Pumping Iron on Capitol Hill

Yosemite Falls - photo by JoAnn Sturman

Scott Sturman

In 2012 my wife JoAnn and I traveled to Tibet to participate in the “World’s Highest Trek,” which takes the non technical climber to 21,500 feet on the the Tibetan side of Mt. Everest.  After our acclimatization hike on Mt. Shishapangma, our group was informed that the Chinese government had summarily closed Mt. Everest to all foreigners, ostensibly due to civil unrest within the Tibetan Buddhist community.  No official reasons were given or right of appeal available–just capricious punishment of the Tibetan people and all foreign tourists.  What a helpless feeling to be subjected to the caprice of the Chinese Communists.  “We’re fortunate to live in America,” I thought, “where autocrats would never be so audacious, much less tolerated.” 

On March 1, 1872, the federal government established the first national park, Yellowstone Park, under the following condition: “as a public park or pleasuring ground for the benefit and enjoyment of the people.”  Now Yosemite Park, a frequent destination of ours, is closed, while Senators and Congressmen pump iron at the Congressional Gymnasium, which is subsidized by the same ordinary citizens who are barred from entering their national parks.  Closing my eyes, I envision Harry Reid and Nancy Pelosi clad in Spandex and gyrating at their Zumba class, while school buses are turned back by barricades and armed rangers at the entrances to our national parks.

Guilt is probably the rarest emotion to well up from a Congressmen’s hippocampus.  Feelings of hypocrisy?  Never!  Why would anyone be surprised the Congressional Gym is open for business during these times as austerity?  Their favored status is a self administered reward for giving us Obama Care, which ironically, the masses are compelled to use, while Senators, Representatives, their families, and political allies are free to opt out.

National parks provide sanctuary for those of us who want to escape politicians and detest listening to their incessant drivel.  From the looks of them, the outdoors, other than a golf course or alfresco cocktail party, is a place seldom ventured.

Washington, having lost its ability to govern, should pass control of the national parks to their respective states.  Congress's seniority system gives extraordinary and insulated power to a few personalities who are in essence national politicians.  Detached from the electorate, Congressional leaders are too easily influenced by lobbyists, money, and the national media.  This makes ill conceived decisions like closing the national parks not all that uncommon.  Devolution of power to state governments makes politicians more accountable and responsive to regional priorities.  The Founders realized the importance of government being as close to the people as possible and a healthy balance between states rights and federalism.  It would be difficult to imagine Jefferson, Madison, and Washington keen on wiling the hours away at the gym, while those who elected them were forbidden to appreciate the beauties of nature. 

       Bridalveil Falls - photo by JoAnn Sturman

Health Care for My Masters

Haute Route - photo by JoAnn Sturman

Scott Sturman

Soon after his presidency began, Barrack Obama traveled the globe on an apology tour, apologizing to anyone who would listen about America’s shortcomings.  Hat in hand, he challenged the concept of American exceptionalism, an argument the Muslim world quickly embraced.  His cheerleaders of the Left called for the repeal of the 22nd Amendment and showered him with the Nobel Peace Prize.  Curiously, four years later he pleaded his case to the world to bomb Syria and proclaimed that the United States was–well, exceptional!  Is this a case of political flexibility or schizoid behavior?

So which is it?  Is America exceptional or not?  Obama Care, the cornerstone of his Presidency and harbinger of national health care, offers some clues.  But first some historical background:

Royalty and elitists were held in contempt by the Founding Fathers.  They believed in the exceptionalism of the common citizen and were deeply distrustful of politicians, who invariably maneuvered to consolidate and further their power.  The thought those who governed were entitled to live under different rules than those who elected them was abhorrent.

One of the most controversial aspects of Obama Care is the exemption of Congress to participate in the program.  A cynic could ask justifiably, “If the system is so superior, why would our leaders opt out?”  Yet more relevant questions are, “Why would anyone vote for a politician who denies them the same access to health care?  And why would the President, who favorite word is fairness, refuse to insist the Affordable Health Care be the law of the land?”

