Not a great way to start one’s Sunday morning, but, it is what it is:


I hope you take the time to read it, but this one paragraph sums up why I sense I will be a temp psychiatrist the rest of my career.

“In a totalitarian state, bureaucrats have a vested interest in a) exercising their power, b) extending and increasing their power, and c) advancing in glory.  They can use the pretext of economizing state expenditures because the state pays for everything.  They also have the option of favoring friends and family.  And they may put a thumb on the scale just because they can.”

Hey folks, I have told you repeatedly about the IPAB several times at least, here is the Wikipedia explanation, so, where is the difference if it is inacted?


“The Independent Payment Advisory Board, or IPAB, is a fifteen-member United States Government agency created in 2010 by sections 3403 and 10320 of the Patient Protection and Affordable Care Act which has the explicit task of achieving specified savings in Medicare without affecting coverage or quality. Under previous and current law, changes to Medicare payment rates and program rules are recommended byMedPAC but require an act of Congress to take effect. The new system grants IPAB the authority to make changes to the Medicare program with the Congress being given the power to overrule the agency’s decisions through supermajority vote.”

You know, the older I get, I really don’t see a real difference between cluelessness versus complicity, basically the same as overt versus covert defiance or recklessness.

Ignorance is not an excuse when one practicing it screws up.  It may mean a bit of a leaner sentence in punishment, but, punishment nonetheless.

And punishment does not infer solely by a court or some other authoritarian edict, but, consequences do play out in some form, like, maybe being marginalized, ignored, or god forbid frank ostracized.

So, I end this post directing to my physician colleagues who read here:  how much more independence and autonomy gets ripped from your grips before you realize you are just naked and surrounded by those who want to inflict pain and anguish???

Oh, already there?…

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