 So finally The affordable the patient portability affordable care act Obamacare This was signed into law on March 23rd 2010. I Watched it while waiting in a neurologist's office for four hours to be seen The reason I was in the neurologist's office is I got a weird neuropathy I thought it was from a pinched nerve in my neck maybe from working out, but My intrinsic hand muscles at feet to the point where I could no longer pinch or turn a key One day I had a patient that went into respiratory arrest. I had to intubate them I used a laryngeoscope to expose their vocal cords and the endotracheal to the plastic to we put down your windpipe I couldn't hold on to it as I was passing it through and I was like, oh crap. I got to figure this out So I was waiting to have a nerve conduction velocity done as it turns out. I had something called cubital tunnel syndrome We were mandated to have electronic medical records or face severe financial penalties in terms of what Medicare would pay you So huge pressure from the hospital we went to instead of voice dictation that was transcribed to this computer template that you had the mouse every little bit of the patient encounter and Where it was was a desk with a glass tabletop and I was raking my own nerve over that over and over again I never thought After 20 years of education, I would have the sort of job where I would have a repetitive motion injury But I was there being evaluated for it while I watched this signed in the law And the thing is everyone's just really up in arms about this Thinking that this is going to do new and horrible things and it's not Here's what it does Is it just takes everything that's horrible about our current system and Mandates that you buy into it even if you object and This is the scariest thing about the latest court case is the first time in American history Someone can tax you for something you did not do You're not being taxed for taking an action You're not being taxed for producing something or selling something or bartering any sort of transaction. You're being taxed for an inaction Okay So this includes all the negative elements of what brought us here But the other thing it does it shuts off any escape valve for cost shifting Everyone's co-opted into this thing. So what's going to happen now is once these price controls are enacted And they cannot be dissipated varying by cost shifting. You're going to have massive shortages It's going to be really hard to get in to see anyone or get care So if you get sick Expect to be deflected to the ER when you go to your doctor's office The doctor's office is for routine care and simple stuff You do anything that screws up the flow of the schedule They're going to punch you to the doctor off to the ER when you get to the ER Expect long waits because everything is being shunted there and then tall remains in effect. Okay Call your doctor's office go out in the hall call your doctor's office on the cell phone University will say if you think this is an emergency call 9-1-1 go directly to the emergency department When you get to the emergency department, what's the thing the triage nurse says to you didn't you call your doctor? no one wants you because You are a liability to everyone involved in this system now If you need admission, it's gonna be a fight We have to find a damn good reason for you get in there We're gonna have to ram the square peg into the round hole to make sure we get some sort of reimbursement for taking care of you And you'll be kicked out as soon as possible whether you're ready or not It's all protocol driven Anytime you receive a treatment it will be per protocol if you come in with chest pain You're gonna be discharged on a statin And if you're not discharged on a statin that's going to create the physician being flagged as an outlier and a troublemaker Okay The sicker you are the more you're reviewed as a liability be prepared to be discharged prematurely Come in with pneumonia. You're not completely better, but you know, maybe good enough. They'll send you home and right now We're experiencing multiple ambulance U-turns and what I mean by that is Almost every single shift I work. I will see at least one ambulance patient There was someone that was discharged from the hospital being driven home in the ambulance That has to do a U-turn and come back because they're decompensating Guess what if you're at writ a read mission within 48 hours, they ain't paying So now the read mission is even more of a fight being a than the original admission because no matter what you do No one's getting paid But lots of people are doing the U-turn because of the premature discharges and Understand This is not because the doctors aren't good. These are extraordinarily Smart and well-meaning people. They're just operating under the constraints of enormous pressures