They VOLUNTEERED TO PROTECT OUR WAY OF LIFE BUT CAME HOME WITH BROKEN BODIES

Posted on July 21, 2025 by Pharmaciststeve

I perceive that battlefield medicine improved so much after WW-2 and from between the Korean and Vietnam wars that battlefield medicine improved so much that more  injured soldiers survived their wounds. So neither did Congress nor the Veterans Admin ever prepared for an increasing number of soldiers coming home with broken bodies. Instead of being brought home in a body bag.

Accepting 16-18 soldiers suicides each day, is this just a covert genocide?  That is abt 6,500 fewer veterans to take care of every year. I wonder how millions of dollars that is saving Uncle Sam for not having to fund proper treatment for all those veterans who VOLUNTEERED to protect our freedom and ended up coming home with “broken bodies”, PTSD or many other expensive health issues.

Average Number of Veteran Suicides Per Day

In recent years, the most authoritative data indicates that an average of 17.6 veterans die by suicide each day in the United States123. This number has varied slightly each year, but recent government reports and analyses agree on figures between 16 and 18 daily.

The Role of Inadequate Health Care and Pain Management

It is well established that inadequate access to health care, particularly mental health and pain management, is a significant factor among veterans who die by suicide45.

Key Findings

  • Mental Health Access: Veterans who experience delays or gaps in mental health services have a higher risk of suicide. Barriers to quality care, long wait times, and an overburdened VA system are repeatedly cited as contributing to the crisis45.

  • Chronic Pain and Suicide: Chronic pain is strongly linked with increased suicide risk in veterans. Pain that is poorly managed or untreated can lead to severe psychological distress, hopelessness, and suicidal thoughts6.

  • Pain and Mental Health Comorbidity:

    • Veterans with both chronic pain and conditions like PTSD or depression are at especially high risk56.

    • Pain-related sleep disturbances and daily function interference were also frequently reported among veterans who died by suicide7.

Specific Numbers Related to Pain and Health Care

While the reports do not attribute a specific number of daily veteran suicides solely to “inadequate health care” or “pain management,” public health research and VA documents show:

  • Pain (physical, emotional, or both) was identified as a factor in over 50% of veteran suicides reviewed by VA Behavioral Health Autopsy teams7.

  • The majority of veterans who die by suicide have at least one chronic medical or mental health condition—chronic pain and untreated PTSD being particularly prominent6.

  • Proper pain management has been shown to reduce suicidal thoughts and self-harm behaviors, but access to such care remains inconsistent6.

Conclusion

  • The average daily veteran suicide rate is 17.6, with inadequate health care—including poor access to or management of pain—playing a documented, significant role in many of these deaths12456.

  • However, there is no official daily statistic that isolates veteran suicides caused purely by inadequate health care or pain management. Instead, these issues are recognized as key risk factors contributing to the larger crisis.

If you or any veteran is struggling, reaching out to local mental health resources or the VA crisis line is strongly encouraged.

  1. https://www.mentalhealth.va.gov/docs/data-sheets/2024/2024-Annual-Report-Part-2-of-2_508.pdf
  2. https://news.va.gov/137221/va-2024-suicide-prevention-annual-report/
  3. https://ptsdlawyers.com/how-many-veterans-commit-suicide-a-day/
  4. https://pmc.ncbi.nlm.nih.gov/articles/PMC5563010/
  5. https://scholarlycommons.pacific.edu/cgi/viewcontent.cgi?article=1042&context=pjh
  6. https://mentalhealth.va.gov/MENTALHEALTH/suicide_prevention/docs/FSTP-Chronic-Pain.pdf
  7. https://www.mentalhealth.va.gov/docs/data-sheets/2023/2023-National-Veteran-Suicide-Prevention-Annual-Report-FINAL-508.pdf
  8. https://www.prainc.com/22-veteran-suicides-a-day/
  9. https://en.wikipedia.org/wiki/United_States_military_veteran_suicide
  10. https://www.rand.org/pubs/perspectives/PEA1363-1-v2.html
  11. https://www.veterans.nd.gov/news/why-are-so-many-older-veterans-committing-suicide
  12. https://pmc.ncbi.nlm.nih.gov/articles/PMC10031829/
  13. https://academic.oup.com/painmedicine/article/22/12/2846/6373910
  14. https://americanaddictioncenters.org/veterans/suicide-among-veterans
  15. https://www.in.gov/issp/
  16. https://www.va.gov/painmanagement/
  17. https://missionrollcall.org/veteran-voices/articles/the-state-of-veteran-suicide/
  18. https://www.vaoig.gov/reports/hotline-healthcare-inspection/inadequate-care-patient-who-died-suicide-medical-unit
  19. https://phs.weill.cornell.edu/news/linking-va-and-non-va-data-study-risk-suicide-chronic-pain-patients
  20. https://www.ebsco.com/research-starters/social-sciences-and-humanities/united-states-military-veteran-suicide

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Imagine if this was your Daughter?

