Calling H1 Visa Applicants - be a doctor in America

The Wall Street Journal reported that we are going to run short of doctors and the medical schools can't keep up. Due to the new legislation the medical schools are not able to turn out enough doctors, and most are choosing specialties due to higher reimbursement from the insurance companies. Specialties provide much needed revenue for the doctor starting off with usually over $100,000 in debt. A solution is to bring doctors in from around the world using the H1 visa. All the H1 Visa doctor must do is pass medical school in India, Batswana, or Mexico and then residence here in the US for 2 years. Heck, they have been doing this at the VA hospitals for years, and we have seen what excellent care our Veterans have received. But what do we do to solve this crisis? Yes another crisis. We update the law of course. We have already added incentives to go to medical school and for primary care physicians they receive a 10 percent bonus for seeing Medicare patients. We will spend tax money and give bonuses for number of patients seen, or we will pay for someone to become a general physician. Give the past success with Medicare, it makes you wonder why around 13 percent of doctors are refusing Medicare patients? With all of this incentives it just doesn't make sense.

Of course the fact that the amount of paperwork, incomprehensible regulations, and bureaucratic oversight to diagnosis and treatment would have no influence on the doctors decisions. That's ok. We will be able to find doctors who are more interested in conforming to these new regulations than treating patients. Those who are interesting in helping others will be better suited elsewhere like Batswana. At least when the patient dies we will have a well documented record of the attempt at a diagnosis, a list of the suggested tests that were denied, and the standard substandard treatments that were tried and failed. But it is really not their fault they did everything they could. We have examples of this in Europe, China and in the DMV. Very nice people who have become serfs. At work they cease to think for themselves or take initiative because they are either punished for violating procedures, or derided for thinking they are better than others. Having worked with multiple government agencies, I have found this to be true. Many of these individuals are very hard working, and have good ideas, but will not follow them because they understand the results. Given the current health care bill and the belief that a centralized system is the best way to handle our problems, let us explore the results.

Patient has an acute pain in the right side of their stomach on Friday morning. Our patient (Ms. Smith) calls the central scheduling office, who asks the standard scripted questions, to determine the appropriate doctor for our patient to see. After a 15 minute hold and another 10 minutes providing identification, so that the scheduler can access Ms. Smith's records to verify the supplemental insurance information she has paid to receive, the scheduler then begins the questions to determine the appropriate course of action. "Do you have a fever?", "Yes?" "Are you on any other medication than the ones I have just listed?", "Do you smoke?". "Thank you Ms. Smith", I can get you into Dr. Smeagol on Monday at 8am will that work for you.

Given that our patient is in extreme pain they ask to speak to the nurse practitioner, for a recommendation to visit the Urgent Care facility. "Of course ma'am, one moment please." Since we are experiencing a hirer than usual call volume your hold time is estimated to be 20 minutes. Twenty something minutes later the nurse practitioner, comes on-line and asks the same set of questions, "to insure quality care", and authorizes Ms. Smith to go to the Urgent care. Once at the Urgent Care facility, completing 3 sets of information and treatment authorization forms, government insurance authorization numbers, and spending 4 hours in the waiting room, they are moved to the examining room for the last hour wait to see the doctor. The resident who has been up for 14 hours and speaks pretty good English, tells Ms. Smith that she has appendicitis and she should go to the emergency room right away. He also says he will get the emergency authorization number from the Federal authorization line as soon as possible. Do to the higher than expected call volume, it takes about 30 minutes to obtain the emergency room authorization. (if this were a real emergency they would have called a special number for that authorization). See if the doctors treat without authorization they may not get paid and they waive their exemption from lawsuits. Ms. Smith authorization in hand heads to the emergency room. Once there she enters her name on a list and is soon called to provide her authorization and personal information. This is all verified and she is entered onto the schedule to be admitted. Now the pain in her stomach as really increased, and she is shaking quietly due to the fever. She is offered two Tylenol as the standard approved pain and fever control medication. Five hours later (because we have a doctor crisis), she is admitted. The nurse takes her blood pressure, temperature (yes it is 102), and pulse. The nurse dutifully notes these numbers on the emergency patient form. It is now late evening and the emergency room physician determines that Ms. Smith is suffering from acute appendicitis and needs surgery. He calls for authorization to perform the procedure (because it might be unwarranted), and requests for authorization for extended hours compensation since he must bring the surgeon in after hours. The on-call surgeon is then called. An IV is started to hydrate Ms. Smith. Because the authorization panel for the surgery grants a temporary authorization until it can review the case on Monday. No one foresees any issues. Ms. Smith receives her appendectomy Saturday afternoon, and leaves the hospital Sunday Morning (her supplemental insurance only covers one day in the hospital) to recuperate at home. This is the optimistic view. Ms. Smith was able to get surgery on a weekend and her appendix did not rupture, or any of the hundreds of other little things go wrong. I tried to focus on success in the scenario above. Somehow this seems ok and efficient to some.