The President and his supporters of the Left do believe in exceptionalism–the exceptionalism of the politically elite.  This perversion is understandable from the point of self serving politicians, who do not trust the government to care for their families, but for the voters who support them it is a different story.  They truly must believe in their own unexceptionalism and nod in agreement as their President reminds them of it.  

San Joaquin River at Jackass Flats - photo by JoAnn Sturman

Skin in the Game

 Love in Malibu - photo by JoAnn Sturman

Scott Sturman

John Hancock signed his name boldly on the Declaration of Independence, so King George could not help but see it.  Few know the names of most of the other 56 signatories, much less what happened to them. All were well to do and faced a certain trip to the gallows, if defeated by the British.  As it was, many lost their lives, fortunes, and families during the Revolutionary War in order to gain independence for the fledgling nation.  (See Paul Harvey's video discussing the subject.)  Unlike today’s political class, who live by different rules than those they serve, the signers had skin in the game.
 
I saw a patient yesterday, who doesn’t have skin in the game.  She is on welfare, always has been, and probably always will be.  She’s eating herself to death and costing taxpayers a lot of money as her diabetes and hypertension riddle her body.  In her early 30s, 5 foot 2 inches tall and 260 pounds, she’s substantial but not unusually large for a patient population which grows heftier by the year.  She didn’t seem bothered by the prospect of losing her vision, going to dialysis three days a week until she receives a kidney transplant, or dying long before her time.  The staggering costs incurred to treat diseases caused by over indulgence are the least of her concerns; that responsibility has always been somebody else’s problem.

I’m not a primary care doctor but with her mother in attendance and a few extra minutes at hand before a procedure to treat her diabetic retinopathy, why not talk about losing a pound or two?  Who knows?  Maybe something will click this time around.

“Your high blood sugar and blood pressure are more than just numbers.  Now they are destroying your eyesight.  Your kidneys and heart will be next.  Has anyone ever talked to you about the importance of losing weight?  Just a few pounds can make a difference.”

Before the patient could answer, her mother piped in, “We’ve heard this before.  We don’t believe what you’re saying.  We’re just big people.  It’s genetics.”  Sounding like South Africa’s former President Thabo Mbeke, who denied HIV causes AIDs, her enabling mother had the last word when it came to discussing her adult daughter’s health.

ObamaCare and its end result, socialized medicine, theoretically guarantees equal access to health care.  No line jumping or individual considerations are allowed except for Congressmen, who exempt themselves from the program, the very wealthy, for whom expense is no object, or those with special needs, which are determined by politicians.

Perhaps the primary advantages of the private insurance system is the ability to obtain both emergent and non emergent, high quality care quickly and to maintain a personal relationship with one’s physician over an extended period of time.  The costs to obtain these benefits have spiraled out of control due to a complete cost-demand disconnect, waste, fraud, and a rapacious personal injury industry.  Furthermore, the ultimate “skin in the game” solution, the health savings account model, has not received wide spread support due to its emphasis on personal responsibility and financial prudence.

Imagine shopping in Barrak-o-Mart, a grocery store where you are one of half the customers who have pre purchased every product within the building.  It’s all basic merchandise–nothing fancy but good enough to keep the masses from going to the barricades.  Despite the allure of limitless chocolate chip cookies, potato chips, and sugar laden soft drinks, you pass them by for healthier fare.  Having to return to work in a few minutes, there is no time to while away the hours browsing the shelves or devouring every food sample thrust upon you by obliged employees.  You rush to the check out area looking for an express line, but there is none.  The lines are long, and the checkers work with the speed of Third World bureaucrats.  Half of the customers have two grocery carts brimming with food products selected for sweetness and mega calorie counts.  Forget returning to work on time.  The checkout time is measured more aptly in days or months than minutes.

Beleaguered, but with the cash register finally in sight, the store manager halts your progress and allows two customers with more pressing needs to cut in front.  One resembles the patient described earlier in the article to such a degree that he could be her twin brother.  The other is Senator XX, whose comely assistant is pushing a cart packed with caviar, truffles, filet mignon, and bottles of the finest wine.

