American Medicine 2010 --- A View From the Bridge

Stephen R. Katz, MD

By the year 2010, all remaining physicians will be housed in penitentiaries, where they will have been placed thanks to the effectiveness of the False Claims Act, Kassebaum-Kennedy, and the AMA/HCFA E&M Guidelines. These places will have been renamed "meditentiaries," since all of the other "penitents" will have been released because "reasons" for their maleficent actions will have been explained away by the social experts. Thus rehabilitated it will have been deemed safe to release them. This "Grand Release," as it will have come to be known, will have been ordered by the same deadheads that gave us Kassebaum-Kennedy and the guidelines.

The "meditents" will practice telemedicine under penalty of solitary confinement for pay equivalent to that paid for the manufacture of license plates. The meditents will send their interpretations of the data received back to the data collector/therapists, who will be Alternative Practitioners (APs), PAs, LPNs, and occasionally, an RN without any "advanced training." These practitioners will weigh the cost/benefit ratio and decide whether to treat or withhold treatment depending on their evaluations of the c/b ratio. Difficult decisions will be referred to the specialists, the APRNs.

Surgery will be a thing of the past because all of the hospitals will have crumbled to the ground from disuse, nonpayment, and neglect. No new ones will have been built. Shopping malls will have been neglected too, since REITS will have abandoned them once they had written off their depreciation. As a result of this, there will be no "doc-in-the-box" facilities to fill the hospital void. Besides, the docs --- or, rather "meditents" --- will all be in jail.

There will be no nursing homes, no long-term care facilities. These will have been replaced by "Euthanatoria," where you can go and be done-in efficiently by the Thanatologists, who will prefer to be known by their common name, Kevorkiologists. For an additional fee, they will play your favorite music as the pentothal flows in. A special viewing loge will be available for your heirs to watch, as your estate turns into their reality.

Medicare will have been saved, since life expectancy will have dropped to age 68, but this will still be of concern to HCFA because its goal of achieving a life expectancy of 58, as in the former USSR and Russia today, will not have been realized.

Social Security will have been saved for the same reason. The surplus will be used to fund promotional activities of the Alternative Medicine division of the NIH. All other divisions will have been closed, because they were "not cost effective" and they were keeping people alive too long.

The government will have learned from the Army Medical Corps. The national medical slogan will be "Conserve the Working Strength!" Production of tax money to service the government, especially HCFA, will be all citizens priority! No work, no care.

And, oh, yes! The AMA will still be here, "working tirelessly to achieve reasonable compromises with the government that are good for all, patients and meditents alike!"

"Oh! Brave New World that hath such efficiency in it!"

Dr. Katz is an AAPS member and president-elect of the Connecticut State Medical Society. His e-mail is CHUCHIM_1@PRODIGY.COM.

Originally published in the Medical Sentinel 1999;4(2):67. Copyright ©1999 Association of American Physicians and Surgeons (AAPS).