Americana: June 2011 Archives

I can see that we have yet another "I don't take any kind of health insurance" medical practice that appears to be doing well.

A doctor in Minnesota has borrowed a page from other doctors around the US that have abandoned the endlessly more complicated (and expensive) system of health insurance covered health care. Instead all she will accept is cash, checks, and foodstuffs.

It's amazing how much costs go down when you no longer have to deal with the paperwork and regulations imposed by health insurance companies and the government if a medical practice accepts health insurance (and particularly Medicare and Medicaid).

As Minnesota Public Radio reports, Dr. Susan Rutten Wasson finds she's doing just fine without all the extra dross that comes with accepting medical insurance.

It's more a scene from the days of frontier medicine than from the modern health care system. And that's because Rutten Wasson, 42, is a throwback to a time before HMOs, electronic health records and hospitals with fountains in their lobbies. She sees patients the same day they call if she's not booked up, spends at least a half-hour per visit -- compared to the more typical 15 minutes -- and usually charges only $50 for a consultation. She takes cash or check, but no insurance -- and sometimes accepts gratuities of a dozen fresh eggs or a pie.


In an era of high overhead, ever more byzantine regulations and payment models, cuts to Medicaid and Medicare benefits, and large medical systems swallowing independent practices, Rutten Wasson relishes her straight-forward manner of practicing. Since many federal health care reforms -- such as those requiring electronic medical records -- are tied to Medicare, they tend not to apply to her.

As she says, not having to deal with the insurance is a big time saver, allowing her more time to actually spend with patients, something that is becoming more important as even with more sophisticated medical technology at our beck and call, doctors still need to talk with patients and get to know them in order to do a better job diagnosing and treating them.

"Factory" medical clinics that so many of us go to are more like an assembly line, with doctors rushing about, seeing them for the minimum amount of time possible, before rushing out to see the next one. It isn't uncommon for some physicians to see as many as 40 patients in a day, meaning they can't possibly give the time and attention some patients need in order to be treated properly for their medical conditions. If you miss an appointment don't count on getting another one for months. I had to reschedule my annual physical due to a schedule conflict. That was three months ago and they still haven't been able to tell me when I'll be able to get another appointment. If I had to guess, it won't be until next year. And if I'm actually sick, they might be able to squeeze me in in two or three weeks.

Think I'm kidding?

After our return from a week's vacation in Florida two years ago, I came down with a bad case of bronchitis which swiftly turned into pneumonia. I called my doctor's office and they said they might be able to see me in week. It got so bad I ended up at our local hospital's ER. The physician there said I probably wouldn't have lasted long enough to see my own doctor. It took a lot of antibiotics and another week before I was well enough to return to work.

But if I had a doctor like Dr. Susan Rutten Wasson, chances are she would have come to my home, examined me, and written a prescription for what I needed, as well as make a follow up visit a couple of days later. I don't see anything like that happening under the present system or ObamaCare. Do you?

I've just returned from an exercise in small town democracy.

While most of our town's deliberations and voting on spending for municipal functions and education take place in February and March, an education issue going back to the March voting has come to a head and our school board decided it had to meet this head on rather than continuing an ongoing fight in the local papers, with heated point/counterpoint letters to the editor creating some of the best local gossip seen around here in some time.

It all came down to what is called a petition warrant article, in this case dealing with one specific petition warrant article that was aimed at eliminating an administrative position the petitioners believed was never authorized when our school district broke away from a larger school administrative unit (or SAU) 13 years ago. The warrant article passed by a 2 to 1 margin, but the school board ignored it, claiming it was "advisory only." That didn't sit well with a lot of folks in our town.

On top of that, the school board announced the day before the vote in March that they had hired a replacement to fill administrative position being vacated due to the retirement of the person occupying that position. Quite a few people saw that as a slap in the face, taking it as arrogance on the part of board by flaunting their decision ahead of the vote as if to say "We don't care what you want, we going to do it our way."

But was it arrogance? Or was it poor timing on their part? It doesn't matter, the reason being that perception is reality. (If the voters see it as arrogance then it is arrogance, motives not withstanding.)

A lot of people showed up for this 'special' school board meeting, held at the our high school auditorium, and a lot of people spoke up, not pleased with the way the board handled the matter. There had been a lot of name calling in the letters to the editor published in our two local papers. Some of the anger displayed in those letters was evident at the meeting as person after person took the opportunity to address their comments and questions to the board. There was plenty of fancy footwork (figuratively speaking) displayed by the board and the school district's attorney. A lot of people left the meeting feeling nothing had been accomplished.

Some questions did get answered. The one I asked dealt with what criteria is used to determine whether a petition warrant article is advisory or binding. (If the petition deals with a specific action, such as adding or cutting funding for a specific purpose, such as a job or activity within the town or school district, then it's binding. If it doesn't address a specific action, then it's advisory.)

One thing is certain, the people got involved in how our school board is performing its function. Another thing that's certain is that a number of school board members will be seeing some serious competition come the next election in March.

And so it goes in small town New Hampshire.

Can Mayor Dave Bing turn Detroit around? (This isn't the first time I've asked this question.)

Maybe. He has a long way to go before anyone can say Detroit has been saved.

He is doing one thing long overdue for his blighted and ever shrinking city: tearing down abandoned homes that have become nothing more than shelter for the homeless or hideouts for drug dealers, rapists, and other criminals preying upon the rest of Detroit's citizens. Some of those dilapidated homes are too dangerous to be occupied even by the criminals or the homeless.

I think I can safely say many of us have seen video or photos of what's left of Detroit's once vibrant neighborhoods, with many of them looking like something out of a zombie-apocalypse movie thriller. Most of the homes and buildings in those areas aren't worth rehabilitating or renovating, leaving block after block after block of decaying homes and businesses empty and soulless.

One of the more interesting parts in the article linked above are the thoughts of those actually performing the demolitions. You wouldn't think that tearing down abandoned homes would be an emotional trial for the wreckers, but for many of them it is.

Wreckers hide it, but when you spend weeks with them, riding in their trucks, sitting in their machines, trailing them all over their job sites right out to the dump where they'll deposit the remains of a house, it becomes clear that they're a reflective and empathetic group. They're raconteurs and historians. They want you to know what they've seen in this city. They want to take you there. They believe it'll help.

Mark Sherman insists on driving me down a street called Robinwood, a few blocks from Adamo's home base. "This one," he says, "breaks me up every time I'm on it." The stretch is so blighted it seems haunted. Somehow it's totally devoid of color. All the Craftsman-style homes, with their tapered support columns and stonework porches, are empty. "You can see," says Mark, tugging on the brim of his black John Deere cap, "these were really beautiful. Unique." And he's right. They're exactly the kinds of homes young families in Portland and Los Angeles line up to live in. "This is the perfect example," he continues, "of what can happen in two years. Two years ago, this street was mostly full. This is what happens when nobody cares."

They try not to think of the people who used to live in those homes. Those who worked hard, raised families, took pride in their homes, now long gone, leaving echoes of what used to be behind them.

I'm not sure I could do their job and not feel what they do. But they know it's a necessary job, so-called creative destruction, where the only way to rebuild Detroit is to remove those homes and other buildings that are now a blight infesting their city.

Will it work?

Only time will tell.

Expatriate New Englanders

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