“Excuse me, Senator.  Where did you find such bounty?”

“I don’t shop in the same part of the store as you, lad.  Now enough of your pretense, let me through!”         

Suing Anyone, Anytime, Anywhere

El Capitan - photo by JoAnn Sturman

Scott Sturman

A judge can be dismissed for only a few reasons, and stupidity is not one of them.   --W.R. Priskna

My friend’s recent experience with personal injury attorneys confirmed that this group of predators are among the lowest life forms on the planet.  When unhampered by financial limits to their demands, they exhibit a rapacious and disingenuous ability to push damages to the extreme.  The larcenous quest is assured when dunderheaded judges preside over a carnival atmosphere, and jurists are selected by how well they fit into a court fool’s costume.

A death occurred on a job site, when an entry level employee with a wife and small child thoughtlessly put himself in harm’s way.  In the hands of an elite team of personal injury attorneys, the story would be rewoven and embellished to convince a jury the fault was due to the employer rather than a careless mistake.  Punishment rather than compensation became the objective, as the attorneys were quick to point out the lifestyle disparities between the deceased and his employer.  As it is in the political arena, class warfare is a handy tool in the courtroom, when jurists lose sight of facts and rely on emotion to redistribute wealth.

Of all the penalties, punitive damages, awards, and attorney fees levied in the case, one element typified how matters spin out of control when personal injury lawyers run amok:  The jury was convinced that without a man in the house, the widow feared for her personal safety at night.  The obvious solution was to provide a security guard in her home while the sun was below the horizon–seven days a week, 365 days a year, for a lifetime.  The cost was only $1.5 million, and one the jury agreed was entirely reasonable, although before his death the husband earned only $20,000 per year.  And what if the widow had a live-in boyfriend or remarried at a later time?  This was a trifling consideration compared to the pain and suffering she had endured since her husband’s passing.
 
Physicians in California are protected from exaggerated pain and suffering awards by MICRA legislation which caps limits at $250,000.  The program reduces medical costs and discourages physicians from fleeing the state to escape a predatory legal climate.  Now the program is under attack by personal injury attorneys, who feel emboldened by a 2/3 Democratic majority in both the California Assembly and Senate.  The lawyers, of course, declare their only concern is adequate compensation to injured parties.  A healthy share of the settlement has nothing to do with their love of humanity.

Californians should consider the following before tinkering with MICRA and its effect on the number of physicians practicing in the state:  There is already a shortage of physicians that only will intensify when Obama Care is foisted on the public.  Educational debt for physicians continues to escalate and often far exceeds a quarter of a million dollars.  With sagging reimbursements, adding more fixed costs in terms of higher malpractice premiums will further discourage highly qualified students from entering the medical field or force them to practice in more physician friendly states.

Listening to NPR’s California Report on the way to work, an anti MICRA advocate was asked what he thought was a reasonable limit to pain and suffering awards, “At least a million dollars,” he quipped.  To an increasing segment of the public who don’t know how many zeros are in a million, it doesn’t seem like a lot of money, but its impact on medical practices translates into a financial burden that a select profession must bear.  When there are too few doctors available to tend to life threatening medical conditions, consider having a personal injury attorney take care of the problem.  If they can’t talk your way out of it, at least they can find someone to sue to ease your pain and suffering.

No Words for Thank You

Tibet - photo by JoAnn Sturman

by Scott Sturman

Looking back over a nearly forty year medical career, advancements in technology and interference from bureaucrats have redefined the practice of medicine, but patient attitudes, particularly those receiving government sponsored care, are no less significant.  Early in practice, most welfare patients seemed to appreciate the efforts of the medical staff who treated them.  There was a tacit understanding the care they received resulted from the sacrifice, generosity, and ethical commitment on the part of physicians, nurses, and hospital administrations.  This relationship has changed.

