Locums and Lunacy

I've been trying to tell you that there's a Big Business scam raking in BEAUCOUP bucks, making a mess and dumping it on Obamacare.  Here's the scam.
Places - ESPECIALLY THE  WITHHELD, dig - pretend to be hiring doctors.  They post ads.  They collect resumes.  They whine and say that nobody's applying. 
They take these "unfillable" positions and BUNDLE THEM AND SELL THEM to BIG national physician enrollment firms doing "locum tenens" work.  If "your primary care doctor" is changing every six months, that's probably because they use locum tenens warm-bodies to fill the slots.  The locum tenens docs are cheaper - they are on "contract" and have no benefits - not even HEALTHCARE, for God's sake!  And if they don't zip the lip, and complain - they get walked off the premises - problem solved for management.  Henry Ford would be impressed!

Presto!  The WITHHELD gets a 30% discount over hiring someone; everyone gets bonuses.  The WITHHELD gets a guy or gal who's spent the last six months in Vermont or West Virginia; and after this shift, will move on to North Dakota or Nevada.  There are even some "trailer-parks" for the locums.  Campesino medicine, you betcha!  Move along, now, boys, move along!  Locums work is considered to be valuable for newly-divorced doctors who are single moms.  If you can get everyone into a Winnebago, and they're out of diapers, it's Partridge Family Time! (Or Joad family, or Dr. Snopes MD)  No ties to the local medical community; and no 'problems.'

Who owns the physicians?  Well, it's the big national locums companies, of course.  The whole racket probably moves a billion dollars a year through it, and with that sort of money comes friends - Federal friends and local friends.  Some physician becomes incontrollably independent, or just can't keep their yap shut, or goes to some liberal social awareness meeting against the hospital - zam!  That's it for you!  Once you work for locums companies, your "professional references" come from those companies.  Patients don't care for you?  Too bad - bye!  Maybe that's why the suicide rates are up for MD's.  As if anyone cares.
Everyone wins - even the patients; they get death benefits and a burial at the cemetery of their choice.  Box'em up, boys, this is for-profit medical care.

Best of all - answer all the complaints with "Obamacare!"  Now, this slick system's been in place for a dozen years, building and building - and the cost of medical care hasn't been plummeting along with it.  So the next whizbang techo-revolution that's coming to deal with the "pending doctor shortage," remember that it's a PLANNED pending doctor shortage - including at the WITHHELD.  Increased patient autonomy, freedom of choice, app-based self-diagnosis and self-treatment - remember, that's all they have in Guyana and Zimbabwe.  The vast majority of people never will see a doctor in their life.  And maybe, maybe that's the future for you, too.  Do you feel lucky to be an American, modeling our future on Turkish and Kenyan medical care?  I used to think we did things the other way around, were a beacon to the rest of the world.  Oh, well.

On Liberty

It was, of course, impossible to simply erase a concept - such things are not necessary, are intolerable in the world of propaganda.  One needs to jellify the words into having no comfortable meaning. That way, they can be brought forth now and again when necessary to salt their original meanings into the dialogue, but carefully-carefully.
Liberty is such a word.  We insist that we Americans are passionate defenders of liberty; but of course, we are no such thing.  We can barely distinguish between frank tyranny and ordered liberty.  What we so aggressively demand in the name for liberty, is the access to those things that allow us to conform in keeping with our station.  Such things as welcoming Condoleeza Rice into the Augusta Golf Club, that is put forth as progress, somehow meriting the approval of the ghosts of civil rights leaders.  Any Mercedes dealership that would turn away Dexter King or another King child would be roundly booed.  In one's station, one has the right to purchase the symbols of it - that is Liberty.  And so, you see - it is a comfortable elitism, like carrying the SS dagger.  That is Liberty, in the sense we convey the new word order. 

Coffee (continued)

The gazes began to patter onto her face like soft April rain; one, and yet another, and there's another.  They were warm and friendly; she did not mind - they seemed innocent.  Then one boy let out a snicker, quietly and choked-off, sounding like stifled prurience.  That annoyed her.  The gazes continued, onto the Professor and the Priest; now they seemed to have turned cold, unseasonable.  She spoke more with the Priest, appearing absent-minded; she was toying with her iPhone as she spoke.

