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August 2, 2012

Reflections on a Medical Career

by Robert S. Dotson, M.D.


The Impending Collapse of American Medicine

Just as is every issue in the US, Obamacare and the wider question of the state of
American health care are obscured by propaganda and disinformation. In the article
below, Dr. Robert S. Dobson looks back on a lifetime of medical practice and provides
facts and insights that might help us to understand our situation.

The US medical system is the most expensive on earth without being the best and
without providing full coverage. One-sixth of the American population has no medical

There are two main reasons that US medicine is so expensive. One is that profits are
piled upon profits. In addition to wages and salaries for doctors, nurses, and medical
personnel, the American health care system has to provide profits for private
hospitals, diagnostic centers, insurance companies, and for the accountants,
attorneys and management consultants made necessary by the enormous litigation
and regulatory compliance cost. American medicine is the most regulated in the world
and the most criminalized.

What “Obamacare” does is to divert Medicare and Medicaid monies to the profits of
private insurance companies. Instead of providing medical care to those in need, the
taxpayers’ money will provide bonuses for insurance executives and profits for their
shareholders. It is the height of folly for Obama worshipers to defend a law written by
the private insurance companies that uses public revenues to provide insurers with 50
million more customers and to add yet another layer of profits to the cost of American

Reflections on a Medical Career
Robert S. Dotson, M.D.

All lovely things will have an ending, All lovely things will fade and die; And youth, that’
s now so bravely spending, Will beg a penny by and by.
-Conrad Aiken (“Disenchantment IV”- 1916)

Thirty years have passed since a much younger physician opened his ophthalmology
practice in East Tennessee. A lifetime of hopes and expectations, intermingled with
the usual collection of fears and uncertainties, has sped past at blinding speed.
Children came, grew up, and moved on to their own lives. Parents and grandparents,
aunts and uncles, many friends and colleagues have returned to dust in advance of
their fading photos.

Patients and their parents and children and grandchildren have moved in and out of
this world, too, inextricably woven into the fabric of my life. Sadly, a few may have
been hurt by lapses in judgment or the arrogance of youthful physician pride and
overconfidence. But, at the end of the day, most were helped. I was fortunate to be
recognized as a “doctor’s doctor” early on and, though there was no attendant reward
other than the respect of peers, that was a sufficiently gratifying laurel to carry.

As in any human story, joy and pain, love and sorrow, have marked these same
years. The Millstone of Time has also worn away foolish aspirations and vainglorious
pretensions. There is no one left to impress, no accolades to seek, no rank to which
to aspire. Consequently, I feel freed to offer some end-of-life reflections on my
profession and career.

Any thinking American knows that there is something terribly wrong with the health
care system in this country. Throughout my career, the political ruling elite has been
enacting piecemeal a version of “universal” healthcare coverage to satisfy the
demands of an increasingly vocal, but also increasingly disenfranchised citizenry. Our
overlords, of course, have been more motivated by enhancing corporate bottom lines
and enriching themselves, than in genuinely helping the peasantry.

Every U.S. President since Kennedy in 1962 has dealt with the issue in one way or
another – by policy statement or passage of legislation. LBJ oversaw the creation of
Medicare and Medicaid in 1965. Nixon oversaw the passage of the HMO Act (Health
Maintenance Organization) in 1973 and ERISA (Employee Retirement Income Security
Act) in 1974. Amazingly, he also introduced CHIA (Comprehensive Health Insurance
Act) in 1974. Even more incredible was the spectacle of Ted Kennedy working to
ensure its defeat. Doubtless, Kennedy regretted that in future years. Following the
untimely departure of the 37th President, Gerald Ford signed ERISA into law in 1974
on his behalf, thereby introducing some minimal regulations to ensure that separated
employees could maintain benefits, such as health insurance, for a limited time.

