Vic Socotra

18 November 2009

Going Out of Business

“Step right up, step right up, step right up,
Everyone's a winner, bargains galore
That's right, you too can be the proud owner
Of the quality goes in before the name goes on
One-tenth of a dollar, one-tenth of a dollar, we got service after sales…”

What a song! It rolls, it laughs, it reaches back into every ad you ever heard on the tinny speakers of the tube television or the transistor radio. Gravel-voiced Tom Waits sung it, back in the day, and I never thought I would hear the message where I heard it yesterday.

My pal Bonds made the song famous for me; he always had great tune-sense, and Bear, rest his soul, he had one of those Sansui sound systems at the rental house on John Street in Ann Arbor that would blow your eardrums out.

Well, Tom could do that all by himself with that raspy whiskey-and-wine roughened voice. “Small Change 1976” was the album it came from. That was a tough year, as best I can recall, and it must have been bad enough that I have succeeded in forgetting most of it.

Course, I don’t think it was as tough a year as what is coming. Tom was singing about unbridled commercialism, I think, and that is part of all our problems, the trade imbalance with the Chinese, the carbon dumping, all that stuff.

And there is the health care thing. I have managed to put that as far out of mind as 1976. I would not have thought about it yesterday, either, until after my blood pressure was taken and I was talking to Doc Nino about my blood pressure and what sorts of new drugs I could pour into my body to stop the dull numbing pain from my joints.

He is a funny guy, Doc is, and we have a lot in common. He was Navy trained, like me, though he got an honorable trade out of the deal, and I just got a license to steal from the government.

The whole thing is on its head. The Doc got all solemn after he suggested two new drugs. He handed me a flyer that looked a lot like the ones from the Condo association. It said he was no longer going to accept insurance.

I was dumbfounded.

“Doc, are you OK?” I thought he might be getting sued, or not able to afford his malpractice insurance or something.

Doc shook his head sadly and said, “No, nothing like that. The insurance companies aren’t paying me, and the government is helping them do it.”

“So what does it mean?” I said, puzzled. Doc directed me to the last page, which had the new effective rates for an office call. My periodic monitoring and prescription renewal will now cost $200 bucks a visit. More detailed and complex procedures- back pain and inpatient procedures- go up to $350 a pop.

“How on earth are people going to afford that?” I said.

“That is not the question,” said the Doc. He looked sad. “It is how can I afford to treat people? I have one insurance company (he named it)- that sends me checks for $1.04 cents on a co-pay office visit. The patient pays around $35. My cost to run the office is closer to a hundred, with no profit.” He shook his head. “I know for a fact that the company charges $1,000 a month for coverage. One of their execs took home $400 million last year.”

“Shoot, Doc, I’ll stay with you! It was hard enough to find you to begin with.”

“You are part of the problem, too. Your retired military coverage reimburses me at 20% below Medicare rates. I had to fight to renegotiate to get it to only 15% below Medicare, and that is going to get cut if Congress doesn’t act before January.”

“So, let me get this straight, Doc. You can’t afford to stay in practice with insurance the way it is, and all the stuff in the House Health Bill is just going to make things worse for you, right?”

“You got it. I have enough resources to hang on until next June. After that I am going to have to get a real job, if charging the real prices doesn’t turn things around.”

I ran through some options, like going to an all-prescription business (illegal) or forming a consortium of chosen customers to pay a flat rate (business case doesn’t work). Doc Nino pursed his lips when I ran out of prospective schemes.

“Trust me, I have thought about all of them. It does not pay the bills.”

“Well, you can still count on me,” I said, though mentally, I was thinking that I could cut back from four visits to two a year and still pay the full cash benefit. I wondered if I could just write my own prescriptions and have them filled in India, now that I knew what medicine I needed.

I got up and shook his hand, looking into the eyes of a small businessman who is being put out of the business he loves by a combination of rapacious capitalism and relentless government.

“You are on the business end of a going out of business sale,” said Doc Nino. “You are either going to pay, or you are going to lose service. Either way it is going to be ugly.”

I shook my head sadly. “I think I heard that in a song one time, Doc.”

I stopped by the receptionist to make an appointment for next May, since if I had done the math right, he would still be in business. I could probably get paper for enough drugs through the end of next year.

I don’t know if the front office gal will still be working then, though. The Doc might have to do that for himself to cut the overhead. Too bad. She is cute as a button.

I whistled a tune on the way back out to the Hubrismoile. I drove the fancy car since the day was chilly but clear. I figure you might as well enjoy things while you can. It was a nice day to have the top down, and this will unquestionably be the last luxury convertible I will ever own.

Pity that everything is going to go in the crapper, you know? If what is happening to Doc Nino now is any indication, squeezing Medicare for savings and putting the screws to the insurance bandits is just going to screw the docs who are in private practice providing the service.

They will be forced out of business, or into some grim government employment. Nino told me he was looking at that as an option, even if it was not the medicine he wanted to practice.

In the end, it means that health care may be a lot more affordable, but there just won’t be anyone left out there to provide it.

“Everything must go, going out of business, going out of business
Going out of business sale
Fifty percent off original retail price, skip the middle man
Don't settle for less
How do we do it? how do we do it?
Volume, volume, turn up the volume…”

Song lyrics Tom Waits, 1976

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