Healthcare and Populist Backlash

        I’ll get back to our left brain/right brain discussion in my next post.  For now though I wanted to digress. 

        Take heart, there are small signs some power might get back to the little guy.  All we gotta do is revolt.

       If you think about it, big ain’t working in modern society.  What went wrong in Health Care is it got too big.  When an Insurance company CEO makes 64 million bucks a year they need to be busted.  

        It happened in sports.  Too many guys who don’t have the skill or passion to learn to shoot, throw, dribble, or hit made a business out of a game.  I’d rather play golf at the local muni on a pretty day than watch the ‘sports’ business.

        The same is true for country music.  Business people who can’t pick ‘The Wildwood Flower’ on the guitar controlled the flow of the money and the art suffered.  It is one reason I love bluegrass music so much.  We don’t care if you are rich or poor.  Anyone can join in.  The only requirement for recognition is dedication, practice and time.  You can not create a market image and package a  picker.  The music is too hard to learn to play and can not be faked.    

         In medicine you can make far more money by denying care than providing it, at least at the primary care level.  Greedy people who report to stockholders rather than patients brought the system to its knees.  I don’t want the Government plan to get too big either, but I would like to see it position the other players where they have no choice but to do right.  (Against their will for some of them, by the way.) 

        A model which creates true competition would help.  Every day when I go to work I need to understand someone younger, smarter, and better looking than me (ie a heck of lot of people) would like to have my job.  I do my best for my people ’cause that’s the way my mama taught me.  (in the South you never go against mama)  For the ones who aren’t natured or trained that way, I’ve found they can learn fast if they are forced to.  It should stay that way too.  (In reality no one wants my job right now.  Primary care is now a hopeless quagmire.  Big insurance makes it as difficult to help people as possible, at least as far as daily grunt work.)

        No doctor needs to survive because of political favor.  I know some who do.  They couldn’t pass Boards on a day of divine inspiration, but are protected because of their alliances.  Trust me, you don’t want them as your doc.  I’ll take one like legendary Dr. Jess every time.  He’s a surgeon at a major medical center, plays the fiddle and wears string ties.  He has no use for administrative fools.  They’d get shed of him, but the guy is too dang smart and good to patients for the political types to take him on.  They are at least bright enough to understand there’d be a populist backlash.  It amuses me to know how they lay awake at night and worry about maverick docs like Dr. Jess.  Indie was that way, as you will see in ‘The Mandolin Case.’  (Still slated for a 2010 release).     

         Here in Harvey County, true competition salvaged some hope for our little medical landscape.  (I plan to show you how in a second novel.)  It’s like George Bailey said in ‘A Wonderful Life.’  “This town needs the measly Building and Loan, Potter; if for no other reason so everyone doesn’t have to crawl to you.”  (paraphrased)  Monopolies, be they business or government always get bloated.  I never dealt with a bureaucrat with a heart.

         According to Newsweek, “the Founder’s vision was a republic of self reliant farmers and small town tradesmen.”  The article referred to banking, but the same principle applies to medicine.  It was better off in the hands of patients and providers.  Now it is controlled by very large institutions whose ‘important’ people often can’t distinguish gas from a heart attack, nor do they care or realize why this might be an important skill.  As one industry insider wag told me, “When I got into health care I thought we’d be talking about germs.  All we talk about is money.”  

         Niall Ferguson wrote in Newweek that the Founding Fathers had a significant mistrust of big.  There isn’t much new.  Maybe history will just recyle.   He recalled there has been more than one backlash against big in the past.  President Andrew Jackson used to say about the central second Bank of the United States, ‘The Bank is trying to kill me, but I will kill it.”

          Large institutions, be they banks, sports, country music, newspapers, publishing houses, government, political groups, or health care conglomerates need to heed history.  The privileged few depend on the daily toil and drudgery of ordinary folks to sustain their good fortune.  When they forget where they came from and get above their raising, a populist backlash awaits.

        Oh, by the way, you might note there is no longer a second Bank of the United States.  It went out in 1832. Old Hickory was  a stubborn man, and he prevailed.

Dr. B

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22 Comments on “Healthcare and Populist Backlash”

  1. Excellent post. Big is often the enemy of excellence. I can only think of a few things were big is better. The military is one and our forefathers understood that when they created this country. They reserved rights to the states except where specifically enumerated.

    I am a fiscal conservative. My worry in all this reform talk is that the federal government will take the power for decisions that should be decided at the local level — like between doctor and patient. It won’t make things appreciably better and likely worse for the majority and it will cost us all a great deal now and into the future.

    Visit my post from time to time at I try to cover the health care debate and health care delivery issues.

  2. Ted Lehmann Says:

    Good one, Doc! You may catch some H*** for this one, but you’re on the right side, along with a pretty large majority of all docs. IBMA!