Posted on July 21, 2025 by Pharmaciststeve

She has just been told that all the chemo that she has been dealing with is not working and there is nothing else to try. She was also told that what little pain management she has been getting is ALL THEY CAN GIVE HER.

Over the last few weeks, she has become more and more lethargic. She has went thru so much with all the Chemo and its side effects – nausea & vomiting. You have done your research and you know that her pain will most likely get worse toward the end, and her practitioner says that they can’t give her any more pain management – don’t want her to become addicted!

If you caused your Daughter to have as much  pain as you anticipate she is going to have to deal with – Child Protective Services would be at your front door.

“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey, Pharmacist, VP

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IS MAHA A MIRAGE OR JUST MIA OR AWOL ?

Posted on July 21, 2025 by Pharmaciststeve

Filed under: General Problems | 1 Comment »

Biden pardoned >4200- ONLY ONE PHYSICIAN -Dr. Anthony Fauci

Posted on July 21, 2025 by Pharmaciststeve

What If . . . We Stopped Asking "What If"? | Vance Morgan

Biden pardoned ONLY ONE PHYSICIAN -Dr. Anthony Fauci

Joe Biden’s Presidential Pardons and Physicians

Total Number of People Pardoned by Joe Biden

Joe Biden’s Presidential Pardons and Physicians

Total Number of People Pardoned by Joe Biden

  • 80 to 158 official pardons:
    During his presidency, Joe Biden issued between 80 and 158 official pardons, according to different official records and media tallies. The U.S. Department of Justice lists 80, while other sources note that Biden’s total may be higher when accounting for individual and categorical pardons12.

  • Clemency acts:
    Biden granted a total of more than 4,200 acts of clemency—including commutations and pardons—marking the most by any president in U.S. history12.

Notable Types of Pardons

  • Preemptive and high-profile pardons:
    A significant number included high-profile or preemptive pardons, including to Dr. Anthony Fauci (former Chief Medical Advisor), General Mark Milley, several members of Congress, police officers, Biden’s own family, and his son Hunter Biden2345.

  • Categorical pardons:
    Biden also issued proclamations pardoning thousands convicted of certain federal marijuana offenses and former military members convicted under past discriminatory policies1.

How Many Pardoned Were Physicians?

  • Physician pardons—Known recipients:
    The best documented physician pardon is Dr. Anthony Fauci, who received a preemptive pardon from Biden at the end of his term345.

  • No public data on additional physicians:
    There is no available comprehensive list indicating other individuals pardoned who are licensed physicians617. Most recipients of individual pardons had convictions for non-violent offenses, as well as activists, educators, veterans, and community advocates. Official clemency lists published by the Department of Justice and the White House do not consistently specify profession; thus, apart from high-profile figures like Dr. Fauci, the number of physicians among those pardoned by Biden is unknown and likely very small617.

Summary Table

Category Number / Details
Total pardons by Biden 80–158 (depending on accounting method)12
Total clemency acts Over 4,20012
Physicians pardoned At least 1 (Dr. Anthony Fauci)345
Other physician pardons Not publicly documented617

Key Takeaways

  • Biden set records for acts of clemency, but the number of official presidential pardons ranged from 80 to 15812.

  • Dr. Anthony Fauci is the only widely documented physician known to have received a pardon from Biden345.

  • There is no evidence that large numbers of physicians were pardoned, and data for ordinary recipients does not typically include details about professional background617.

