More on healthcare: A Surgeon Asks About the Direction of the Future

Yesterday I wrote this phrase: "heathen healthcare insurance companies."
I meant it.

Dr. Robert Sowell, a surgeon who bravely terminated every private insurance company that required authorizations for services (which greatly influences what treatment a physican may administer to a patient), denials, and also stipulates how much they will pay,  shares his thoughts in General Surgery News.
Click here:  Where Do We Go From Here?

"About nine years ago, I made the conscious, albeit impulsive decision to resign from every private insurance contract. I believed then, and still believe today, that these contracts, with their preauthorizations and denials of payment, were indirectly and inappropriately influencing a wide variety of medical decisions. Plus, under these contracts I had no say in determining what the actual value of my services should be. I was essentially an employee of the insurance companies because they were the ones who paid me, according to their fee schedules."

The Medical Practice and Why Money Motivated Us

Note: I hope you will click on all the links.

The insult came over lunch. "Private medicine and hospitals are motivated by money," said someone in the military. They gave me a look, like I could never understand what it was like to have sick patients.

It dawned on me. To them, I was just a snotty surgeon's wife who was sitting there having spent her entire life playing Marcus Welby MD. They probably thought we played golf on Wednesdays and that I had my hair and nails done on Monday, followed by tennis at the country club. Of course, it would never dawn on them how I got here.

But I couldn't say much. Because anyone who comes in from business knows, no one cares about your issues. The small practice or business owner wants to know: "Can you handle the job? Can you bring it in on time? Can you do it in a way that is efficient, well mannered, and profitable?  Do you treat people well? Are you going to fit in?"

But still, I can't let this stereotype just sit there. No. Because the group of civilian medical practitioners that I know, the very ones who are seeing a mindblowing 500 patients a day in the ER at trauma centers in major metropolitan cities deserve better than to be thought of greedy, self serving money whores. Because they are not. They're in a trench that lasts them a lifetime, with absolutely no guarantee of a pension and the only question that both the heathen insurance companies and Medicare/Medicaid have is: Will you do it and how little can we pay you?  And then they both run over the physicians, hospitals and staffs.

Physicians today --whether in individual, or small groups, wonder whether or not insurance companies are going to pay out. Their administrators will often have the numbers of two CFO's of different healthcare organizations on speed dial in order to badger them to pay what has been billed. The physician has to work their tail off in order to come up with quarterly payments to malpractice insurers --a healthy chunk. There is also payroll to be made, and one must be diligent and pay the payroll taxes at the same time by sending them into the state. The practice owner looks at their staff and realizes that every purchase made by them (a car, their children's clothing, or medicine) was because of the hard work that everyone in the business performs as a team.  Without money, we couldn't run the practice to help patients. Without money, my employees couldn't feed their kids.

 I cannot and will not speak for other physicians, but we were always motivated first to provide the highest quality medical and surgical care in a compassionate and disciplined setting. However, money is important. We just see money in a different way.

The small business owner sees money as a necessary resource to grow and fulfill professional and personal dreams; to be able to pay their employees well and to provide sustenance for their family. Money bought us equipment, helped us make our quarterly taxes on time, and all the other payments that come with a business.

When we had our practice, we didn't take a vacation for four years. We worked on an average of 60-80 hours a week. Our appointments were double booked, and often the wait to see us was several weeks. We were on call 24/7. Everyone had our phone numbers. As the administrator of the practice, what worried me was coming up with the $18,000 minimum each month to keep the doors open. That's just what it cost to run the practice each month. Anything over that was ours.  Admittedly, there were months when we'd sweat --wondering if Blue Cross, Aetna, United Healthplan, or any other combination of IPA's would pay out enough after having taken their cut, so we could make both mortgage and office rent. But don't forget: it was all pre-tax. Our profit was less than a fireman, higher- paid teachers, and realtors. But don't get me wrong: while it was hard, we also loved it. When we closed it we were at the top of our game and we found all our employees jobs. Ironically, we netted much less than what we are making now. My husband drove a used Toyota truck, then. Today he has a souped up Mustang.

Something most people in the service don't realize: the small business or practice owner always pays their employees first, the payroll taxes second, rent, expenses and themselves last.  It's a common formula, and if one is lucky it goes smoothly and the owner gets the lion's share. But it takes every waking moment to get there.  That's our story, and it would behoove those in the military who might think they will never be motivated by money to perhaps look at it in a slightly different light. Money allows business owners to support themselves while serving others.  I would argue: military medicine must also be motivated by money in that they must work very efficiently with the dollars entrusted to them by the tax payers.