This scenario is really not that far off. In fact it is easier than what some Medicare patients go through today. What is frustrating is that we have become so conditioned to the current state that is difficult to imagine that our grand-parents often had no insurance, lived saw doctors and received excellent health care. Of course it was simpler then, doctors didn't cost so much. Really? Or was it that we didn't use insurance as a prepaid health care card, and that medical schools were not as expensive, and when you didn't sue the doctor for your child having a cleft pallet. The fact that everyone will now see your private health information from the scheduler to the nurse practitioner. This was an example of a medical emergency, what about the headache that won't go away, and the doctor orders an unnecessary MRI because your are under a lot of stress. Why is it that a government board can make decisions for you, but you can't make them for yourself, based on your ability to pay and what is happening. If the headaches are very bad, and you don't feel they are just stress, then you and your doctor should make the choice whether it is a necessary test or not. Who are these people to make choices for us? Why do so many think that this is a better way to live? These issues are not government problems they are a society's view of the world. We will pay the price for all of these things, because we are not willing to think for ourselves, make critical judgments or make choices that may be painful. Until we change as a people we will have exactly what we deserve. Good intentions do not matter, only good actions. Good actions can only come from correct thinking and the courage to act.

Change Management and the house that Jack built

Most of us are familiar with the Mother Goose rhyme “the house that Jack built”. What I love about this rhyme is that it shows us the cause and effect of small things. In business we are often building something if not houses, and all of those things have things that happen in and around them. Has anyone noticed that we often have not just one rat that eats the malt? We also seem to have a lot of cats that we are trying to herd into chasing the rats. The problem is not necessarily the rats or the cats, but the fact that we are not focused on the root of the problem. The malt. Why didn’t someone pick it up? Where was Jack? Like most of us he got busy, building a new house, maybe chasing squirrels or just on vacation. Regardless, by not taking care of the clutter in the house he has a rat problem.

We all have rat problems in our personal and business lives, and why we are constantly looking for or trying to herd cats to solve the rat problem. What we have though is a malt problem. Have you ever noticed that “Change Management” is rarely taken up by consultants?

Do you know why? Cost? Nope. Too hard? Closer. In order to do this right the person or organization must want to change. Look at the show “Biggest Loser” focused on people who have been out of control in one or many aspects of their lives and retrain to restore balance. Change Management are the words we use to describe something that we should be doing every day. Changing how we do business to meet new challenges. What has been successful in the past will not necessarily be successful in the future. The only things that can stand the test of time are our morals and values. These are continually tested and we often think of them changing but what often is the case is our inability to live up to them. Values such as trustworthiness, loyalty, being helpful, courtesy, kindness, obedient, thrifty, bravery, and reverence seem to be missing in our everyday lives. If we adhered to values then managing change becomes much less complicated. If you look carefully the people have forgotten to follow these basic values. They cannot trust themselves around food. In the business world it is short term gains. They stopped being helpful and were selfishly feeding their pain rather than facing it. They stopped being kind to themselves and were not brave enough to carry through. Luckily they have found a trainer.

