Doctoring the New Millennium

“Hi, Laura, what are my choices?” I asked.

This is my personal health care story. Sadly, there is scant pathos, little conflict, and no resolution.

Although I moved to South Puffin more than a decade ago, I have maintained my medical ties to North Puffin and even to Canada because it takes a lot of effort to break in a new doctor.

I’m an engineer, so I usually know a lot more (and can hash out even more) than a doc figures on. I’m also very much a minimalist, meaning I will opt in for a procedure only if it fits my own idea of “value added,” not if it is merely “doctor’s orders.”

All that does not make me the best patient.

Anyway, we met “Dr. Bob” when we first moved to North Puffin. We were a young family then and he was about our age. We’ve all kind of grown up together. His kids and ours knew each other in school. SWMBO married his daughter. Mrs. Dr. Bob and I have done some artsy stuff. Dr. Bob acts in the hospital’s bi-annual Cardiac Capers. And, with the exception of the time I cleaved my finger with the chainsaw and the other time SWMBO broke her leg, Dr. Bob has treated pretty much everything that ailed us. He understand what it takes to treat me. He gets it.

Primary care is an onging conversation, not a brisk look at a chart and tap on the knee.

The connection is even deeper. Just before we bought our house, we were driving around, seriously lost, in North Puffin. We stopped to ask directions of an older gent walking along the road and told him we were house hunting. Mr. Smith told us where we were. He told us a bit about the area. He told us he had lived there all his life so far. He was 96. He didn’t tell us that his lovely, brick, farmhouse with barn was for sale.

First, check the insurance.
Then, do no harm.

A couple of months later, we bought a different lovely, brick, farmhouse with barn on the lake and a fellow I worked with bought Mr. Smith’s home. Then he sold the Smith house to Dr. Bob and Mrs. Dr. Bob.

Getting back to health care, Dr. Bob is a couple of years older than I and he has retired. Ah hah! I thought. I can transfer my primary care (what we used to call the G.P.) down here.

Side story. Dr. Bob told me my increasing snifflinesss [<==technical medical term] is an allergy and I should find a specialist. I talked to a nurse at a sprawling medical practice in Vermont about an hour from North Puffin. I’m looking for someone to do allergy testing and they have three. The nurse told me two of the docs there are Peds only. The third allergist there as well as the one doc in Puffin Center don’t have the greatest reps. In fact, Dr. Bob won’t send patients to the one allergist in Puffin Center.
I asked a friend if she knows anything about an allergist in South Puffin or even the one in Key West who also has offices in Palmetto Bay and South Miami. Turns out the Marathon guy is the doc who admitted he sexually battered a patient in Illinois and then got sued by an employee he groped and pointed a handgun at. He also does weight-loss workshops. That’s worse than the Puffin Center guy.


Laura told me (remember Laura?) that their new medical director is an ER Specialist at our critical care hospital in Puffin Center but he’s the only doc listed on staff at the Federally Qualified (rural) Health Center Dr. Bob built. They have a nurse practitioner, two physican assistants, and a wellness counselor.

Doctor's OfficeMeanwhile, down here we find the 57-year old who diagnosed that I had either flu or pneumonia a few years ago. He treated for both. Either his treatment or tincture of time worked but it didn’t leave me feeling particularly confident. There are four other family medicine docs, two men and two women. Three are over 60 and the one with the most recommendations from neighbors is 69. That’s a year older than Dr. Bob. The youngest is a 54-year old. She’s not taking new patients.

So my choices seem to come down to one of a bunch of physician’s assistants or a doc who will likely retire tomorrow.

I don’t care if I have the pro from Dover for day-to-day stuff but I do care that I get the same person. Primary care is an onging conversation, not a brisk look at a chart and tap on the knee.

Is it too much to ask to see an actual doctor, let alone one young enough that I might not have to do this again for a couple of decades? I don’t mind training a newbie too much if they seem to be in it for the long haul.

Our dentist lives and works in Quebec. He was about 12, I think, when he bought the practice there, so I figure I can keep him at least as long as I can keep what’s left of my teeth.



Headlining It

As promised, President Trump signed an executive order on Tuesday that calls for a full review of the H1B visa program — that’s the highly-skilled immigration visa program — and include more language for government agencies to buy from US companies. The way different media players chose to spin it in the headlines is interesting:

NYTimes: Planned Trump Order Will Discourage Hiring of Low-Wage Foreign Workers
Recode: Trump will sign an executive order reviewing high-skilled H-1B immigration visas
USA TODAY: Trump to sign ‘Buy American, Hire American’ executive order
CNNMoney: Trump administration moves to combat H-1B visa fraud

The quoted headlines did come from the White House briefing. Each took a different fact and emphasized it.

That was yesterday. Today, the visa kerfuffle is forgotten in favor of a congressional seat up for grabs in Georgia.

CNN: Ossoff falls just short in Georgia special election
NYTimes: Jon Ossoff, a Democrat, Narrowly Misses Outright Win in Georgia House Race
WND: Republicans force runoff in Georgia race

It’s true. Jon Ossoff received almost half the votes. But that’s less than half the story.

From the NYTimes: “Jon Ossoff, a Democrat making his first bid for elective office, narrowly missed winning outright in a heavily conservative House district in Georgia on Wednesday, throwing a scare into Republicans in a special congressional election that was seen as an early referendum on President Trump.

