Dispatch #4 Physician Mission Grim Possible

IT WAS A DARK AND STORMY NIGHT. The thudding and wheezing reverberated closer and more forbiddingly. As air raid sirens wailed and spotlights prowled the skies, the apocalyptic atmosphere was staccatoed by the chopping rotors of Department of Health Services helicopters, their loudspeakers blaring out warnings and threats to the approaching Leviathan. The capitol shuddered with the impact of each quickening step of the monstrosity steadily lurching forward.

Legislators, litigators and lobbyists frantically scurried in the Capitol warrens to build barricades with their reams of legislative bills. The statutory books of health care regulations piled into the corridors were at least 5 feet thick; they whirled in the gusts of the gathering tempest.

"Bring me more bills, there are gaps in the coverage!" yelled one frenzied legislator. He packed more reams of Department of Health Services bulletins and CMS manuals into the bulwark. "I don't know how we can take it... These regulations are not going to hold it back! Spiritual Nonecumenical Being, help us!"

"Call in the attorneys," cried another.

"Maybe we can still sue! Someone! Anyone!" a staffer pleaded.

"No! No! It is too late for that," a grizzled state senator squawked in reply. "Look! The tort lawyers have been stampeded. They are now in alliance with this demon! The tentacles of the monster have meshed with them and they are symbiotic! See, their subpoenas are flaccid!"

In the corner of the governor's quaking cigar-butt strewn HQ tent fidgeted a sultry brunette. She flicked her long-stemmed Virginia Slims ash on the barbells next to the governor's Lazyboy. Her demeanor could make a scientist guy cosine away his hypotenuse and integrate his differential to a new inflection point. Wisps of smoke curled languidly upward as she pouted and asked. "Well, what about the other politicians? Can't they help?"

The governor shook his head and stammered "Our healthcare budget may be terminated and, and I may not be back. I am afraid we have only one last hope! The reports are that LA and SF and all the major cities in California are under similar assault. We have got to call upon the physicians of the state. Maybe they can save us from judgment day!"

He winced as he saw the flood of impoverished sickly citizens fleeing up L Street, past the shuttered businesses of a growing economic exodus. Their pockets were empty, their obese forms silhouetted by the glowing embers of cigarettes. Michael Moore, clutching a super-sized French Fry bag, lurched in the lead of the pack, his rolls of "Sicko" spent film dangling like a ghastly train of celluloid entrails from his paunch. Already the regulatory bills were being whipped into a vortex whirling and fluttering into the maws of the monster.

The governor commanded, "Get me the Physician Transmission! Call the CMA. Sound the general alarm!"

Shrieks and screams were punctuated with the thudding, whooshing cacophony as it turned the corner. Bursts of borborygmi bellicosity issued from the mass: "Feed me more money! Feed me more resources. Screw your uninsured, your tired and your poor, your huddled masses at the ER door. I want more!" It belched.

Statewide the physicians' pagers beeped and buzzed in unison as the SOS beacon beamed throughout the state.

Jamie Bonda, MD (Medical Board of California 007), glanced at his Motorola. He shuddered as he read the message. "Medical Crisis. It is coming closer - the horror, the humanity, the budget, the jobs, the taxes, and the uninsured…arrrrgghh!!!…" The words flat-lined and the screen went black.

Dr. Bonda had dreaded the message's inevitable arrival. For years, just this eventuality had been forewarned and prognosticated. Health Care Expenditure and Budget Situation had reached DEFCON 4. The CMA agents and physicians were now prepared to fully mobilize and take control. They had trained and been cultivated with the best of the CMA Academy. They had written, testified, protested, and tried to convince politicians, regulators and others of what was looming. Their efforts and pleas had been ignored by the influence of special interests and the pervasive condition of a political pathology clinically known as cephalic intrasigmoidus.

Bonda reached into his lab coat pocket and grasped his weapon. The rumbling of the creature was closer and the night was getting darker and stormier. He was thankful that Q at the IMQ, special branch of CMA, had prepared him.

He stepped outside his office. He could already see other MDs dashing out of their offices, sheathed in their white coats - pockets bulging with their special ammunition.

