I am currently embroiled in a fight with a company and it made me think about the fact that we used to discuss business across a table. These days people make decisions over the phone without looking their opponent in the eyes. Negotiations used to be done in person where you could audibly and visually see the other human being that you were dealing with. Now negotiations are done via Twitter or text message.  

I, personally, believe that all of this social media nonsense is a poor replacement for real experience. Please, people, go enjoy the beach, and do not just use it as scenery for your social media post.

Relax. It is OK. Your phone can wait.


Here we stand with the (non-essential) government closed and the Democrats not willing to budge on the border wall. An impasse. What to do? And as I have been writing this even more absurdities have come from Washington. Now the Grand Dame has disinvited the President from delivering the State of the Union address.

Let us for a second stand back and see what has brought us to this fine state. Illegal immigration has been an issue throughout my lifetime and neither Democrats or Republicans have been able to solve the problem. Why? Because they have vested interests in the status quo.

Democrats see new immigrants as potential voters and have been quick to provide a lot of benefits, or ‘handouts’. What benefits? First of all, we provide safety – it is a nasty world out there. Then we provide school for the kids. We provide welfare for people not working. This is all done in the name of compassion, and that is all well and good, but we cannot provide this for the entire world.

Republicans see donors who use the illegals for cheap labor. They get rich running companies that use workers unfairly. When you are an illegal alien you do not have a voice to complain about poor working conditions or low pay.

So the problem goes on and on. It is not as simple as people walking across a border because people are being used and abused. People are raped and abused and die in this insane system we have concocted and supported for years, but the reality of that world remains light years away from the cushy seats in fancy houses in Washington.

How can we fix it? A wall is a great start. We need to close the door to further illegal immigration. Legal immigration is great and provides us the people we need to make a better country, but illegal immigration needs to be stopped.

Democrats say that we should open the government first, and then we can negotiate. Fool me once, shame on you. Fool me twice, shame on me. What evidence can the democrats provide to show that they will actually negotiate this time? Remember, this problem has been going on for twenty years or more.

And that brings us to a bigger question, which is, why should all of these non-essential things be run by government anyway? The key is right there: they are non-essential. So yes, it may be nice to have things provided to you, but those are niceties which may be better provided to you by independent companies. There is no reason that the government should have taken over most of these niceties. When the government takes over something it stops developing, it becomes bland, and you lose options. Now I will admit that there are good people who work in government and you may have a good experience once in a while, but for the most part state operations are lacking.

Why is this? Simple nature. Survival of the fittest. Government goes against survival of the fittest. I will explain. People create companies to make money by providing a product or service for the community. These companies compete for the public’s money by providing value. If a company does not provide any value, the company will not succeed and will die. The companies with the best products and services grow and thrive.  The companies, and the people that run them, are motivated by making money. This is capitalism and survival of the fittest.

Now compare this to government. Companies come and go but the government just stays. What is the motivator to get government to do anything? There is none. The government couldn’t care less about what consumers want.

Most of the fuss about the government shutdown is not even about the supposed services that these bureaucracies provide. Most of the kerfuffle is because the government workers are not getting their paychecks. And when they don’t get their paychecks they can’t go out to eat and shop and it makes the rest of the economy have problems (mainly in the Washington, DC area). Hey, I feel for these people, I really do: I know what it is like trying to balance a budget when you have no income. But compared to what is at stake for the entire nation these are small potatoes. And just how sorry should we feel for these government workers who:

  1. have Cadillac benefit plans with a pension (who else gets pensions anymore?)
  2. have almost unlimited job security
  3. will end up getting their pay in the end anyway

Maybe some of them should try getting jobs in the private sector and see how the real world works.

So how do we fix all of this? What is the solution? We need to get back to fundamentals. We need to recognize that government is not the solution to every problem. We should start to dismantle some of the more useless parts of our bureaucracy and get back to basics.

And to all the Washington insiders, the ‘establishment’, the ‘swamp’, the ‘deep state’: Know that we are watching you, and we are getting more and more tired of your sorry excuses for getting nothing done. One of these days we may come with our pitchforks. So just do it. Solve the problem. Give him the damn wall and take the DACA deal in trade. It’s not that hard.

Unintended Consequenses

Unintended consequenses are inevitable when making global decisions in a system as complex as medical care. Unfortunately doctors have ceded too much ground to the bureaucrats and it may be too late to save the system without a complete collapse. Over the past two decades the number of doctors in this country has grown with the population. The number of medical administrators, however, has exploded, and these people now consume a large portion of the health care dollar. The administrators and non-practicing physicians spend a lot of time NOT caring for patients but telling the rest of us what we are supposed to be doing with our time and talents. We now have a number of very entrenched special interests that dominate medicine (i.e. Pharma, device/medical equipment companies, hospital corporations, and the government) with little to no input from physicians and with little thought to the consequences for individual patients.

I could give hundreds of examples of the insanity of the current system, but in the interest of time I will give one: a single example of the mind-numbingly idiotic machinations of “the system” is the fact that inhalers are quite expensive for my patients to the point that people are going without medicine and dying. Why? Global warming!

What? you ask? Now we can argue all day about the amount of climate change going on and how much humans have to do with it, but I doubt that anyone would argue that asthma and COPD sufferers are big contributors to climate change. But that does not matter in today’s insanity. Because of “climate change” big Pharma can lobby to make the propellant gases used in inhalers illegal, so that the reformulations – now required by law – can allow them to extend patents for another decade or so. So the old MDIs are out. Now people have to use these “respi-click” inhalers which are difficult for elderly patients with arthritis. And Pharma gets to charge hundreds of dollars for these new inhalers for medicines that should be dirt cheap.

People get hurt. And I would be willing to bet that if you calculated the carbon effects of creating the new manufacturing plants for the new inhalers the overall balance in the carbon calculations would be a wash, if you even believe the carbon dioxide hypothesis of climate change to begin with.

This is just one small insanity in the sea of insanities that is modern medicine. It is no wonder that good people are leaving the occupation in droves. Why would anyone want to be a doctor today? The prestige is gone. The money is gone. The work is shit and we have to listen to the ‘C’ students who are now hospital administrators telling us what to do. Bad EHRs are just adding insult to injury.

I did see a sign posted in one doctor’s office that I think should be a standard sign posted in all doctor’s offices. “Don’t mistake your Google search for my medical degree”