    • drtombibey Says:


      As an old country doc and bluegrass picker I am used to being contrary and rather enjoy it. Long live bluegrass. Go IBMA!

      Dr. B

  3. Billy Says:

    “When I got into health care I thought we’d be talking about germs. All we talk about is money.”

    You hit the nail on the head.

  4. twoblueday Says:

    I wish I could say I liked bluegrass music. I guess its cliches (all genres of music have cliches, and I’m using the term in that respect) just don’t thrill me. Maybe it’s because it is too immediately recognizable (like unto Reggae–I often say there is only one reggae song). My older brother was a 5-string banjo picker for years, and had mucho recorded bluegrass music about, so I didn’t suffer for lack of exposure.

    However, I do like to hear good mandolin playing.

    As for “Big,” I tend to agree. I think until we have universal health coverage in this land, we are pretty much screwed.

    • drtombibey Says:

      two blue,

      Sometime take a listen to Emory Lester’s new release, ‘Reminiscing Today.’ He comes out of the bluegrass world, but his mandolin work is sophisticated pure acoustic melody. It ain’t your father’s bluegrass.

      I am like Ike Eisenhower and fear both big business and big government. They need to be pitted against each other to where each has no choice but to be responsive if they want to enjoy their position of privilege.

      You are right. At this time we are in a bad way with health care.

      Dr. B

  5. iceironman Says:

    I came over from the Berry street beacon to read your article. The only thing that scares me is that you bring up salaries. There are laws on the books right now that should keep the companies from holding too much market share. There are laws on the books possibly contributing to the problem of companies getting too big also. But leave salaries out of it or the guy making 15000 will be after your nest egg some day because he knows you are an evil rich doctor

    • drtombibey Says:


      I share some of your fears. I had one or two threaten that along the way, but when they realized I didn’t have much money they went away.

      I like for the system to be such that if I decide to go up three dollars on an office visit I have think long and hard ’cause they might talk bad about me in the beauty shop.

      It was like that before all the big players got involved. Believe me, it was a very effective check and balance. When you live with people, share meals with them, play music together, and go to church with the folks you take care of, you either understand it intuitively, learn fast, or in short order don’t have any patients to see.

      Dr. B

      • iceironman Says:

        I had six screws and cadaver bone placed in my neck 5 years back from collapsed vertabrea. I want my doctor to have a lot of money because he earns it, because he is the best.. I dont want him to get up in the morning, knowing he cant be sued, and knowing he makes less than a good car salesmen.

  6. Felix Miller Says:

    Doc, on medicine, you got this exactly right: “It was better off in the hands of patients and providers.”

    Forty years ago, when I first went to work and had medical insurance, it was just what we would call “catastrophic coverage,” everything else I paid for at the Doctor’s office or the pharmacy.

    Having children caused me to plan ahead, not a bad thing, since there was only a couple of hundred dollar insurance payment for an uneventful delivery, and the rest was up to us. We handled it.

    Big is not always better, for sure.

    • drtombibey Says:


      Whatever happens I hope we return to being in charge of our own destiny rather than have it decided by strangers who only know of us as a number on a profit loss statement.

      Dr. B

  7. Julius Says:

    Doc, I’m not smarter or better lookin, but you seemed to have got it again! I’m guessing you had to talk to an insurance reviewer today as well….

    I think this is something that needs to get out there; before I became a medical student, I too had the thoughts that doctors had a good living. Now I realize that I’m already $300 THOUSAND in debt from school loans; I’m going to have to work 12-16 hours a day while getting called at all different times of the night while only getting paid what I’m getting in loans now for the next 3-6 years before I can actually have a day off per week. Nevertheless, I had a smart preceptor that said that a doctor “won’t starve, but won’t get rich either.” There are some that make high end, but the majority make enough to just provide for their families, something that is all I want to do.

    Still can’t wait to read that novel of yours; and now a second!!! I’ll have to put Harrison’s textbook of medicine down for a little while….


    • drtombibey Says:


      Young’un, you are all three, which I why I want you to look after me in the Nursing Home some day.

      As to the primary care crisis, Julius makes his point well. Nowadays students do not have the luxury I had to choose a lower pay primary care specialty because they can’t pay back the debt.

      ‘The Mandolin Case’ inches towards publication in 2010.

      Dr. B

  8. danny fulks Says:

    I wonder how doctors lost control of their practices. They should have a lot of power; like the doc who lately removed a cataract from me, he seemed to be leery of suits, had discarded his lab coat long ago during office conferences. I just got the feeling the suits would leave him alone because they didn’t know what a cataract was, the Med school dean, the college pres, the board of directors. I heard the AMA was supporting a government plan but they have not made a lot of noise. It’s like a poker game with a side pot. The executives who plan retirement programs, establish policies on average number of minutes a doc spends with a patient, detail people’s activity, billing, collecting bad debts, overseeing doctors’ recommendations in order to put more money in the side pot, building fancy buildings, raising money, letting two or three hospitals compete in the same area with all having the same expensive equipment. Come here, we have the cyber knife, we can remove your intestines better. No one in a hospital asks a patient who his favorite radiologist is or whom he would like to have call on him. Hospitpals: even Motel 6 won’t put you in a room with a stranger. Keep on fightin’, at least you can control some of your own actions as the systems continue to expand.