  1. https://www.pewresearch.org/short-reads/2025/02/07/biden-granted-more-acts-of-clemency-than-any-prior-president/
  2. https://www.axios.com/2025/01/17/biden-presidential-pardons-clemency-record
  3. https://www.chiefhealthcareexecutive.com/view/why-president-biden-pardoned-anthony-fauci
  4. https://www.nbcnews.com/politics/joe-biden/biden-issues-preemptive-pardons-milley-fauci-jan-6-panel-members-polic-rcna188368
  5. https://apnews.com/article/biden-trump-fauci-milley-pardons-january-6-3cba287f89051513fb48d7ae700ae747
  6. https://en.wikipedia.org/wiki/List_of_people_pardoned_or_granted_clemency_by_the_president_of_the_United_States
  7. https://www.justice.gov/pardon/clemency-recipients
  8. https://www.justice.gov/pardon/pardons-granted-president-joseph-biden-2021-present
  9. https://www.aa.com.tr/en/americas/factbox-biden-leads-us-presidents-with-8-064-pardons-as-more-than-45-000-have-been-issued-since-1775/3459194
  10. https://www.presidency.ucsb.edu/documents/icymi-president-biden-grants-clemency-approximately-1500-americans-including-military
  11. https://nymag.com/intelligencer/article/joe-biden-clemency-list-pardons-commutations.html
  12. https://www.nbcnews.com/politics/white-house/biden-record-most-pardons-commutations-2500-nonviolent-drug-offenses-rcna188081
  13. https://www.justice.gov/pardon/commutations-granted-president-joseph-biden-2021-2025
  14. https://www.newsweek.com/full-list-joe-bidens-last-minute-pardons-marcus-garvey-2017376
  15. https://www.npr.org/2025/01/17/g-s1-41788/biden-pardons-commutations-drug-sentences
  16. https://bidenwhitehouse.archives.gov/briefing-room/statements-releases/2025/01/17/clemency-recipient-list-8/
  17. https://bidenwhitehouse.archives.gov/briefing-room/statements-releases/2024/12/12/fact-sheet-president-biden-announces-clemency-for-nearly-1500-americans/
  18. https://www.nytimes.com/2025/07/13/us/politics/biden-pardon-autopen-trump.html
  19. https://www.justice.gov/pardon/clemency-statistics
  20. https://www.newsweek.com/biden-pardons-fauci-trump-list-2098567

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GLAD YOU ASKED: what happens to your correspondence sent to Congress

Posted on July 20, 2025 by Pharmaciststeve

Your question is an excellent one and reflects what many constituents wonder about communication with their members of Congress.

How constituent emails are actually processed:

1. Automated Sorting & Keyword Scanning

  • Most Congressional offices receive thousands (often tens of thousands) of emails, letters, and phone calls every month.

  • To cope with the sheer volume, they use constituent management software (examples: Intranet Quorum, IQ; Congress Plus) that can:

    • Automatically “read” messages using optical character recognition (OCR) if needed.

    • Scan for keywords (like “Social Security,” “Medicare,” “abortion,” “Ukraine,” etc.) or issue categories.

    • Group similar messages together (called “batching”).

2. Staff Review

  • Most offices have a team of constituent services staffers (or interns) who are responsible for handling communications.

  • These staffers read a sample from each batch and may individually review some messages, especially those that are unique, personal, or complex.

  • If your message stands out—such as including a compelling personal story or being written in your own words—it’s more likely to be read by a human.

3. Template Responses

  • The software or staff then generates a template (form) letter based on the identified topic.

  • These responses are often personalized with your name and may reference your town or the specifics you mentioned but are largely pre-written and not individually crafted.

4. Exceptions

  • Personal, hand-written, or unique stories are FAR more likely to be read by a real staffer and potentially passed to the member of Congress.

  • Messages from constituents (i.e., people who actually live and vote in the district/state) are prioritized over messages from outside.

5. Direct Member Involvement

  • Members of Congress rarely read constituent emails themselves, unless flagged as especially significant. They may get weekly or daily briefings about the volume and topics of constituent communications.

Summary/Table: What Happens with Your Email?

Type of Email Likelihood of Human Review Response
Form email (pre-written, mass) Low; mostly scanned for keywords Template reply
Unique, personal story Higher; more likely to be read by staff More personalized
Hand-written letter Highest chance of personal attention Personalized

How to Get Noticed

  • Write in your own words

  • Include personal stories

  • Specify your connection to the district/state

  • Avoid sending only form letters from advocacy groups

In short:
Most congressional emails are initially processed automatically for key words and topic, which trigger a template reply. However, unique or heartfelt messages do get more attention from staffers, and all messages contribute to how the office measures constituent opinion.