Carter campaigned in favor of National Health Insurance, but failed to pass anything
similar during his time in office. He cited Kennedy’s opposition to CHIA and to his own
proposals as the main reason for failure. Reagan’s era witnessed the passage of
EMTALA (Emergency Medical Treatment and Active Labor Act) and COBRA
(Consolidated Omnibus Budget Reconciliation Act) in 1986 that, among other things,
provided for emergency medical treatment coverage for anyone who could drag
themselves into an emergency room (of course, such a visit might bankrupt them
unless they were lucky enough to be an illegal alien). Medical labs and imaging
centers (and, the providers staffing them) were given “special attention” under CLIA

The first President Bush had little time for national health care issues, as he was
primarily focused on launching the NWO. Poppy’s “Thousand Points of Light”
degenerated into in-coming tracers from the illuminated Angel of Death – simply more
“peace, freedom and liberty” being delivered to millions of innocents across Battlefield
Earth. It seems so trivial now, but Bush was unseated after reneging on his pledge of
“no new taxes,” not for offshoring the US economy or taking the first step toward
turning US foreign policy into the pursuit of world hegemony.

The Clinton administration tried to force through “Hillarycare” in 1993, but met with
stiff opposition from their Republican opponents (of course, the opposition was due to
perceived threats to corporate profit margins). Nonetheless, Team Clinton was able to
push through HIPAA (1996) (Health Insurance Portability and Accountability Act) and
SCHIP (1997) (State Children’s Health Insurance Program) which, contrary to the titles
of the acts, neither improved health insurance portability or accountability nor
improved the health of children.

The Clinton White House had more important fish to fry: war in the Balkans; the liberal
distribution of depleted uranium and cruise missiles across the globe; test wars on
Americans at places like Ruby Ridge, Waco, and Oklahoma City (OKC); the
appearance of numerous “Arkan-cide” victims whose mortal remains seemed to be
discovered at the most inconvenient times; and, a semen-stained blue dress. The first
versions of the Patriot Act were trotted out in response to the false flag event of OKC,
but Congress and even the Imperial Senate balked at moving so precipitously toward
the New Amerikan Security State.

The ascension of son Bush and his neoconservative cabal turned the government to
the drive toward world hegemony. The serendipitous events of 9/11 opened the door
for passage of the neocon’s PATRIOT Act and for the still on-going implementation of
their Project for the New American Century (PNAC). New alphabet agencies like DHS
and TSA were created to augment existing departments and agencies (FDA, DHHS,
IRS, FTC, FCC, EPA, FEMA, DEA, BATF, FBI, NSA, CIA, and DOD) charged with
dominating the nation and the planet beyond. Orwell’s dystopia, 1984, became reality:
“War is Peace. Freedom is Slavery, Ignorance is Strength.” President Bush modeled
Big Brother’s third slogan for an admiring populace more concerned with Harry Potter
and Janet Jackson’s nipple than with the deadly machinations of the psychopath in

It seems likely that steps toward the Third World War were taken during Bush II’s reign
with “war, war, WAR” being unconstitutionally declared against the nebulous (some
might say, non-existent) terrorists lurking under every bed and in every closet, cave,
and country on the planet. In spite of a premature proclamation of “Mission
Accomplished” from a flag-festooned carrier in 2003 by the Decider-In-Chief, the
killings have continued with little pause up to this day. The Great Decider used the
opportunity of “victory” abroad, however, to turn his attention to the healthcare needs
of his subjects.

What could be a better bone to throw to the peasants than the expansion of
pharmaceutical coverage for those under Medicare? And, what could be a better pay-
off for corporate buddies than massive new government wealth transfers of taxpayers’
dollars to Big Pharma via such a plan? It was a perfect “win-win” for the oligarchs at
the top of the pyramid and a “lose-lose” for the peons at the bottom. To the great joy
of Big Pharma, the Medicare Prescription Drug, Improvement and Modernization Act
(Medicare, Part D) was launched in 2003 to insure unimaginable profits for its
corporate members and more expense for the common people it was alleged to help.
As in any casino, our healthcare croupiers are well trained to leave no dollar on the

President Obama, a corporate stooge par excellence, was able to ram through
“universal healthcare” with the help of a Howdy Doody smile, his corporate sponsors,
and the slavish devotion of an ever-delusional, pseudo-Left. It mattered not that the
legislation was written by the insurance companies who had been profiting from the
misery of patients for decades.