Abruptly, she stood and told the Priest,

I must go and prepare for class.

In pasing the table, she stopped, and looked at the red-faced boy.  He was smiling wickedly, as though holding a small and dirty secret behind his lips.

Mr. Tromblay, she said.

I see that you are preparing to come to class in a half-hour; refreshed, relaxed, and of course completely prepared.

He jerked up at the call of his name; his eyes widened.  The class was a hundred people, not small; and this was only the second week.  He was not clever enough to realize she was scanning for his photograph on the roster of the iPhone shortly before she visited.  He thought; several thought she was witchy.  She did not correct him.  Witchy, indeed.

As she walked past, the table stirred in discomfort.  A few steps further, they lit out like a frightened flock of pigeons chased by a terrier.  Dirty little minds, she thought; dirty little minds.  Ah, we're early on still in the coursework.  She did not look back at the Priest.

At coffee before the class.

If I may say, Professor (X), you have a bit of the  modus vivendum, perhaps of the teaching orders, no?  Josephines, perhaps?  Admirable.

I'm Jewish.

A blistering volley.

Joan stirred the foam on her coffee indolently.  His air of self-assurance was irritating her.

I thought that you might have been raised Catholic...

She looked up, caught his eyes.

You thought that I thought...?  I'm not interested in your incorrect speculations.  You're pretty arrogant, even for a Jesuit.

He smiled, eyes downcast, complimenting her starchiness.  His thick brushy black mustache lifted at the corners, no contempt there.  There was no uncertanty about her; her black eyes flashed.  A warrior, a thinker; but not bellicose.  Scrupulous, intolerant of mush; she would have been a right bit for a few of his canon law professors to wrangle with.

Wisely, he kept any further speculations to himself.  There was something fascinating about her, mysterious - what was this path that brought her to the Heights?  He sniffed the air - there WAS starched cotton, somewhere.  An order of some sort, definitely.  And the personality to trust.  If they were in the jungle, he would be quite reassured to have her on his side in a firefight, indeed.

A scarf on the neck, he mused - perhaps for tzniut, the miṭpaḥoth covering the raven hair that flowed down from the nape of her neck.  Una delgada chales de pelo sobre los hombros por la modestia, this woman who would seem to have no modesty.  The Spirit was within her, and defended with a raw ferocity.  But there was no malice, or spite.  This was perhaps the most intriguing woman he had spoken with in a long, long time.  Assume nothing; she was quite acclimatized to victory, although she did not seem to covet it. 

Here, no question - she was the master, the Professor; he was the Student.  That structure gave each an easy domain to traverse; she was on the second floor, and he on the first.  he would not challenge her command of the pack; in fact, he was entertained and pleased to see someone so easy and fit at command.

Ran across some interesting Smith...

Adam Smith, The Theory of Moral Sentiments, On the Character of Virtue VI.II.42

The "Man of System" is discussed.  It appears that this is a person who does not come up with his worldviews pragmatically or empirically, but according to an ideal - Socialism, Platonism &c.

The man of system, on the contrary, is apt to be very wise in his own conceit; and is often so enamoured with the supposed beauty of his own ideal plan of government, that he cannot suffer the smallest deviation from any part of it. He goes on to establish it completely and in all its parts, without any regard either to the great interests, or to the strong prejudices which may oppose it. He seems to imagine that he can arrange the different members of a great society with as much ease as the hand arranges the different pieces upon a chess-board. He does not consider that the pieces upon the chess-board have no other principle of motion besides that which the hand impresses upon them; but that, in the great chess-board of human society, every single piece has a principle of motion of its own, altogether different from that which the legislature might chuse to impress upon it. If those two principles coincide and act in the same direction, the game of human society will go on easily and harmoniously, and is very likely to be happy and successful. If they are opposite or different, the game will go on miserably, and the society must be at all times in the highest degree of disorder.