In the series Game of Thrones Viserys Targaryen arranges for his sister Daenerys to marry Drogo, the Dothraki king, in order for the Targaryens to reclaim the Iron Throne.  It’s a match of power politics, for at first glance it is difficult to imagine an odder couple.  Drogo is a brute of a man and epitomizes his culture’s savagery and thirst for violence, while Daenerys appears meek, sheltered, and physically graceful.  They are worlds apart and speak no common language.  When Daenerys, also known as Khaleesi, receives her wedding gift from Drogo, she asks her knight Jorah Mormont how to say “thank you” in the Dothraki language, so she can express her gratitude to Drogo personally.  Mormont replies, “Khaleesi, there are no words in Dothraki for ‘thank you’.”

Obstetric floors specializing in indigent care provide a glimpse into the mind set of the welfare class.  Most patients are either young or have had a generational affiliation with government funded health care.  The likelihood that any of them have ever paid for medical care is vanishing small.  It is a way of life, an expectation, and a right. 

Labor epidurals are the standard of care whether a patient pays for the service or not.  The technique provides great benefit but is not without medical or legal risk.  Within minutes after the nerve block is placed, the patient realizes near complete pain relief.  And who is more likely to offer the physician an unsolicited “thank you,” the paying patient or the welfare patient?  Ironically, it is almost always the former.

On occasion after the procedure and prior to leaving the patient’s room I’ll ask her, “What do you say when someone does something good for you?”  The answer depends, of course, whether Dothraki is one’s primary language.  More often than not, there will be a pause and a reply more in the form of a question, “Thank you?”  Yes, that is the right answer, but one that should not have to be coaxed or coerced and whose meaning is frequently lost on those who view medical services as an entitlement.  

      Passion Tree - photo by JoAnn Sturman

(No kidding, we found this tree along a path in Costa Rica)

Medicare Breaks the Bank - Again

Serengeti, Tanzania - photo by JoAnn Sturman

by Scott Sturman

The nearly complete disconnect between cost and demand is the primary reason Medicare is broke.  A surgical colleague shared a story which illustrates the problem. 

Provenge is a FDA approved vaccine used in the treatment of advanced, metastatic prostate cancer.  The drug costs $93,000 and in clinical studies extended life expectancy from 21 to 25 months - a mere four months.

A company representative visited the surgeon at his office and encouraged him to use the product.  A gist of the conversation follows:

“Why should I prescribed Provenge for my patients?”

“It increases life expectancy 20% for patients with advanced prostate cancer.”

“Prostate cancer is an indolent process.  A 20% increase in life expectancy from initiation of treatment sounds impressive, but actually it’s only four months.  It’s a small benefit for a lot of money.”

“The cost is not a problem; Medicare pays every cent.”

“Nearly $25,000 per month for four months seems exorbitant.  Besides, the last four months of life with metastatic prostate cancer are miserable; the patient is generally bed ridden and requires high doses of narcotics to manage the pain.” 

“Imagine what the public would think, doctor, if the newspaper reported your unwillingness to help dying patients in your care from spending a few more months with their loved ones.”

If the cost benefit ratio is unreasonable, then the threat of  exposure to the media as a heartless physician who knowingly deprives his patients of all available treatments may be the most convincing sales strategy.

The surgeon was curious how his patients with advanced metastatic prostate cancer felt about a cancer vaccine.  After explaining the risks and benefits of the treatment, he informed them the drug costs $93,000.

“No way I’m going to pay that kind of money for maybe four extra months, doc.”

“I thought you’d say that, but the drug costs you nothing.  Medicare pays the entire bill.”

“Well ... in that case.”

“Let me ask you another question, while we are on the subject of finances.  If I offered you the choice of $20,000 in cash now or the $93,000 cancer vaccine free of charge, which one would you take?”

“I’d take the $20,000, doc.”

“That’s what everybody else said.  We could save Medicare $73,000, if they would just pony up the cash, and you would forego treatment.”

Vast sums of money are wasted in the Medicare program. Rather than proposing Health Savings Accounts and similar programs which restore financial accountability, ObamaCare regulations undermine them.  As long as there is no link between the specific service and its expense, massive cost overruns and eventual rationing of care are inevitable.

Ostriches, Neville Chamberlain, and Doctors

On the Serengeti - photo by JoAnn Sturman

by Scott Sturman, M.D.