It is no accident – and would be comical, if it were not so serious – that there will be no
true, equitable national health care system under the Patient Protection and
Affordable Care Act of 2010 (aka, “Romneycare II” or “Obamacare” or, lately,
“Robertscare” in homage to a Supreme Court judge) and its accompanying
legislation, the Health Care and Education Reconciliation Act. No Single Payer. No
mutual insurance system that provides a basic level of healthcare for the proles of this
collapsing Security State. Instead, we are witnessing the imposition of a system that
will further enslave and impoverish the peasants here in Gulag Amerika. How poetic
that a self-identifying “black man” is the front for resurrecting a 21st century version of
chattel slavery in the twilight years of Empire.

Obama was positively beaming in his many photo-ops with the sponsoring corporatist
representatives of Corporate Medicine, Big Insurance, Big Pharma, and Big
Government who enabled the Prince of Change to achieve this milestone deception of
America. The very fact that this “wonderful” new system – lauded by supporters as
“revolutionary” – is to be enforced by a projected army of 16,500 new IRS agents
should give us pause.

Notwithstanding passage of the legislation, decades of bad healthcare policy and
corporatist plunder are finally taking their toll. The collapse of the ill-conceived US
health care system might be near.

Ever more intrusive regulations are driving up the cost of medical care, and the
practice of medicine is being criminalized. Even with all of their flaws, Medicare and
Medicaid have provided a safety net for the elderly and disadvantaged since their
inception. Those systems’ days are numbered, however, as they are being gutted to
turn health care into profits not for doctors and hospitals but for insurance companies
and Big Pharma. For starters, large sums have been ear-marked to be taken from
Medicare and Medicaid to help fund PPACA (Patient Protection and Affordable Care
Act). Is looting Social Security and Medicare “change one can believe in”?

If this system is bad for patients, what does it mean for doctors? It means falling
reimbursement rates and rising overhead costs for providers, onerous government
mandates and regulations, and institutionalized, legalized larceny by Big Pharma, Big
Insurance and Corporate Medicine. As an example of how time and circumstance
have affected my own profession of ophthalmology, one need only look at Medicare
approved reimbursement rates for cataract surgery.

In reflecting back over my many years in the field of ophthalmology (as of this writing, I
am 63 years old and feeling pretty shop-worn), I am staggered by the changes that
have occurred. When I opened my practice in 1982, Medicare approved surgical fees
for cataract and implant surgery were near $1200. By 2012, that approved charge
had dropped to about $570 in Tennessee. (There is some variance within states
based on rural versus metro areas and between states where some are declared to
have higher costs of doing business.)

Additionally, the US dollar has declined in value an average of almost 2.5% per year
over the past 30 year period. Needless to say, overhead operating costs – salary,
rent, insurance, personnel costs, taxes, and normal business expenses – have
exploded during this same 30 year period. My office rent was raised 20% in the Fall of
2011, for instance.

To further illustrate the absurdity of the situation, it is worth recounting an anecdote.
Several years ago, a patient excitedly told me of the vision restoring cataract surgery
that her poodle had received at the local veterinary college. It “only cost $2600 for
both eyes!” At the time, Medicare was paying about $1400 for two eyes in a human –
including work up, surgical fee, post-op care for 90 days, and the very real liability
associated with being a physician in a litigious society.

I do not begrudge my animal doctor friends their success, but surely the worth of
human care should at least approximate that for a poodle. Although I know
veterinarians who are struggling in their own practices due to the economic recession,
at least they do not have to deal with government fee-setting and the liability and
costs associated with treating humans. They are able to price their services
sufficiently to keep their practices open and to provide for their own health care and

In my own practice, the amount of “write off” on charges for legitimate services
rendered began to climb as we entered the 21st Century. For years, the “disallowed”
charges by Medicare and private insurers resulted in “discounts” of 20-25%. As the
economic upheaval of 2008 rolled around, those fee adjustments (actually theft of
labor from providers) began to climb – 30%, 32%, 35%, and in my last year of practice
over 60%! For years, I had been able to subsidize my Medicare (cataract) side of the
practice by offering elective refractive surgery procedures (LASIK, PRK, etc.) to my
patients. As these were private pay cases, they offset the draconian cuts in Medicare
and insurance fee “adjustments.” The economic collapse of 2008, however, reduced
that income stream for many ophthalmologists and, subsequently, led to the closing of
many practices throughout the country.