    • drtombibey Says:


      We all have lost control of our practices. I spend my days outwitting the system so people can get the medicine they need, fighting with insurance companies, filling out forms, and going to meetings. At times you have to force the system to see people in a timely fashion. I have gotten very good at that.

      I love this one. “Something has to be done about all these patients. They are getting in the way of my paperwork.”

      All I ever wanted to was read books and see sick people, but I spend most of time dealing with other issues.

      But in the end, I do it for the privilege to be doc for at least a few folks every day, and that makes it worth it.

      I have to keep on, because that is what I am. I don’t know how to do anything else. By pro standards I am a marginal mandolin picker at best.

      You are right about the poker game. Much of the health care debate is but a giant car deal on steroids by a bunch of folks who got picked last in softball years ago. Nothing but one big pissing contest for some of them, excuse the language.

      Dr. B

  9. Ray Says:


    You continue to impress me. I think you have got a good common sense flow. It might be that you are good at flushing out the points. I still think the keep It Simple Stupid (KISS) rule applies. Of course, I have worked in a Cooperative job for quite sometime. I think some kind of cooperative insurance program could be another option. Actually I think having multiple cooperatives that are allowed to compete against corporate insurance.

    It probably won’t drive down costs initially, but if the focus of a cooperative is as it should be at least there mission statement should be centered around the cooperative member (the patient).

    I believe I have seen my own cooperative loose focus on the customer at times. It is easy to get blinders just trying to do your job instead of knowing why you do your job. You impress me as someone who understands why you are Doctor, and ultimately seem to keep the focus on what is real.

    • drtombibey Says:


      Thanks so much for your comment. I am no expert at designing programs but I like your model of multiple cooperatives. Anything that forces accountability for all parties is what I want.

      As it is now an insurance company can make a decision and if it goes bad for the patient they just say, “Well if the Doctor would have just told us more, we’d been happy to approve it.”

      That is as disingenous a lie as the treaties that were made with the Native American people. They know it is not true, but continue on because of the money involved.

      On a day to day basis my only counter is to tell the little manager guy I am on the side of the patient, and will support their rights should the company make a bad decsion.

      Then I tell thm I have a friend who is a bad ass plantiff attorney who is chomping at the bit to test the legal precedent they have no responsibilty for their actions. I go on to say I made the 90th+ percentile on the boards, know my patients up one side and down the other, and love them almost as much as family. The company is welcome to try to second guess me from a distance but I wouldn’t recommend it.

      Then I get their name and number, and also make sure to tell them I doubt their company will stand behind them if the case goes bad, esp once they read my dictation. They give in, but is sure takes a lot of time to do business that way.

      I was a nice southern boy, but the system forces you to be a street fighter. Better that than let your people go without.

      Dr. B

  10. gargamel Says:

    Hi Dr. B,

    I am a European, living in one of those countries where federal social insurance is mandatory. This covers healthcare, pensions, unemployment, and (although only basic) dental care.

    From time to time there are movements towards opening the system to private insurance companies, but – fortunately as far as I am concerned – nothing ever came even close to implementation.

    Like many of my compatriots I follow the controversies about Obama’s health care plans with interest – and shaking of the head in complete disbelief.

    Almost ironically, the arguments against public healthcare in the USA are exactly the same as those against private insurance here!

    Yes, the system here is also far from perfect, but everyone can see a doctor without prior notice, nobody will ever have to file for bankruptcy because of treatment costs, and if health insurance would ever reject necessary treatment, it would be a nation-wide scandal.

    By the way, life expectancy at birth in my country is 1 year higher than in the USA for males, and 2 years higher for females …

    • drtombibey Says:


      Thanks for your comment. It is good to hear from a human being in another country where you have ‘been there and done that.”

      Our system is very far from perfect. A big problem is it encourages overuse by some while it assures very poor access for the less fortunate.

      I am sad to report your stats are true. This is a great country in so many ways, but we have some catching up to do in others.

      Thanks again for your comment and perspective.

      Dr. B

  11. drtombibey Says:


    I think when things go wrong we should all be treated fairly, patients and Docs alike. Fairness can be hard to come by at times.

    A neurosurgeon deserves to make more than I do, ’cause he has put in more time. (and I put in a lot)

    Of course Brittany Spears makes far more than both of us put together. I don’t know the child, and have nothing against her. I guess she sings better than me, but I’m confident I can outplay her on the mandolin. But then again I’m also sure she is better looking than me. America can be a funny country.

    Dr. B

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