The United Auto Workers were at their best this week as they took to the streets in protest of Michigan’s Right to Work Law.  Woe to anyone who disagreed with their world view.  Despite inflated wages and the inability to compete without government subsidies, they were willing to put a fist in the face of anyone who felt otherwise.  At least one has to admire the passion and gall of a group whose skills can be easily outsourced to more efficient, non union automobile plants in the South.  To the union worker Right to Work is a call to arms and an invitation to resort to any means to prevent its implementation.

Doctors’ responses to Obama Care has been considerably more tepid.  Gaging the level of protest, one would think they were dealing with a minor traffic violation rather than being confronted with a program which will certainly destroy private practice medicine.  The promise of less independence and income with more restrictions and hours on the job and no talk of tort reform has done little to arouse the profession.  Rather than strike, punch a politician in the nose, or display abject anger to the public, doctors prefer to lay down hoping the outcome will not be all that bad.  They are team players and not confrontational by nature, so it best to avoid the withering censure of the media about selfishness and moral turpitude. 

Physicians require years of training, sacrifice, and expense to become competent.  The profession is utterly indispensable to society, but apparently its leaders prefer to disregard this bargaining tool.  Unlike the fire breathing UAW, physicians opt to complain among themselves and accept what has been thrust upon them.  This is a time for a Churchill not a Chamberlain, otherwise the profession resembles a gaggle of ostriches with their heads buried so deeply in the wrong place that it is unaware a battle needs to be fought.   

 Neville Chamberlain shows proof of Hitler's good intentions and proclaims "peace in our times."

Barry Soetoro - Safe at First Base

Out for a Stroll in Buenos Aires - photo by JoAnn Sturman

Scott Sturman
fliesinyoureyes.com


The President is so fond of sports cliches and analogies, I wrote a story to amuse him.

It was the bottom of the ninth inning with two outs and nobody on base in the seventh game of the World Series.  The home team was down by three runs.  As he strode to the plate, all hopes pinned on 8th place hitter Barry Soetoro.  The gangly left handed hitter swung widely at the first two pitches which were out of the strike zone.  With the count 0-2 he hit a slow hopper to the second baseman, who fielded it cleanly, and made the routine throw to the first baseman, two steps before Soetoro stepped on the bag.

“Safe!” exclaimed the first base umpire.

Even the partisan home crowd winced at the blunder, and Soetoro’s manager smiled sheepishly and kept his eyes downcast.  The sportscasters were flabbergasted and fumbled with their monitors to see if their eyes played tricks on them.  “We’re having some problems with the instant replay.  What did you think of the call, Tim?”

“Wasn’t even close, Jack.”

Visiting team manager Bubba Gutierrez exploded from the dugout, “Are you blind, ump, or just retarded?  The runner was out by six feet!  Six feet - that’s twice as long as you’ll need for your coffin when I get done with you.”

“Shut up, Gutierrez!” warned the first base umpire.  “The call was razor close, and the first baseman’s foot came off the bag when he stretched to make the play.  Who do you think you are to question Soetoro?  He’s a great man.  You’re ahead by three runs anyway with two out in the bottom of the ninth.  Where’s your sense of fair play?”

“You’re an idiot, ump,” screamed Gutierrez as he kicked dirt at him and sprayed his face with as much saliva as he could.  “This game is not about charity.  This is the World Series, not the Special Olympics!”

“That was insensitive of you, Guiterrez.  You’re out of here!”

Back in the booth something weird was happening.  None of the television networks could view the replay of the controversial play.  “Sports fans, this is a first for me,” confided Jack.  “I’ve never experienced a technical glitch like this.  I mean all of our tape of the play is blank, and checking with other broadcasters, they have the same problem.”

“It’s got to be like one of those Bermuda Triangle or Area 51 events,” offered Tim. 

The bizarreness didn’t stop there.  Every cell phone camera and every video cam was blank.  There was just no electronic record of the play.  No record except of the pictures from Bob Smith’s point and shoot taken from the upper tier in left field.