Many organizations need trainers like those on biggest loser. Bob the spiritualist and Jillian the bully to get them moving. Both are necessary for true change to occur. Internally we must bully ourselves into doing things that are not comfortable, but need doing and to push ourselves beyond what we think is possible. Nothing is impossible it just requires will, and often help. I have been involved with many projects that have been divided into consultants implementing the technology and management responsible for “change management”. After many years of working with this model, I am certain that management was looking to solve a series of problems with the little blue pill. Inevitably it did not yield the results advertised or expected. Why, because there is no pill that will solve the problems, nor a piece of software that is a solution. The solution is in the application of the software, much like the treadmill, it is only good when used often and properly. We can make all the excuses and listen to all of the infomercials we can handle. Nothing will make the treadmill work unless you use it. ERP will not help your company unless you change processes and properly come to understand the capabilities of the tools at hand. We have created some amazing tools. It is time we start to learn to use them.

Why do we turn to the Government for help?

I recently received a call from a "concerned citizen" talking about how her child was diagnosed with Autism and that she had contacted her congressman for help. I am sorry for her situation, but the first thing that lept to my mind was "why?". Why would you call a congressman or senator for help on a personal matter? Given the track record of our representatives, I think we all understand that he needed the photo op. I would have been more impressed if he had helped this person as an individual rather than spend money that wasn't his so there was no cost to him. I am sure I will receive mail asking why I don't care about autistic children. I do, but this is not about autistic children. It is about a systemic and cultural challenge that we face not only in this country but in board rooms and in our personal lives. We all want the bailout. Why didn't this person go to her church or community before going to her United States representative? Given all of the examples and historical information regardless of party in charge, why would anyone ask the government for help? Oh, yeah it's the money.

What are we thinking?

According to the Government Accountability Office (GAO) study (I wonder how much that cost) the "stimulus" has been bogged down in a bureaucratic morass. "As of February 12, 2010, $88.7 billion, or a little more than 30 percent, of the approximately $282 billion of total Recovery Act funds for programs administered by states and localities had been paid out by the federal government. Of that amount, approximately $36 billion has been paid out since the start of federal fiscal year 2010." To put things in perspective, the Stimulus package was enacted on February 13, 2009, Fiscal Year 2010 begins October 1, 2009. We are now into the third quarter of the 2010 fiscal year with little result. Economists are reporting that the stimulus bill has little or no effect. So we have authorized over 716 billion in funds and what do we have to show, a website that provides information that has yet to be substantiated by any reputable group including the GAO, and the government run around. How many people understand the process or criteria for obtaining funding? Not many as we hear in this audio clip. How many corporate groups behaved in the same way. Companies too big to fail, yet when we hear the news coming out about Goldman Sachs we begin to see the ability of large organizations to manipulate other large organizations. What we learn from this is the fact that people will follow the rules, the question is what rules are we following? This is true for any large organization. People are trying to get along find their way and the rules can be used both for or against you. Apple one of the most innovative companies has a general rule, "do what Steve Jobs says". He is an innovator, what is not certain is whether he has been able to "institutionalize" that spirit and ability to innovate. Microsoft has suffered significantly since Bill Gates has left. The leadership has not been able to capture the spirit of its founder. Business schools are filled with case studies on how to build a culture that innovates, few have succeeded. So how does this affect our government?

We the people need to be innovators, and transform how we view the role of government, business and ourselves. We must first determine what we want. Most people don't know what they want for breakfast, and while they would like to be the hero, it takes work, blood sweat and tears. Most of us may be too comfortable for that. The audio clip tells us the story of what we will become. The content of our character will be the person not wanting to work but standing in line for a handout. Rather than building something, we will wait for something to be handed to us. That is the result of social justice or socialism taken to its logical conclusion. We can look to Russia and China as examples of our future. If we are not careful, Cuba will be our legacy. In the business world, all we need to do is look to the Automotive industry as an example of this type of thinking. India will replace us as the new world leader. We must make choices and like all choices they have consequences.

