All the happy-happy assumptions about sickcare "reform"--a codeword for the diversion of ever more of the national income to a group of insatiable cartels--depend on the base assumption that doctors and nurses will happily continue toiling away in a venal, inefficient, destructive and completely broken "healthcare" system.

Guess what, America--they don't have to put up with the grinding insanity of the system or the increasingly burdensome task of taking care of us. At some point, no amount of money is worth it.

Do people outside of the "healthcare" system really think all the providers prefer this costly, obtuse mess to a single-payer/universal care system? Think again, and consider the point of view of those who have to work inside the crazy-making system we have now--and which 2,400 more pages of complexity ("reform") will not fix.

Let's begin with a commentary from M.L., R.N.

I enjoyed your article Tyranny of the Majority, Corporate Welfare and Complicity and I wanted to make a few comments, as I noticed you wrote that some people find you contrary (or feel that you are writing about unpopular ideas).

I am nicu nurse for almost 14 yrs and have been at my current job for 3 yrs. It has been an eye-opener, to say the least. In my working life, I have known people on welfare who have taken complete "advantage" of the system and those who were on just long enough to recover from having their baby and gotten back to work or school. So I always thought the system was "fair" and was "working."

At my job now, 90% of my unit has patients on welfare. Our "typical" patient mom is around 27 and has 3-5 kids, some of whom live with her and some that live with relatives, taken by the state, etc. We have had quite a few moms who were 18 and working on their 3rd babies (I am not kidding). We even have had moms come from Mexico specifically to have their babies in the U.S. (and the delivery and care of those babies can cost up to $800k!).

I love my job and would never do anything else. However, with the economic downturn and people losing their jobs, etc., my coworkers and I frequently discuss how come the system allows these moms to have thousands upon thousands of dollars of completely free care, while some of us are charged $400 for tests our insurance refuses to cover (the same insurance that *we* pay hundreds of dollars for a month)?

It just seems that something is terribly wrong with the system and it cannot continue (as you describe so eloquently in your book). Actually, almost all of my coworkers, from secretaries to nurses to respiratory therapists, all wanted universal heathcare, since we are already paying for everyone in one way or another (via e.r. visits, etc). I was also surprised at how many of my coworkers (dems, repubs and libertarians alike) told me they *would* pay more in taxes if the $$ would go to fixing the healthcare system (and not just keeping up the status quo with insurance companies).

More clinics with drs/nurse practitioners/physician's asst/nurses/techs-- that would free up our e.r.'s (emergency rooms) and create many, many jobs. Too bad it's not going in that direction.

Thank you, M.L., for a report from the inside. Next, we hear from "ER/Primary Care Dr."

The American Medical Association has some interesting statistics on Medical Student Debt:

* 79 percent of graduates have debt of at least $100,000.
* 58 percent of graduates have debt of at least $150,000.
* 87 percent of graduating medical students carry outstanding loans.

According to the Association of American Medical Colleges (AAMC), the average educational debt of indebted graduates of the class of 2009 is $156,456.

when you graduate $200,000 in debt, what would you choose - a high paying specialty, or low paying primary care medicine? It's a simple choice.

In socialist Canada, my university and med school tuition was highly state subsidized (I paid $780 in 1974 dollars for a year of med school). I also always had academic scholarships. I worked every 6 - 8 week summer break of med school, and for two years, worked a 12-hour night a week drawing blood at a hospital while attending med school. I graduated with a few hundred bucks in my bank account. My parents were chronically short of money, and contributed what they could, but it was minimal.

In residency training, I got my medical license as soon as I finished my first year of internship. I moonlighted doing 34-hour continuous shifts per month on the weekend in a rural hospital E.R. That is where I got my love for emergency medicine. I made good money at this, and finished my medical training with $48,000 in the bank.

Editor's note: this M.D. currently works in the U.S. as a primary-care physician.

As the baby boomers age, they will need more and more medical care. Preventive care is great, and should be emphasized (made mandatory?), but have you ever met a 1,000 year old person? We all eventually grow old and frail (unless we drop dead of a heart attack or die of a head-on collision or war), and need medical care.

Primary care is the only field of medicine that addresses preventive care, and is by far the cheapest way to provide care for illness and injury. Yes, specialists are necessary, but should only be used when the condition is beyond a primary care doctor's expertise. You need a neurosurgeon to remove a brain tumour, and they have the longest residency of any medical specialty, and deserve high pay. They tend to have genius I.Q.'s, as their field is so complicated.

We primary care physicians are gonna quit! You can bet on it. Most of us (as I am) are working some extra now to replace our lost retirement funds (thanks a lot, Greenspan, Bernanke, Geithner, et. al.). When we save up a little more dough - WE ARE OUT! It'll be like Canada - even without Obamacare - you'll wait ten months to get an appointment with a primary care doctor to get your blood pressure checked.

This week I got a six page form from an insurance company that had to be filled out-- at my boss' expense, so the company would pay for the treatment of a patient who CLEARLY was ill - his lab tests spelled it out.

This is harassment, pure and simple. The insurance companies are hoping that if they make it hard enough to get a claim paid, we'll give up and let the small claims slide. WE PRIMARY CARE PHYSICIANS ARE GONNA QUIT. Good luck folks-- better throw away the Ben & Jerrys and hit the exercise bike if you want to make it past 60.

This is from an E.R. MD who has treated a stadium-full of homeless/poor people in the U.S., so it cannot be dismissed as the views of an elitist. There are limits to the endurance of people even if they love their job. The system is now so perniciously and perversely incentivized for both patients and providers alike that its implosion will be triggered by one of two forces: fiscal insolvency and/or providers opting out.

Sorry, America--healthcare is not a "right." Those taking it for granted that doctors and nurses will endure the insanities of the current system forever, regardless of the burdens placed on them, may well be surprised.

Then there's the point at which the well of endless Federal borrowing finally runs dry.

"That can't happen" because the world will always shower us with trillions to squander every year. Perhaps, but let's check in around 2015 to see how that fantasy is working out. By then we will have borrowed another $10 trillion, and perhaps the world's appetite for more U.S. debt might actually wane.

If you want to read more about opting out, check out Survival+: Structuring Prosperity for Yourself and the Nation or the "quickie" 134-page version Survival+ The Primer.


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