“Ossoff received 48.1% of the vote, just short of the 50% threshold needed to win the seat, and he will face Karen Handel, the top Republican vote-getter, in a June runoff.”

[Blah blah Stuff about Mr. Ossoff blah blah]

From the NYTimes, paragraph #127: “As Mr. Ossoff faces Ms. Handel in a head-to-head race on June 20, it is unclear whether he will be able to sustain the success he enjoyed on Tuesday, in an 18-person field.”

Wait. What?

An 18-person field?

And that wasn’t the second lede?

Both sides shot themselves in the foot; Republicans just used a bigger gun. 192,084 people voted. In addition to Mr. Ossoff and Ms. Handel, the ballot included three candidates — Republican Bob Gray, Republican Dan Moody, and Republican Judson Hill — who pulled 28.4% of the vote between them. Seven other Republicans, four Democrats, and two Independents split the remaining 7,100 (3.7%) votes.

The real story here?

1. Democrats came close in a nationalized race about the first 100 days of Donald Trump, all in a now-tightly split district.
2. Out of state progressive activists led by the ultra-liberal blog Daily Kos pumped $8.3 million into Mr. Ossoff’s campaign; out of state conservatives did the same for the top three Republican contenders. $14 million was spent on advertising in the race, most of it fueled by that out-of-state money.
3. 18 people ran in what one consultant called a “bar brawl.”
4. CNN quoted Daily Kos founder Markos Moulitsas.

I had to read 11 different reports to assemble even that information.

The mainstream media takes the facts on the ground and “presents” them in a way that will rile their readers or at least get them to “click through.” And then they wonder why we don’t trust the news any more.


Taxed. Again and Again and Again.

We the Overtaxed People dread most April fifteenths but that terrible day has been delayed to April 18 again this year.

“Tomorrow, tomorrow, I love ya tomorrow
You’re always a day away …”

Form 1040Emancipation Day, a little-known holiday beyond the Beltway, is the primary reason the tax deadline changed this year. Slavery was formally abolished in the United States December 6, 1865, when the 13th Amendment was ratified, but it occurred much earlier in the District of Columbia: President Abraham Lincoln signed the Compensated Emancipation Act on April 16, 1862, freeing the thousands of slaves who lived in the district. Now a legal holiday in Washington, government offices and other public services do not operate on Emancipation Day, usually celebrated April 16. Emancipation Day falls back to April 15 or ahead to April 17 when it falls on a weekend because we couldn’t deprive civil servants in that city of a holiday.

This is the second year in a row.

In other tax news, tax-refund fraud continues to soar this tax season. It will top $21 billion this year, up from “just” $6.5 billion three years ago, according to the Internal Revenue Service. The IRS’ own “Dirty Dozen” lists the common scams that peak during filing season as people prepare their returns or hire someone to help with their taxes. Half are crimes against us including phishing, phone scams, and identity theft.

Elian Matlovsky of Staten Island was found guilty in what the prosecutor described as “one of the nation’s largest and longest running stolen identity tax refund fraud schemes.”

Here’s how it worked. Ms. Matlovsky and the other defendants were found to have filed more than 8,000 fraudulent federal income tax returns for more than $65 million in tax refunds. They did it by stealing Social Security numbers and dates of birth and using that information to file the false returns claiming refunds.

My liberal friends like to make hay on the fact that the rich don’t pay taxes but my liberal friends are wrong.

I ran a quick guestimate for the fabled “one percenter” with a gross annual income of $1,260,508, a $10,000 retirement plan contribution, $26,690 in itemized deductions, and two kids. That taxpayer has $1,152,975 in taxable income and will pay about $411,339 in taxes. The effective tax rate is 32.6% and the marginal tax rate is 39.6%. (That gross annual income is the least that qualifies for “one percent” status.)

Now look at a “ten percenter,” a married engineer earning $133,445 in salary with no investment income, a $5,000 retirement plan contribution, $13,345 in itemized deductions, and two kids. That taxpayer has $107,000 in taxable income and will pay about $17,465 in taxes tomorrow. The effective tax rate is 13.1% and the marginal tax rate is 25.0%. (That gross annual income is the least that qualifies for “ten percent” status.)

“The tax code is about 2-1/2 times the length of Stephen King’s It–except you replace ‘scary clown’ with ‘accounting methods’.”

Finally, consider the married person who earned $40,190 in wages with no other income, no retirement plan contribution, taking the standard deduction, and two kids. That taxpayer has $19,490 in taxable income and will pay about $0 in taxes tomorrow. The effective tax rate is 0.0% although the marginal tax rate is still 15.0%. (That gross annual income is about the most a family of four can make before paying $12 in income tax for the year.)

Want to tell me again who pays the least taxes?

There are now more than a thousand pages of tax forms.

Slate, apologizing again for Big Government, would have us believe the tax code wasn’t 70,000 pages long in 2013. It was “only” 4,037 pages then. Oh, goody.

Want to tell me again why this is fair.

Just remember, the very same people who want nationalized, government-run, single-payer health care (“Medicare for All”) oppose the simple, fair flat tax. I’m pretty sure there is a moral in there somewhere.

SCOTUS Upholds Obamacare: It's a tax
Bet your bottom dollar that tomorrow
your bottom dollar will be gone!