The 16th Amendment Approaches

Section 9 of the Constitution of the United States of America places limits on Congressional powers. The original document stated "No capitation, or other direct, Tax shall be laid, unless in Proportion to theCensus or Enumeration herein before directed to be taken.", limiting the ability of the Federal government to directly tax individuals. The 16th amendment passed in 1913 completely reversed the original intent of the founders and has ushered us into the era we currently reside. The 16th Amendment states "The Congress shall have power to lay and collect taxes on incomes, from whatever source derived, without apportionment among the several States, and without regard to any census or enumeration." This seemingly innocent sentence allows Congress to write tax law in any way they deem fit, as we have witnessed over the last 97 years. The really interesting thing about our "progressive" income tax is that it punishes success, and is used to drive "desirable" social behaviors such as home ownership. Why do most of us own homes? Answer: The tax break. Why? Because a populous that has invested in the land is less likely to leave and as Ronald Regan put it "vote with your feet". They won't leave the Socialist Republic of California if they have significant investments and ties to the property. Fluid populations are harder to control, case in point Mexico.

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The 16th amendment is probably the single most important amendment to our everyday lives, and as April 15th approaches we must ask ourselves why do we look to the government to provide for us? Until 1934 people survived without social security and medicare. In fact, rural doctors were more plentiful than they are today. Why? Has socializing the banks, medicine, and manufacturing really helped us? Really? Where do we go from here? Well there will be a study and it will be someone else's fault because they really don't know what they are doing right? If that is true, then why do we continue to listen and put faith in them? We the people can change the Constitution of the United States by a 3/4 majority of the state legislatures. Remove the 16th Amendment (we did it with prohibition), and return our tax policy to pre 1913, where taxation was based upon commerce. We will have to stop government "entitlements". You know, "somebody owes me something". Do we realize that the reason we think that way is because the government has taken so much there is not enough left, so we have to go beg to get it back. They owe it to me, would not be possible, if "they" did not take it in the first place. April 15th is just the day our taxes are collected, for most Americans they are not paid until June 15th. This will extend into September or even October with current spending and deficit (a nice way to say debt). We owe more than we produce. Soon our interest payments will exceed our operating budget and we will be insolvent. I know many people will say I am crazy and it will never happen. Really? Let's put it in context. You make $100 per month. Your Operating expenses (the government's budget) is $65 per month, debt payments are $25 per month (making the minimum monthly payment) and our income has been reduced due to unemployment by $10. What does that leave us at the end of the month? Correct. ZERO. Now, we want the new doctor plan, and the washer is getting old and falling apart. How are we going to pay for that? Yup add more debt right? That raises the minimum monthly payment to 35 per month and we are now in the hole by $10 per month. How long until the repo man shows up?

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People get themselves into this position every day. Our government has placed us all in this position. We are leaving a legacy of greed, sloth, and indulgence. It is not capitalism that has done this. It is socialism in the name of the greater good. Evil masks itself as good. Good intentions pave the way to where we are headed. I truly believe that no one has intended to do harm, but harm we are doing. I believe that people want to help others, but is this emotion that has lead down the wrong path. Understand, I want to help others, but I must first understand that I am fallible and should only help to the extent I am able. By sacrificing myself, I will cause harm by not being able to help in the future. I must manage my life. It is my life, and if I do not manage myself, then what good will I be to others? Just because we have allowed this to happen, does not mean we must allow it to continue. Ask yourself.

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Is this the legacy we leave our children? Is this really the best we can do? I choose to have faith and reason that others will find the will with me, and we will not leave this as our legacy to our children. I believe we will find a way to put a halt to the travesty of current legacy and become once again the beacon on the hill, signaling freedom and opportunity for all who embrace it.