I'm cognizant that our Army paychecks are only possible because of the hard toil of small business and practice owners everywhere. Am I thankful for their toil? Yes. Are small businesses motivated by providing a good service? Yes. Are they motivated by money? Yes, and I'm grateful for it. 
(And by the way, I am still a small business owner).

West 2012: Possible Pastry Crimes by the Power House Three

Free Registration Here!

I know. It's only December, and already I'm looking at the calendar for 2012.
January is going to be a busy one.
I was anticipating West 2012, probably the best conference for me to go to because

Bootstrap USA

1. It's military related.
2. It's free.
3. There's lots of smart people who go.
4. I was hoping my friend Eric Walrabenstein, developer of Bootstrap Stress Management, a free program designed for veterans would show up.
5. An assortment of smart asses are going to be there.
6. Those smart asses are my friends.

So, Boston Maggie, Mary Ripley of the U.S. Naval Institute and myself are going to be there. The question is whether or not it would be okay for the three powerhouses to stay at the same hotel. I mean, really, there is only so much combustion a building can take --rather the other guests can endure before mass happiness breaks out, and suddenly everyone in the hotel is giggling.
Or so I think.
But what I hadn't anticipated all those months ago was that The Hubs would be assuming the command of a new unit at Ft. Bliss.

On the same dates. Or thereabouts. The unit really isn't sure if it will be 20 January or 24 January.
So if it's on the 24, this means I have to get back from El Paso on the 25th. I'll have to deposit Daughter at a friend's house, say hello to my cat and dog, then high tail it down to San Diego. 

And then, we will have at least one night of infectious giggling, snorting, random tweets and pastry crimes.
The kind of tweets that just cause everyone to think: they've lost it.
Can the Navy brass handle us?  Mary says there's a yoga studio downstairs. I intend to shove everyone in it, have them in downward dog, then walk around with a feather duster and tickle them.

Rants: Small and Large. Yoga Annoyances & Military Frauds

Okay, so I'm back. And for those of you who would like to throttle me, well, too bad. It's already been done.

WarRetreat.Org is going well. We continue to get hits from the yoga community, and hopefully they'll figure out that the VA isn't going to do everything.  I mean, not to single them out. But they are a particularly narcissistic crowd and quite frankly I find a lot of them just annoying. I enjoy yoga as an exercise, I just don't put a lot of stock into the community when it comes to understanding war and peace.

A lot of people in the yoga community think what most other civilians do: the VA will handle all of the problems of veterans. In fact, the #1 question from yoga teachers is how they can get hired by the VA to teach yoga.
But that's so opposite of how I think.
Look, public health has never handled the mental health needs of the population as well as it ought. Why? Well, for all the money we put into splitting monies between social workers, psychiatrists, psychologists, and other therapists in the public sector, the demand will always outstrip the supply. And that doesn't make for a very successful outcome all the time. So where WarRetreat.Org comes in is to encourage yoga doers to work within the yoga community and the non-yoga business world to find financial resources to address needs for veterans.

Look, there's enough money in the yoga industry alone (some people estimate it's a $5-6 Billion a year industry) to fund yoga classes in communities large and small. There's enough money in large corporations to put a yoga DVD into the house of every combat veteran.  As my friend Paul Zipes, founder of Yoga For Vets,  said to me, "The role of the military is to fight, kill, and win." That's what I like about Paul. He's a yoga guy, but in his soul he is 100% warrior (Navy). Always. So really, the civilian community --i.e. the business community, can really make a difference stepping forward for veterans. Government funding is such a slow moving beast, really --we don't have the time to wait.

The other news is that I learned of a fraudster in Orange County. Apparently, there's a woman who surfaced over a year ago, with varying stories of woe. We'll call her "Mama Fraudster." She posted on Dear Deployment, I Hate You, as well as other military spouse sites  she had lost her boyfriend in combat in Afghanistan. When asked for the name, she gave a KIA date, plus name and rank. However, when one of the wives went to look it up on the DoD, it wasn't there. Mama Fraudster then gave a different name to someone else.
Here were the two names:  Andy Mittendorf and Andy Hernandez.
Really, you can't get two names that are more different.  And neither Andy Mittendorf nor Andy Hernandez had been listed as wounded or treated at a military hospital, or deceased.  You see, very well-placed people looked for him at Landstuhl and through data bases after being moved by her story and emails.
By the way, Andy Mittendorf is a U.S. Soccer player.
Anyway,  she told one of the wives she was having his child. This good soul then wanted to toss a baby shower for the Mama Fraudster. She was going to ask people to send her gift cards.
That's when everything fell apart.
A Facebook warning was posted, and Mama Fraudster's Facebook ID was outed.
An all-day long fight ensued.
Mama Fraudster claimed she was "fat" not pregnant (ouch!).  She back peddled  by saying she met a man, and fell in love, and she knew him as Andy. A real man mystery. Or is that bedstery?