If you want to maximize the chance of your message being read—write a personal, concise, and heartfelt message and mention your background and connection to the local area.

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Things are changing – will Walgreen’s pts like the changes?

Posted on July 20, 2025 by Pharmaciststeve

If you patronize a Walgreens store, you might want to consider some other pharmacies in your market place. I got this – below – email solicitation from Walgreens last week and sent me out another one today. It looks like a fair number of their existing  Pharmacists have left or have turned in their notice, because they are seeing “the writing on the wall” and what is probably going to happen after Sycamore Partners acquires Walgreen’s stores. Many will be sold or closed. If two Walgreens stores are merged, the staff from one store will be laid off and will be closed and all the Rx business will be transferred to the store that remains open and if Walgreen follows their previous procedures, no additional staff will be added to the store that remains open. Resulting in longer waits for pts and overall poorer service.

https://www.pharmaciststeve.com/walgreens-woes-retail-pharmacy-giant-reportedly-weighing-private-equity-sale-to-sycamore-partners/

Dear Steven,
We’re excited to share several rewarding career opportunities for Pharmacists and Pharmacy Managers across Indiana in locations including Franklin, Greenwood, Seymour, Indianapolis, Bedford, Aurora, Madison, Greenfield, Carmel, and surrounding areas.
Why consider these roles?
  • Competitive compensation packages tailored to your experience
  • Generous sign-on bonuses available for many positions
  • Relocation assistance to make your move seamless
  • Supportive work environments with opportunities for professional growth
Whether you’re looking to advance your career or explore new communities, these roles offer the perfect balance of great pay, excellent benefits, and vibrant local areas to call home.
Interested in learning more? Email or call me, we’d love to help you find your next opportunity!

Sycamore Partners a private equity firm based in New York that specializes in retail, consumer, and distribution-related investments. Founded in 2011 by Stefan Kaluzny and Peter Morrow—both former executives at Golden Gate Capital—the firm has grown to manage approximately $10 billion to $11.2 billion in assets under management. Its investment philosophy centers on partnering with management teams to improve the profitability and strategic value of portfolio companies, offering flexible capital structures tailored to individual business needs

.Sycamore Partners has made a series of high-profile acquisitions, especially in the retail sector. Its portfolio has included or currently includes brands such as Staples, Belk, Hot Topic, Torrid, Talbots, The Limited, Ann Taylor, Lane Bryant, LOFT, and Rona Inc.

. The firm is also active in acquiring distressed or undervalued assets, often taking public companies private and working to restructure or revitalize their operations

.As of 2025, Sycamore Partners is in the process of acquiring Walgreens Boots Alliance for about $10 billion, marking one of the largest recent transactions by the firm

.The firm is privately held, employs between 51-200 people, and is headquartered at 9 West 57th Street, New York, NY

how many stores did they have before Sycamore invested into them and how many stores does each have today?

Below is an overview of approximate store numbers for key brands before Sycamore Partners invested and their current counts as of 2025. For some chains, historical figures are reported either nationally or for key regions, based on available data.

Brand Stores Before Sycamore Investment Stores in 2025 Notes
1,559 (US + Canada, 2017) 933 (US, 2025) Significant store reduction after Sycamore’s acquisition in 201712.
~300 (2015) 290 (2025) Store base remained relatively stable345.
~600 (2013) [unknown] Still operating but current exact number not available6.
650 (2024) ~470 (2025 projected) 180 stores closing in 2025, representing about 30% of the footprint789.
516 (2012) 516+ (2025) Stable national store count, per recent reports10111213.
981 (2012, Ann Inc. total) [unknown] Extensive closures after 2020 bankruptcy; precise current figure not disclosed1415.
367 (2024) 338 (2025) Reduced count post-Sycamore and bankruptcy restructuring1617.
[unknown] 506 (2025) Count as of May 2025—historic figures before acquisition not clearly documented18.
[unknown] (hundreds pre-2017) 0 (physical, 2025) Closed all stores by 2017; online brand may persist19.

  • has seen the largest drop, shrinking from over 1,500 North American stores in 2017 to fewer than 1,000 U.S. outlets today1202.

  • has mostly maintained its store presence, despite bankruptcy and restructuring345.

  • is in the process of significant downsizing, with nearly 30% of stores to be closed this year789.

  • has also reduced its footprint but remains a notable national plus-size chain1617.

  • ’ store count has been relatively stable through private equity ownership1013.