Mortgage Program Indicative of Future

There is trouble right here in river city. The mortgage program is not working. Does this surprise anyone? If it does, or if you just don't want to believe that something promised was not delivered, I suggest that therapy is in order. Those who have faith in this the government today are delusional. The persistent belief in something despite overwhelming evidence to the contrary. Orwell talked about this with 1984, he was just 26 years off. One plus one equals two. The President promised "help" for those struggling with making their mortgages, or who are in foreclosure. The problem is there is no incentive for the bank or ledger to follow his lead. Why should they? The article in MarketWatch telling us "Mortgage-modification program has major flaws" is really only telling those who have been denying the truth and wanting to believe that there was actual help out there. It is so bad that even Disney owned ABC news did a segment on it.

We funded the program with billions, and so far 31,000 people have been helped. What an exceptional use of funds. If you did not recognize that, it was sarcasm. The mortgage modification program like "Cash for Clunkers" and all of the others, are based upon fantasy and lies. I am sure the intentions were good, but as usually the mechanism is flawed. This is why 3/4 of this country oppose the healthcare legislation. Again look to the VA who is being "fined" for over radiating vets who are suffering with cancer, and the abuses continue. Does anyone realistically believe that this type of care will not expand? Where are the consequences for bad behavior? If you default on your mortgage, the government will help you out. Because it is your fault. We have a new host of "rights" like healthcare, education, a free lunch.. But where are these rights coming from? Our constitution says we already had all the rights available, the government was the one that was restricted. Any "right" granted by a government historically has been restricted to the ruling class. Everyone else just doesn't need the same rights, even though we are all equal.

The fact that our congress has to be flooded with protestors, email and phone campaigns is telling as to who are the servants and who believe they are the masters. Do not fool yourself into believing that this is not socialism. We abandoned the free market in 1908, and have been slowing indoctrinated to believe that this is capitalism. It isn't. This is the entry into socialism and to our freedom and liberty disappearing. The mortgage program was a lie to get people to feel better, not solve a problem. The only good news is that when hyper inflation hits, you salary will be 1,000,000 per hour and your current mortgage should be able to be paid off quickly. Unless the government allows for your rates to be adjusted for inflation...

The Sound of Freedom Disappearing

This is what it looks like when your freedom and choices disappear. For the last 100 years we have been moving steadily to a socialist state. Congratulations we have made it. We did not do this with a yes/no vote. We didn’t need to. We did this based on electing “nice” guys, who wouldn’t hurt us. He was really nice and seemed to really listen. Really? Congratulations, we have allowed the “me” generation to complete the first step to a socialist state. By the way that is why it is called socialized medicine. Congratulations. We watched bribes to senators from Nebraska, Louisiana, and I am sure a number of other states. Why aren’t these officials in prison? The deal making wasn’t even subtle. I am sorry for this country. I am sorry for my children and grandchildren who will live in a country bereft of values and will only know a country where the citizens are servants of the state. I know many will dismiss this as fear mongering, or just an uninformed opinion. My mother taught me history and how to separate hearsay from facts. The people who say this is too complex to understand are those who have not taken the time to understand what is being done to us. This piece of legislation now allows the government to make decisions about what we eat (must be low fat), do we smoke, or what tests are run to figure out what is wrong with us. Remember when the rallying cry was that the government cannot tell a woman what to do with their bodies? They can now. They will fund abortion because it removes potential costs from the system. Taxes for seniors people over 65 are going up. They are raising the deductible for taxes to 10% from 7.5% for those over 65.

In the case of any taxable year beginning after December 31, 2012, and ending before January 1, 2017, subsection (a) shall be applied with respect to a taxpayer by substituting ‘7.5 percent’ for ‘10 percent’ if such taxpayer or such taxpayer’s spouse has attained age 65 before the close of such taxable year.’’.(c) CONFORMING AMENDMENT.—Section 56(b)(1)(B) of the Internal Revenue Code of 1986 is amended by striking ‘‘by substituting ‘10 percent’ for ‘7.5 percent’ ’’ and inserting ‘‘without regard to subsection (f) of such section’’.

