Useful Shit Well I thought it was neat!



There are some surprising parallels between the National Socialists
and certain modern American institutions.


How many of you have had a great experience with your health insurance company? Who here can say that their health insurance company is altruistic, easy to contact and forever has their best interest at heart? Just a quick show of hands. Take your time. I’ll wait.

You should never type while angry. That’s sage advice, to be sure. However, I’m about to, with malice and aforethought, intentionally ignore it.

I’m going to give you a peek behind the curtain that surrounds the modern practice of medicine in America. While all jobs have their administrative headaches, these are mine. If anyone gets their feelings hurt, then I hate it for you.

As part of some truly diabolical medical research, the Nazis forced certain Jews in the death camps to fill out a questionnaire while standing at a podium. The form was of a prescribed length and asked a bunch of mundane demographic questions. After the forms were completed, the Germans just threw them away. They didn’t care one whit about the information. It was simply that to fill out the forms, you had to stand still for a set period of time while a powerful x-ray emitter built into the podium irradiated your groin.

The point was not to gather information. The point was to bombard these poor unfortunates with high-intensity x-rays in hopes of creating a quick and convenient way of sterilizing large numbers of people without their knowledge. Needless to say, that didn’t work. Such a scheme seems about par for the course for the Nazis, the absolute scum of the earth. Now hold that thought …


Many modern medications are expensive. There are a lot of reasons
for this, some of which could be easily addressed with a little political will.
However, creating artificial impediments to good health care seems
counterproductive to me.

PA is a Four-Letter Word


Forgive my bias, but from my perspective, it seems that your health insurance company doesn’t much care whether you live or die. They would sell your kidneys on eBay if they thought they could get a decent rate of return.

There are times that literally half of my professional day is spent worshipping at the profane altar of modern electronic medical records, all the while trying to placate the dark gods of plaintiff’s attorneys and health insurance companies. To wit …

Insurance companies have done a splendid job of shaping my prescribing practices toward cheap generic drugs. In fact, we no longer see drug reps at my clinic simply because I am sick of fighting insurance companies to get them to pay for any drug that costs more than about a nickel a month. As a result, when I prescribe an expensive branded medication, it is always because I already can’t divine a cheaper alternative.

Now, health insurance companies could just explain to the patient in straightforward prose that they will only cover cheap meds and that anything else is the patient’s responsibility. However, that’s not how they do it. They just demand a PA.

In medical parlance, PA stands for prior authorization. I have no idea who ever thought this was a good idea. Satan, the Lord of Darkness, would be my guess.

The online PA clearing house is called, like consolidating this diabolical monster into a single digital location is somehow doing me a favor. I have to log in and then work through a series of online menus begging the insurance company to approve a patient’s medications. Sometimes they demand to know everything that has been tried before and failed. These are things that only the patient knows, and they’ve already gone back home. I don’t have time to do these stupid things until late at night when the rest of the day’s work is done.

The one I did yesterday, by contrast, only had me laboriously enter the name, address, phone number, and sundry other mundane information about my clinic, all stuff that is available automatically from dozens of sites online. They didn’t ask anything about my patient or his history. All this just takes time.

On a slow day, I’ll see 20 patients. A stupid busy day flirts with 40. Spending 10 minutes verifying my address online so some insurance company will cover Eliquis (a fairly safe but expensive blood thinner) for an 82-year-old woman who honestly cannot manage her own coumadin (a fairly dangerous but cheap blood thinner) is time I just don’t have. And, just like the Nazis, that is the point. If they can put enough artificial impediments in my way, maybe I’ll just give up. The patient won’t get the medicines they need, but taking care of sick people is my problem, not theirs.

Some medicines are just stupidly expensive. I get it. I really do. Somebody has to pay for all those obscene billboards adorning every goat trail in America. You know the ones I’m talking about. There will be some two-story grinning ape in a suit alongside stuff like “1-800-SUE-ANYTHING-THAT-BREATHES. We work hard to get you more.”

Nobody wants to see insurance executives sitting on the side of the road holding signs that say, “Will frivolously waste your time for food.” Actually, never mind. Upon further introspection, that might be kind of cool.

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