He gasped as he beheld the abominable behemoth. A gelatinous, sero sanguineous, poorly differentiated mass of health care expenditure crisis oozed forward. It was the Iniquitous Health care budget, Economy, Inequity and Inefficiency Incarnate. IHEIII !!

Sloth, greed, selfishness, personal financial and healthcare irresponsibility, waste, fraud and ignorance had made this seething beast. It sucked in money, state resources, and jobs like a surgical Gomco on steroids, oozing out pustular streams of executive stock options and gaping vacuoles of inefficiency in return. The miasma was of sickness, disease, avarice, and inattention, equivalent to enchiladas left in the call room cabinet by a drug rep a month before…

Steadfastly and slicker than a KY'd catheter, Dr. Bonda bimanually whipped out his weapons. He raised his pen and took aim at his prescription pad. "Now my colleagues," he cried, "Fire one!"

The first salvo of doctors scribbling on pads started. They wrote: "Generic drugs! Cut pharmacy costs! Enhance drug company competition and send more money to research and development! Cut direct-to-consumer drug advertising!

The healthcare expenditure monster groaned and burbled. The doctors' flashed pens like swords, and prescription pads as shields.

"Fire two!" Dr. Bonda charged forward. The scribbling on the RX pads continued. "Educate and effectively persuade our patients in healthy lifestyles. Hold them accountable to lose weight, stop smoking, exercise more, and improve nutrition! Health Savings Accounts!"

The monster belched, quivered and started to shrivel. The sucking and whirling decreased.

"Fire three!" Dr. Jaime Bonda shouted. "Medical malpractice and liability reform. Stop defensive medicine. Order only lab and diagnostic tests that are reasonable. Prevent fraud. Reform practices of bad doctors, clinics, and hospitals."

Though it wasn't easy to decipher the doctors' writing, it seemed effective! The monster's mass deflated and deturgessed further.

A voice rang from the crowd. "It's shrinking!"

Cheers erupted from the besieged Capitol. Treos trilled and Blackberrys blipped out the news, reporting similar dissipations of the menace throughout the state. The stunned and hunted patients swarmed around Bonda and his colleagues from the CMA. Legislators who had been slinging bills and books at the health care expenditure monster stood with jaws agape, wordless for the first time. The tort attorneys shuffled and cleaned the depositions from their pants; the monster was an abating blob coalescing into pools of melted golden insurance executives, carbonizing deflating hospital bills, and an effervescence of wastefulness.

The governor pumped his fists into the air. "You did it! You terminated it!"

The beguiling brunette, menthol cigarette dangling from her lips, sashayed up to Jamie Bonda, MD, and cooed, "Dr. Bonda, how did you do it? How is it all the legislators, lobbyists' attorneys and actors with all their formidable firepower couldn't stop this health care monster? What magic is it that you have? What is it, Doctor, you know?"

"It simple", shrugged Bonda, "We doctors of the CMA know the solution to healthcare problems really begins with us. We can cut the costs by choosing medication, testing, and procedures wisely and prudently; we can convince our patients to change bad health habits that can cost millions, we can persuade our representatives that tort and regulation reform can dramatically cut costs and enhance efficiency. We can advocate that a pluralistic universal basic coverage is a good investment and saves lives and money and maintains economic vitality. We know we can work together when called."

Bonda continued. "Do you remember H.G. Wells' War of the Worlds? Humanity was under assault by Martians, like we were under assault by a medical insurance protean problem monster. We humble, but powerful providers and directors of healthcare are like tiny organisms that doomed H.G. Wells' Martians. Against our many small and individual efforts to provide quality, cost effective and humane care, the monster created by regulation, litigation, over libation and gustatation had no immunity."

"Oh doctor!" she sighed. "How can we thank you!"

Jamie Bonda MD's hand gently reached for her as the clouds parted and a golden ray of sunlight caressed her countenance. He grabbed her cigarette and with a flourish crushed it on the pavement.

"That's how! And start exercising more! Here's looking at you, kid." He winked.

"Now if you'll excuse, me I have some more work to do."

Holstering pen and prescription pad in pocket, he paused, whirled, and then sauntered away with his white coat fluttering like a cape.

rajones@sbcglobal.net