They will limit care to the elderly and restrict care to patients due to costs, all in the name of doing the “fiscally” responsible thing. What I say here if read will be dismissed as just a radical conservative who doesn’t care about the uninsured who will now have access to care. The fact is that what they are shoveling is a lie based upon emotional key words, not upon facts. I have read the various copies. These all give the government control over education, healthcare decisions (you and your doctor don’t count). You have to read and think thought the implications of many of the bill’s provisions. You see the executive summary is designed to cover what is actually there. This is not the end, but the beginning of our total transformation. I hope you are ready to enjoy it.

Do not worry yourself. The socialists are now in control, and if you do not think so, then you are delusional. I am ashamed that we cannot even recognize this fact. My father wants me to play it safe, and not speak out. While this blog may only bring me sorrow, so be it. I can no longer remain silent, or civil. I will not play that game anymore. The reason we are here is that we have allowed ourselves to censor what we say because someone maybe uncomfortable. Our president and much of the congress are socialists. They will argue that they are progressives (same thing). Wolves in sheep’s clothing. They took this vote on the Sabbath. For a country that is 80 percent Christian this seems to be very telling that our elected officials (many profess Christian faith) are working. If you do not believe that this was calculated, and to send a message that we are now a secular country, again you are not a reasonable person. Offended? Me too. I am sorry that I did not speak out sooner. I am sorry I did not become more active. This is only the beginning. I find it fascinating that President Bush took 8 years to add 4 trillion in debt to this country and this president has been about to do that in less than a year. I would say he is much more efficient at destroying our currency and preparing us for a truly socialist state, when the over regulated, semi-socialist system that we currently have will be called the collapse of a corrupt capitalist state. The truth will set you free, but only if you recognize it. The best lies are mostly true, with just enough to corrupt. Welcome to the country now based on lies.

Harry Reid

Harry Reid has created a fire storm of criticism by declaring that those who do not support health care reform are supporting slavery. Don't believe me? check it out. It is interesting that he hasn't checked on the definition of slavery lately. Slavery as defined in the Merriam Webster dictionary is "submission to a dominating influence or the state of a person who is a chattel of another person or group." What I find interesting is that many of the provisions in the health care "reform" bills will establish what many consider a dominating influence of our government over the state of a person. Many view the provision that you could be put in prison for lack of insurance, or fined by a tax levy to be a dominating influence by our government. Most people do not understand that a tax levy can freeze all of your assets and take all of your paycheck or income until the total debt is paid. Does this mean we will be enslaved by our government that we elected? This remark demonstrates the lack of a real education that we as a country have been missing. Rather than ideologies being discussed we are looking to "neutralize" the internet, through net neutrality legislation, thus controlling our ability to express ourselves either in both eloquent and vulgar fashions. The wonderful thing about this country has always been the right to make a public ass of yourself. Harry Reid, in this case, being a prime example. I do not think he should have to apologize for his remarks. He obviously believes in what he is saying. However, I do believe that those who voted for him should take a long look at the person for whom they voted, and the policies and the real effects of what he is trying to do in the Senate. Not just Mr. Reid, but all of our elected officials. We as a people need to take off the rose colored glasses and instead of wishful thinking begin to hold not only our officials, but ourselves accountable.

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There is only one group responsible for this mess, and it is not the democrats, or the republicans, but the American people for not holding these parties accountable rather than reelecting the same people. Albert Einstein said it best "The definition of insanity is doing the same thing over and over and expecting different results." What do we expect? That by rewarding bad behavior we will get a good result. They are all nice people, but without understanding. By bailing out people who cannot make their mortgages, and not helping those who are is rewarding bad behavior. By electing government officials because they promise money from the government demonstrates that we do not understand that they are promising to take the money from us and just give it back at a 40 percent discount. Hand your senator a dollar and he gives you back 60 cents. What about this seems to be a good idea. He even hires accountants to make sure you have all of your 60 cents.

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Slavery is real throughout the world in both economic and terms of how people live their lives. Unfortunately, Mr. Reid got it backwards.