  • Hot Topic, Ann Taylor, and LOFT: Only partial or historical data are available; all remain in business but with evolving store strategies61418.

Brand-level totals and timing are estimates, as precise historical and current numbers are not always disclosed by all companies.

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Modern Medical Mafia

Posted on July 19, 2025 by Pharmaciststeve

The PBM’s share a number of things that another entity seem to do.. except they didn’t want to generate more revenue, other than increasing their operating budget, but they (DEA) are seriously involved in denying care.

Filed under: General Problems | 1 Comment »

Another incident where allegation is more important that pts getting their medications

Posted on July 18, 2025 by Pharmaciststeve

It would appear that law enforcement in Florida has GONE BAT-SHIT-CRAZY.

In one high-profile case, undercover officers purchased fentanyl laced with xylazine from a dealer in a Publix parking lot, leading to felony trafficking charges.

That substance mentioned above was ILLEGAL FENTANYL ANALOG ADULTERATED WITH THE VET MED XYLAZINE.

I am not an attorney, but I have owned commercial rental property once upon a time and unless Publix owns the shopping center – which I doubt – any problem in the parking lot will fall back on the property owner.

“I live in Palm Beach County and have been filling my pain medications at Publix for 15 years.
I was told today that my doctor is on an internal list of doctors being “investigated” for “over prescribing.”
I was told this was because Publix recently got in trouble with the DEA.
Does this mean my doctor is under DEA investigation? Can Publix refuse to fill for me even if my doctor has an active medical license in good standing?
I couldn’t get a straight answer from the pharmacist on if this was a list Publix made or if the DEA was somehow involved…apparently there are at least 10 other doctors on this list…”

 

Judge sides with Publix in fatal shooting lawsuit
Florida Publix shooting leaves multiple dead, including suspect
Publix allegedly required nonexempt assistant managers to ...

  • :
    Publix has been named in federal lawsuits related to opioid dispensing practices. Records indicate that Publix was one of the largest sellers of oxycodone in Florida by 2019, and some lawsuits allege the company failed to properly monitor suspicious opioid prescribing and dispensing patterns within its pharmacies. However, as of early 2024, the DEA has not undertaken public enforcement actions specifically targeting Publix for criminal wrongdoing. These matters appear to be part of broader civil litigation over national opioid distribution, rather than a targeted DOJ/DEA investigation exclusively into Publix in Palm Beach County1.

  • Drug Trafficking Intersections (Not Direct Publix Investigations):
    Law enforcement agencies, including the Palm Beach County Sheriff’s Office, have conducted major multi-agency investigations into retail theft and drug trafficking that at times intersected with Publix locations—such as illicit transactions occurring in Publix parking lots. In one high-profile case, undercover officers purchased fentanyl laced with xylazine from a dealer in a Publix parking lot, leading to felony trafficking charges. These operations targeted criminal networks and drug dealers operating in the area, not Publix or its corporate practices directly2.

  • :
    Publix has participated as a partner with law enforcement in investigations and press conferences related to major retail theft rings. These theft rings targeted Publix and other large retailers, leading to the arrest of multiple suspects. Again, the focus was on criminal organizations stealing from Publix, not on Publix being under investigation itself34.


  • There have been lawsuits and allegations around labor practices and personal injury claims at Publix locations in Palm Beach County, but these do not involve DOJ/DEA criminal investigations56.

:
There is no evidence as of July 2025 of Publix in or around Palm Beach County, FL being the subject of a federal Department of Justice (DOJ) or Drug Enforcement Administration (DEA) criminal investigation. The most relevant connections to DOJ/DEA interests involve Publix’s historical role as an opioid pharmacy (primarily scrutinized in broader civil litigation) and instances where Publix premises were used by outside individuals for criminal activities. The DEA has declined to comment on Publix’s opioid sales history, and no enforcement actions are publicly listed against Publix by the DOJ or DEA for activities in this region123.

