Poor People Don't Get Care

That was the comment.

That was the comment from the wife.

As she cried and cried and cried.

The crying was sad.

Her husband was sick.

A very sick man.

And she was overwhelmed

Overwhelmed with fear.

The fear of the unknown.

But I could sense the anger in her voice.

Through the tears and the sobbing, i could sense an anger.

An anger of entitlement.

You see.

Her husband is 280 kg.


The rest of the world knows how big that is.

In America, that's equivalent to 616 pounds.

That's right.

Poor people don't get care.

Those words resonated through my ears.

Here was her husband.

In my hospital.

Being seen by me.

Being seen by a urologist for man related stuff

A pulmonologist for his newly diagnosed sleep apnea

A cardiologist for his newly diagnosed biventricular heart failure and rapid afib

A nephrologist for his newly diagnosed severe hypertension and renal insufficiency.

Severe medical problems with limited evaluation options.

You see, by today's standard technology standards, with all the fancy graphics, 3D computer reconstruction, catheters, procedures, imaging.

With all that technology, nobody has yet figured out how to build a better cot.

You see. Cath tables and CT scanners, at least in my neck of the woods, have a maximum weight capacity of 550 pounds.

That's a shit load of weight. But my patient has some how managed exceed the safety standards of these high tech pieces of equipment.

No CT scan for him.

No cath for him.

We are stuck with good old fashioned medical management.


Through all this illness, the stressed out wife is crying.


"Poor people don't get care", she says.

What on earth was she talking about?

Well. It turns out that husband took the giant step of seeing a local surgeon regarding options for gastric bypass in the not so distant past.

And he told the patient he doesn't accept Medicare.

That's right.

My poor person?

The person who's wife says "Poor people don't get care."

I forgot to mention.

He's on Medicare.

Oh, Yeah.

And he's got Blue Cross too. But his Blue Cross policy has a gastric bypass exclusion.

But poor people don't get care because a surgeon told him he doesn't accept Medicare.

Since when did a surgeon's services become a right?

Since when did a surgeon get put into surf dome?

Since when did a surgeon become your slave?

Since when did any professional's skill become everyone's right?

Poor people don't get care.

My Ass.

You know why the surgeon doesn't accept Medicare?

Because Medicare will only pay for gastric bypass surgery at predetermined

"Center's of Excellence"

In other words,

Rationed health care.

I find this fascinating.

There must be something very special about gastric bypass where only a limited number centers in this country are allowed to perform these often life saving procedures and get paid by Medicare.

Why not only allow lap chole's at "center's of excellence"

How about only treating heart failure at "center's of excellence"

Or Pneumonia

Or CABG

Or all medical treatment

Why not have a "center of excellence" designation for the management of all surgeries and all medical illness.

Oh wait. I forgot That' why I'm board certified to practice internal medicine. I'm considered an expert in the evaluation and management of adult illness by an organization that has tested my abilities and has sanctioned me as capable of practicing adult internal medicine. And I am recognized by my state licensing board as qualified to practice medicine.

But, for a board certified surgeon, that's not good enough.

The government says you're not good enough.

So the patient suffers. They must travel hundreds of miles away from home.

To see a "center of excellence"

Where poor people can get all the care they need.

Via the Rationed care of the Medicare National Bank.