She called military wives and girlfriends not nice things in CAPITAL LETTERS.  Some military wives who decided to overlook the fact that Andy Mittendorf or Andy Hernandez had been searched for and not found on databases, decided to support Mama Fraudster anyway.  A woman who claims to be a Major  and worked as a doctor for 2 years in the Army sided with Mama Fraudster too.
Upon checking the Army Major Doctor's profile --she listed Chick-Fil-A as "a great place to work."
Shit. Things go down hill for Army Majors who are Doctors.
Then the suspense grew...well, but only if you're into conspiracy theories.
Her friend  claimed that the reason there was no DoD notice was because Andy Mittendorf or Andy Hernandez was Special Ops.
Now you tell me, why is every fraud claim to be Special Ops? 
His death was supposedly covered up, and his sister and parents were placed in protective custody.
Yeah, this gets better and better.
Some digging around, and we couldn't a listing on Zaba Search for Mama Fraudster in Costa Mesa where she claims to live.
Even her name is a fraud.  Or maybe she's Special Ops too.

So stay tuned.

The Final Chapter?

I'm really undecided about this blog.  The KD was the blog I started as a way to find my way in this military landscape three years ago. I took my existing writing and editing skills --used for literary fiction, book reviews, and writing posts and applied them here. The result was a marvelous journey where I met a lot of friends, got my feet wet, and while coming to grips about this new life.

I feel I've posted some fine writing on this blog. But I also feel --like a good book, some blogs must come to an end. It might be time for this one to have its final chapter. What I've learned about myself is the best favor I can do the military community is to be myself.  Because anything else would be a compromise, too boring, and way too contrived.  And I'm at an age, where really --I don't have the time for a charade.

The sequel to this blog (of course) is one that I have been spending more time on: WarRetreat. It's oriented to addressing the needs of our service members and their families in the aftermath of war through stress reduction. Jillian and I have been writing it in consultation with the wonderful Dave Emerson, and also with input from Paul Zipes. The feedback is positive: we've become a bridge from the military side into the yoga community. We have an opportunity to make a difference in the lives of a new generation of service members coming home in small communities across the U.S.

I've always felt the future well being of veterans should not be the sole responsibility of the V.A. or the military itself. I've also felt that a lot of people get caught up in philosophical discussions about war, and prefer to stay in that zone because helping veterans is too darn hard.

But for all the talk, and even though we all give much needed money to national organizations, the question that packs the most punch is whether or not our efforts are making a difference for the veterans in our community. PTSD is a community concern: if someone can't sleep, if they can't hold down a job, if they can't get along with others, and if they cease to believe in themselves, then the direct impact is on the people they love, and those with whom they work.

By sharing empirical data gleaned from studies about trauma and stress, WarRetreat can serve as a useful tool to not only help those suffering, but those who want to help, find pathways to work together.  While Kitchen Dispatch will always be my home, WarRetreat is the need that beckons me more everyday. I think I can bring the same aesthetic sensibilities that I've used on the KD, and before that Easy-Writer to War Retreat. But the truth is --I can't do them both at a level that would make me pleased. Three years --have I run out of steam? Not quite. But I sense the rails are shifting to a different plain.

As one prepares to leave Afghanista, Another Arrives

BabaTim is getting ready to exit Afghanistan. Catch his latest post on his blog, Free Range International. It's called Diplomacy 101, and you'll find out why. It's hilarious.

Artist Skip Rohde has deployed again. He's a contractor in Afghanistan. Last year, he was in Iraq working with the Army Corps of Engineers (I think). Catch his updates on Storypaintings.

Our House, The Cat, Dog, The Swiffer

The main reason for Swiffering

Because I cannot regale you of gunfights a la BabaTim of Free Range International,  I' can only tell you about my preoccupation with this house.

We've been cleaning a lot as of late. I've discovered the Swiffer family. Meaning, Swiffer as in those little things that you push around. Swiffers are the tribbles of household cleaning products.  First you buy one product, and then another, and suddenly there's an entire closet filled with white fluffy things in plastic tubs, and in boxes. There is never a time when there isn't a bit of swiffering to do around this dustbin of a house,  (and I'm also amused over the new verb --to swiffer, to have swiffered, am swiffering). Anyway, swiffering is sort of like using a tape roller. You can't help but notice how much dog and cat fur the pad picks up. My small mammals aren't much into learning how to swiffer, so I've thought of just wrapping their paws in Swiffer materials and letting them pick up their own fur.

The only place I have yet to conquer is under the fridge. Watch this, to find what Simon's Cat finds.