Add to follow-up
Check sources
  1. https://kffhealthnews.org/news/article/tampa-bay-publix-pharmacy-opioids-crisis/
  2. https://cbs12.com/news/local/tranq-laced-fentanyl-meth-cocaine-drug-trafficking-ring-busted-in-palm-beach-county
  3. https://cw34.com/news/local/operation-on-the-fence-substantial-multi-agency-bust-retail-theft-criminal-network-pbso-credits-success-of-operation-on-the-fence-to-community-retail-partnerships-palm-beach-county-sheriffs-office-october-26-2023
  4. https://www.wptv.com/news/state/operation-on-the-fence-nets-14-suspects-in-south-florida-retail-theft-case
  5. https://www.wptv.com/news/local-news/investigations/55-current-former-department-managers-now-suing-publix-over-accusations-of-denied-overtime-pay
  6. https://datnylaw.com/publix-supermarket-accidents/publix-lawsuits-florida-accident-attorney/
  7. https://www.justice.gov/usao-sdil/pr/timeshare-owners-re-victimized-florida-telemarketer-promising-court-ordered-restitution
  8. https://cw34.com/news/local/man-arrested-on-30-counts-of-child-pornography-possession-publix-the-villages-west-palm-beach-police-department-ip-address-south-florida-news-may-1-2025
  9. https://www.youtube.com/watch?v=YEyAMi01GH0
  10. https://www.royalpalmbeachfl.gov/manager/page/statement-regarding-june-10-2021-publix-shooting
  11. https://www.wptv.com/news/state/18-publix-department-managers-join-federal-lawsuit-claim-they-worked-off-the-clock-without-pay
  12. https://www.cbsnews.com/news/publix-shooting-florida-royal-palm-beach-gunman-identified/
  13. https://htv-prod-media.s3.amazonaws.com/files/varone-v-publix-complaint-1666234806.pdf
  14. https://www.dea.gov/sites/default/files/pubs/states/newsrel/mia072805.html
  15. https://law.justia.com/cases/florida/fourth-district-court-of-appeal/2024/4d2023-1633.html
  16. https://bbpd.org/police-arrest-woman-who-shot-man-during-drug-deal/
  17. https://www.clarkfountain.com/blog/clark-fountain-files-lawsuit-against-boars-head-and-publix-following-listeria-outbreak-2/
  18. https://www.instagram.com/reel/DDshfvhzxWP/
  19. https://cbs12.com/news/local/judge-sides-with-publix-supermarket-grocery-store-in-fatal-shooting-lawsuit-royal-palm-beach-appeal-july-10-2024?photo=1
  20. https://www.justice.gov/usao-sdfl/pr/three-charged-west-palm-beach-federal-court-conspiring-traffic-crystal-meth

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.DISMISSED!!!!! Montana Board of Medical Examiners’ Dr. Ibsen “Screening Panel”

Posted on July 18, 2025 by Pharmaciststeve

DISMISSED!!!!! Montana Board of Medical Examiners’ Dr. Ibsen “Screening Panel”

 

Filed under: General Problems | 4 Comments »

President Trump signed the “One Big Beautiful Bill” How will it impact doctors?

Posted on July 16, 2025 by Pharmaciststeve

I remember when Pres Johnson created his “Great Society” in 1965, which brought us Medicare & Medicaid. I was in  the second class of Baby Boomers to graduate High School in 1965. The last baby boomer was born in 1964 and so the bureaucrats had a stream of new 76 million new tax payers over the next 18 yrs.

Those born in 1900 By age 65, only about 2% of males and 2.3% of females from the original 1900 birth cohort were still alive

Those born in 1910  47.6% of Males and 34.7% females died before 65 y/o

Those born between 1946 and 1964 (Baby Boomers)

Approximately 25–30% of baby boomers in the United States died before reaching age 65

Approximately 70%-75% will live until 65 y/o

Medicaid plus CHIP: 23% of the population, (78.6 Million) which includes 41% of all U.S. children and 15% of adults

In 2025, about 40% of U.S. households—approximately 76 million “tax units”—will pay no federal individual income tax

roughly 65 million people in 2025 (based on a U.S. population near 330 million) who are not contributing to Social Security or Medicare through payroll taxes

The problem with socialism is that you eventually run out of other peoples’ money.

Margaret Thatcher

I see a mass exodus of primary care physicians and most office practices will be “stacked” with mid-levels. PA, NP, APRN, and maybe some PharmD. Currently services provided by mid-levels is reimbursed by insurance at 85% of what a MD would get reimbursed, but mid-levels don’t get paid 85% of MD get paid. We may even seen a fair amount of self-care using a AI systems.

