly no idea regarding the seriousness of the economic/debt problem facing our nation. They continue to behave as if money grows on trees. And they don't possess the moral sense that suggests all these giveaways are just problematic from the standpoint of basic human nature.

4. I had an appointment for myself yesterday with a physician in solo practice. He adopted EMR one year ago, and selected his own package. He told me it has added HOURS to his workday.

One other point, Mary.

Those on the left try to make it seem that Obamacare is merely a vehicle for providing subsidized health insurance. But of course, it is MUCH more than that. The bill itself was greater than 2000 pages, and it has generated tens of thousands of pages of regulations. It seeks to control nearly every aspect of the health care industry and the manner in which care is delivered. The comparison with the VA is much more apt than it might initially appear on the surface, because Obamacare sets up VA-like proxy organizations to regulate and ration the delivery of care.

Joe, I was recruited to a hospital-owned "non-profit" practice in MY HOMETOWN of Asheboro (as an NHSC provider) in 1995 in large part to see the Medicaid patients that the private practices were not so keen on covering.

The community was going to step up. At the time, physicians-as-hospital-employees was a relatively new concept. The doctors would be "partners" . . . "valued employees". It would be our practice. We would have a say in the way the practice was managed and shaped.

And it was ALL just a damned lie.

As someone who really cared about the proper care of very sick children in the community setting, I became everyone's battering ram and pawn. Children were commodities. Physicians were "owned" and needed to know their place in the great schemes of their managers - hell, one contract proposed offering financial incentives for church-going (!?!).

I sat in one meeting dumbfounded while leaders of Randolph Hospital explained that we could not market our services to the east side of town (largely poor/black) because that would compete with the Health Department's "business". When I tried to speak, I was silenced with a look from my boss.

There is NO EXCUSE for what was done to me because I put a baby-girl-dying-before-my-eyes first . . . and certainly NO EXCUSE for the government-I-had-served-honorably-and-well to ignore every agreement they every made with me - allowing me to be hung out to dry - while all of the money they spent recruiting two Pediatricians to Asheboro was poured down the drain by a trio of suits more interested in profit than patient care.

I was a poster-child for VA-style delivery of medical care long ago. I just wasn't in the VA.

The Roch-Smith-Jrs. and Cones of this world do not want to hear these stories. They worked for years to bury my tale-of-woe . . . and denigrate me. Because what happened clashes with their noble ideas of what Hillary's village actually was . . . and Obamacare is.

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