Most general ophthalmologists are, by definition, primarily cataract surgeons. Many
people – including Medicare recipients – do not realize that the fees paid to their
physician are fixed by the U.S. Government after consultation with its many corporate
sponsors within Big Insurance, Big Pharma, and Corporate Medicine. Patients also do
not realize that those reimbursement levels are set by central planners at below-cost

Medicare issues cut across all specialties, and ophthalmology has not been alone in
experiencing cutbacks. Primary care physicians have increasingly become “piece
good workers” – managed by corporate pencil pushers to see a patient every 6-8
minutes while being forced to carry all the liability and manage all the data and coding
previously done by insurers. Who can diagnose, much less treat a patient in 6-8

My own solo cardiologist was forced to close his practice last Fall and seek
employment with an area hospital, due to declining reimbursement levels. More than
51% of cardiologists in the U.S. are now hospital employees. One of my medical
school classmates, a successful internal medicine specialist, has recently given up the
fight and has plans to enter some other line of work. Several friends in Radiology
have seen their incomes decline as more and more work is “outsourced” to tele-docs
in Asia. Still other long-time friends who are general surgeons are struggling to
survive (a surgical fee for incisional cholecystectomy, for instance, is now under
$400). Several have retired prematurely and others are looking for other work to do.
As a final example, another of my friends is one of five physicians in a busy urology
practice (2 offices and 26 employees) and they are now borrowing from the bank to
make payroll. A recent article from CNN, “Doctors Going Broke,” confirms the growing

As income reductions are being imposed on private practice, costs are being driven
up by exploding regulations. In addition, the plethora of new mandates and laws have
increasingly criminalized every aspect of the practice of medicine and created vast
new armies of armed bureaucrats whose sole aim is to impose civil and criminal
penalties on any provider unlucky enough to be singled out for attention. The old
Soviet dictum attributed to Lavrenti Beria (Stalin’s NKVD chief), “Show me the man
and I’ll find you the crime,” is in full force in Amerika.

The present puppet in the White House has completed the work begun by his
predecessors in moving the nation into a police state. The NDAA passed in the Fall of
2011 was the final nail in the coffin of personal freedoms guaranteed by the US
Constitution. By suspending habeas corpus and even trial by judge or jury, the Act
has made certain that no person is safe from being violated by a power-mad Security
State. At the mere movement of the Unitary Executive’s pen, it is now permissible to
“disappear” or even execute anyone on the planet – all on the whim of the
unaccountable psychopath in charge. Judge Andrew P. Napolitano, has reported that
our present Unitary Exec spends every Tuesday morning reviewing and signing off on
a kill list supplied by his loyal minions. Nobel Peace Prize worthy stuff, indeed!

One is presumed guilty now in Amerika until proven otherwise and nowhere has this
been more demonstrated than in the policing of medicine. Heaven help the poor
provider who is targeted by the Medicare Police – or now, one supposes, by the new
IRS Medical Special Branch. If targeted, his or her practice will be shut down without
due process. His or her assets will be seized without due process (assuring the
inability to even defend oneself). Finally, the unlucky guilty-until-proved-innocent
physician will be permanently discredited (libeled) in his or her community with the
ready help of the Government’s countless propaganda organs – press, radio, and TV
– all before any day in court is seen.

New restrictions, rules, and regulations on healthcare – on providers and patients
alike – have imposed legal constraints with which full compliance is impossible.
Medicare rules and regs alone fill tens of thousands of pages, and ignorance of any
of them is no defense for the unlucky. The original HIPAA legislation has been
amplified with many additions since its inception in 1996: FERPA, HITECH, ARRA
(2009). Each additional act or regulation has further criminalized the practice of

Finally, the entire health care system is being forced to switch to electronic health
records (EHRs) and, soon, to a completely new coding system (from ICD-9 to ICD-10).
Failure to comply with these mandates will result in further reductions in provider
payments with every year that they remain unimplemented. For a solo physician
practice, it is estimated that each mandate will cost as much as $80,000 to implement
initially and, then, $10-15,000 annually to maintain. For multi-physician practices,
costs run as high as three times (or more) that of a single provider practice. Of
course, the purpose behind all of this is to make each person’s most private and
personal information available to government bureaucrats and regulators while also
ensuring its accessibility to the Security State’s many law enforcement tentacles and
to all the corporate members of the Medical-Industrial complex.