Our healthcare system seems to be on the brink of a major transformation – to what – I am not really sure

 

Five Ways Trump’s ‘Big Beautiful Bill’ Impacts Doctorshttps://www.medpagetoday.com/washington-watch/washington-watch/116518After President Trump signed the “One Big Beautiful Bill” into law on July 4, the question remained: How would it impact doctors?With more than $1 trillion in cuts to Medicaid and the Affordable Care Act over a decade, the mega-bill “represent[s] the biggest rollback in federal support for health coverage ever” according to Larry Levitt, executive vice president for health policy at KFF, an organization that researches issues in healthcare. Here are five ways physicians will be impacted by the law.Swamped Emergency DepartmentsBetween a decrease in the Medicaid rolls — largely due to the law’s imposition of a federal work requirement — and the expected expiration of the Affordable Care Act’s enhanced premium tax credits, an estimated 17 million people will lose their health insurance between now and 2034, according to KFF. And for emergency departments (EDs), fewer insured patients equals more uncompensated care.Joanne Conroy, MD, president and CEO of Dartmouth Health, which provides primary and specialty care throughout New Hampshire and Vermont, said about 10% of New Hampshire residents and one-third of Vermonters are on Medicaid. When patients lose insurance such as Medicaid, they don’t see a doctor and don’t get their medications. “Their healthcare kind of goes sideways, and they end up in our emergency rooms with healthcare conditions that are much more serious than if they’ve been addressed ahead of time,” Conroy said.Alison Haddock, MD, president of the American College of Emergency Physicians, agreed, telling MedPage Today that the health system isn’t functional if the ED is the only place patients receive care, because patients come to the department potentially much sicker.Looming Hospital Closures, LayoffsOver the last decade, a “huge swath” of small hospitals in central New Hampshire have closed their obstetrics departments, Conroy said, and now, with Medicaid cuts looming, some others are beginning to restrict services and lay off physicians. And if patients don’t have care they can walk to or care they can access with a short ride, they don’t get care, she added.UC San Diego Health recently cut 230 positions, blaming, in part, “federal impacts to healthcare” and “regulatory uncertainty.”A Medicare Payment Bump — But It’s InadequateAmerican Medical Association (AMA) president Bobby Mukkamala, MD, said changes the AMA sought that would have tied Medicare physician payment to the rate of inflation disappeared from the final bill. The law does include a 2.5% 1-year increase in the Medicare Physician Fee Schedule beginning in January, but both Mukkamala and Haddock said that was insufficient.For emergency physicians, seeing more patients with poor or no coverage — and trying to serve them with fewer staff and resources — has consequences. “When you’re trying to do more with less, constantly … It leads to that moral injury, that burnout, that has people saying … ‘This is not a sustainable job,'” Haddock said.Mukkamala, an otolaryngologist in Flint, Michigan, agreed. While he can diagnose a patient’s throat cancer, “Then what?” he asked. “Where are they going to get chemotherapy? Where are they going to get radiation therapy?” Without health insurance, the patient likely can’t get follow-up treatment and their cancer will grow exponentially, he said, adding that continued stress from these types of situations can lead physicians to early retirement.A Shrinking Physician Pipeline Those early retirements are compounded by a provision of the bill that caps unsubsidized federal loans for professional degrees at $200,000 over a lifetime.Medical student debt is on average a quarter of a million dollars, Mukkamala said. Even for those whose passion was to become a physician and help people, “the math” just may not allow them to pursue what they love. That could really hurt subspecialty care, especially in rural areas, according to Manan Trivedi, MD, MPP, a hospitalist in Washington who participated in a webinar hosted by the nonprofit Protect Our Care.“In the middle of the country, there could be two orthopedic surgeons in all of rural Nebraska, and now there might not be any because of this bill,” Trivedi said. “And so the sum of these sorts of hidden things in this bill, like the loan caps, are really going to have a significant impact.”Growing Maternity Care DesertsOne provision of the law — a provision which was temporarily blocked by a federal judge on July 7 — bars Medicaid funding for Planned Parenthood for 1 year. This provision is especially concerning to ob/gyns because Planned Parenthood provides a range of reproductive health services, including preventive care. Many of the clinics expected to close as a result of the provision are located in areas where services were already sparse, according to Sarah Bogdan, director of federal affairs for the American College of Obstetricians and Gynecologists.“Care deserts are likely to grow,” she said in an email to MedPage Today. Since ob/gyns practicing in care deserts are already struggling with large patient volumes, clinic closures will only add to their patient load, said Bogdan.

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