Soetoro was called safe, Guiterrez was ejected, and it would take some digging later on to recognize the enormity of the error.

The next hitter hit a line shot to center field, putting runners on first and second.  The following hitter walked on four pitches to load the bases.  It was a fait accompli that the next batsman smashed the first pitch over the centerfield wall, giving the home team a one run victory and the World Series crown. 

The team poured from the dugout and the fans burst onto the playing field and lifted Barry Soetoro high into the air.  “He’s a hero, the perfect man, a gift from Heaven!  When all seemed lost, he made the impossible happen and won the game for the home team!”

Later, Bob Smith realized he owned the only proof of the miscue.  He contacted the major media outlets to sell his pictures but was rebuffed as a crackpot.  Shortly after a man in a dark suit offered him a substantial sum.  The film and signed contract obligating him never to speak about the affair seemed a small price to pay for his serendipity and new found wealth.

When Barrack Obama got to first base in November 2008 as the least known American President in history, significant repercussions followed.  Obama care, the explosion of the national debt, a lingering recession, high unemployment, an inept foreign policy, and the incendiary politics of class warfare are the results of electing an amateur to the world’s most important job.  The Bob Smith’s of the world need to step up and shed light on a murky past.

Are Social Programs Like a Bad Marriage?

Ambulance used on Mount Kilimanjaro, Tanzania, to evacuate climbers suffering from acute altitude sickness. It is the prototype transportation device for the Obama National Health Care Plan.

Scott Sturman
fliesinyoureyes.com

Bliss is the honeymoon - a care free time filled with optimism and mutual infatuation. As the romance matures and novelty gives way to routine, the marriage will be confronted by a number of challenges, not the least of which are financial. If the couple fails to save and spends beyond their means, the union is in trouble.

Social Security and the American people exchanged vows in 1935 with promises to live prudently in order to provide retirement benefits for generations to come.

“I love you, sweetheart. I'll take care of you forever. Social Security is voluntary and will cost only 1% of the first $1400 of your yearly income.”

“I love you too, honey, but do you think we can afford it?”

“Trust me. It's not a problem. Our payments will top out in 1949 at 3% based on a maximum $3000 annual income. Next year I'll give you a pamphlet which will promise this is “the most you will ever pay.” (This claim actually was printed in 1936 and sent to the American people!)

Social Security is now the largest government program in the world and the single greatest expenditure in the federal budget. Presently the taxation limit is 6.2% for both employer and employee calculated on a maximum $106,800 annual income. Despite the ever larger appetite for tax revenue, the Chief Actuary for the Social Security Trust Fund in 2008 calculated $13.6 trillion of unfunded obligations. Clearly, this marriage foundered due to unreal expectations, too many credit cards, and way too many dependents.

When it comes to betrothals with social programs, the American people have polygamist tendencies. President Johnson presided over the next ceremony in 1965 as Medicare stood at the altar with a naive bride-to-be. The couple's financial plan was initially modest as they pledged to live modestly and carefully watch expenses. The monthly Part B Medicare payment was set at $3, but by 2009 it soared to $96/month, while wealthier retirees owed between $135 and $308. By this time the 45 year long marriage had plunged so far into debt the only hope was to sell the family farm and move into a commune.

When examining the history of Medicare, it is clear as more benefits were added to the program red ink cascaded over the balance sheet. Patients viewed all aspects of their health care as insured and lost the connection between supply and demand. Politicians, never having demonstrated far sighted financial judgment, eagerly acted like credit card companies sending unsolicited credit applications to teenagers, promising more benefits to increase their chance of reelection.

Obama Care transfers control of the medical industry to those who repeatedly have shown they cannot manage anything very well, but this time things are different. The marriage has a savior – Barrack Obama, the best marriage counselor available. It was reassuring to hear him comfort us a few weeks ago when he stated this massive, convoluted program is actually a “middle of the road solution.” This is good news! Never mind the legacy of the United States Postal Service, Medicare, or Social Security. This is not business as usual. The President promised it will save money, not ration health care, and he will love me in the morning.