Unfettered access to this information will ensure that the Corporate State can
maximize its profits, largely avoid all risk and liability, and eliminate any potential
competition (such as, often cheaper and more effective alternative medicine providers
and therapies, non-GMO whole foods, and nutritional supplements). It will also ensure
that medicine is practiced/delivered within strict cookbook guidelines that are carefully
written by non-physician bureaucrats to maintain corporate profits and government
power. All of this is well along in implementation.

A recent article, “Efforts to implement Obamacare law raise concerns of massive
government expansion” from Fox News, 5 July 2012, (http://www.foxnews.
government-expansion/#ixzz1ziuZDCSV) informs us that lawyers have already “drafted
more than 13,000 pages of Obamacare regulations and that this number will increase
further over coming months. In addition, we are told that DHHS (Department of Health
and Human Services) has been given more than one billion dollars to date in order to
begin oversight of this mess and that more than 180 “commissions, boards, and
bureaus” within the Agency are already hard at work implementing the final
destruction of American medicine.

Widespread vaccination of the population with untested “stabs” will be mandated and
enforced. As long predicted by Tin Hatters around the planet, this will permit biometric
“nano-chipping” of the citizenry without the unpleasant need to ask their permission.

Vast sums will be committed to “preventive” medicine which will prevent nothing and
will only expand the reach of the Medical-Industrial complex into every nook and
cranny of a person’s life – and, into every wallet. Certain corporate profit-driven diets
and treatment regimens will be mandated and enforced; access to nutritional
supplements and alternative medicine practices will be limited or banned altogether;
behavior patterns of all types will be monitored and carefully scripted and controlled
(what we see, hear, read, do, eat, drink, and breathe – where and how we work, play,
and live) under the guise of State Security concerns and its new companion, Public
Health or Public Good; and, finally, the Corporate State will deploy “death panels” to
decide when a person has outlived his or her economic usefulness to the State. In
spite of Obama’s denials that such bodies exist and Palin’s diversionary, hysterical
rantings at Tea Party rallies, there is clear provision in the Act for bureaucratic
decision-making bodies which will make end-of-life decisions for us all. These entities
are already being formed and deployed across the land. Our Anglo cousins in the UK
are showing us the way by withholding food and fluids from as many as 29% of their
hospital patients now who are judged to be living beyond their government-dictated
“use-by” dates (pragmatically justified “to free up beds” – oh, those Brits and their
refined sense of humor).

What can be done about the failing American health care system and the wider
collapse of the economy and civil liberty? Frankly, very little. The system is rigged
against the people as it has always been, only now one can be “black-bagged” and
disappeared at any time. Protest too loudly and one is liable to literally see a grim
Reaper overhead with one’s personal biometrics programmed into its fire control
system. Like every other institution within the United States, the medical system is
totally and completely broken. It can no longer be fixed by “voting” for the lesser of
evils, by printing bales of fiat currency, or even by deploying fleets of obsolete aircraft
carriers across the planet.

If as it seems we are arriving at the end of an age, if we can survive the end,
something better might arise from the ashes. The prospect of collapse turns one’s
thoughts to escape and survival. Can you do either? Volumes have been written
about preparedness in a time of chaos, so I will spare readers a rehash. But, a few
comments about healthcare, in particular, might be in order.

In a perfect world, it is my opinion that we should have some form of single payer
healthcare system and divorce ourselves from corporate medicine. In my opinion, this
will not happen without the complete collapse of the present system. Since that is
unlikely to occur before more seasons of national election fraud are imposed on us, a
few “in-the-meantime” suggestions follow:

Avoid contact with the existing health care system as far as possible. Yes,
emergencies arise that require the help of physicians, but by and large one can learn
to care for one’s own minor issues. Though it is flawed, the internet has been an
information leveler for the masses and permits each person to be his or her own
physician to a large degree. Take advantage of it! Educate yourself about your own
body and learn to fuel and maintain it as you would an expensive auto or a pet
poodle. One does not need a medical degree to:

1. avoid excessive use of tobacco or alcohol or, for that matter, caffeine;
2. avoid poisons like fluoride, aspartame, high fructose corn syrup, and addictive
drugs (legal or illicit);
3. avoid unnecessary and potentially lethal imaging studies (TSA’s radiation
pornbooths, excessive mammography, repetitive CT scans – exposure to all
significantly increases cancer risk);
4. avoid excessive cell phone use and exposure to other forms of EMR pollution
where possible (the NSA is recording everything you say and text anyway);
5. avoid daily fast food use and abuse (remember: pink slime and silicone) ;
6. avoid untested GM foods (do you really want to become “Roundup Ready?”):
7. avoid most vaccinations and pharmaceutical agents promoted by the establishment;
8. avoid risky behaviors (and, we do not need a bunch of Nanny State bureaucrats to
define and police these);
9. exercise moderately;
10. get plenty of sleep;
11. drink plenty of good quality water (buy a decent water filter to remove fluoride,
chloride, and heavy metals);
12. wear protective gear at work and play where appropriate (helmets, eye-shields,
knee and elbow pads, etc.):
13. seek out locally-grown, whole, organic foods and support your local food
14. take appropriate nutritional supplements (multi-vitamins, Vitamin C, Vitamin D3);
15. switch off the TV and the mainstream media it represents;
16. educate yourself while you can;

And, lastly…


Doing these simple, common-sense things will add healthy years to a person’s life and
help one avoid most medical encounters during his or her allotted time on earth.

Finally, we have a responsibility to our neighbors and our families. We need to reach
out to those around us – talk to them, listen to them – sympathize and empathize.
Take time especially to listen to those who are in pain and are suffering and to help
them by being humane. If you do this, you will discover that we have more in common
with each other than the ruling elite wants us to believe. Governments obtain power
and control by taking advantage of divisions along religious, ethnic, class, economic,
ideological, and nationalistic lines. We must awaken to this fact if the 99% are to
prevail against the 1%.

As for me, I was finally forced to close my practice earlier this year. Nearly two years
of consulting with multiple attorneys, accountants, practice management consultants,
and bankers, and expending most of my resources in a vain effort to keep operating,
were simply not enough. It seemed only poetic that April Fool’s Day 2012 should be
chosen for turning out the lights and ringing down the curtain. Patients and
employees and suppliers were notified of the end. Many had been with me for my
entire career and leaving them was and remains painful. More than nine thousand
active charts were transferred to the care of a younger ophthalmologist still trying to
stay afloat.

I share the heartache of many physicians forced out of medicine by the high cost of
practicing it. As the health system is stripped of medical care in behalf of corporate
profits, its exploitative character will become clear to all. In the meantime, don’t give in
or give up. Plan for something better on the other side of chaos.

I wanted a perfect ending. Now I’ve learned, the hard way, that some poems don’t
rhyme, and some stories don’t have a clear beginning, middle and end. -Gilda Radner

Glossary of Terms:

ARRA American Recovery and Reinvestment Act of 2009
CHIA Comprehensive Health Insurance Act
CIA Central Intelligence Agency
CLIA Clinical Laboratory Improvement Amendments of 1988 – administered by CMS
CMS Centers for Medicare and Medicaid Services
COBRA Consolidated Omnibus Budget Reconciliation Act of 1985
DHHS Department of Health and Human Services
DHS Department of Homeland Security
DOD Department of Defense
EMR Electromagnetic radiation
EMTALA Emergency Medical Treatment and Active Labor Act – part of COBRA1986
EPA Environmental Protection Agency
ERISA Employee Retirement Income Security Act
FEMA Federal Emergency Management Agency
FBI Federal Bureau of Investigation
FDA Food and Drug Administration
FERPA Family Educational Rights and Privacy Act (1974 original legislation)
GM Genetically modified
HCERA Health Care and Education Reconciliation Act of 2010 – supplement to PPACA
HIPAA Health Insurance Portability and Accountability Act
HITECH Health Information Technology for Economic and Clinical Health Act (2009)
HMO Health Maintenance Organization
ICD-10 International Statistical Classification of Diseases and Related Health
Problems 10th Revision
IRS Internal Revenue Service
NDAA National Defense Authorization Act
NSA National Security Agency
NWO New World Order
PPACA Patient Protection and Affordable Care Act
SCHIP State Children’s Health Insurance Program
TSA Transportation Security Administration
USAPA Unifying and Strengthening America by Providing Appropriate Tools Required
to Intercept and Obstruct Terrorism – aka, The Patriot Act