Post Date: 05/22/2016

The Raving Over VA Reform

Once again the VA is under attack from the right. Here are some thoughts from 34 years in the trenches.

On a midnight dark and hazy, I was thinking, “Are they crazy?”
As I poured o’er stacks and stacks of madd’ning bureaucratic lore.
Suddenly I heard a tapping; something at my door was rapping,
Or inside my head was snapping, snapping I could not ignore.
“T’is some windbwlon branch,” I muttered, “on the wall outside my door.”
“Only this and nothing more.”

All that night I had been reading regulations superseding
Reason, thought, ideas, ethics, morals, truth, and furthermore,
From the bureaucratic treacle rose aromas faintly fecal,
As from drugs shot intrathecal; my poor brain could stand no more.
Noise persisted, perhaps cecal, so I still dismissed the door.
But I erred, for there was more.

Yes, there was incessant tapping that prevented me from napping
So I was compelled to rise and open up my study door.
“Fate,” I cried, “you witch, you vixen!” There stood ghosts of Richard Nixon
And a bureaucrat just fixin’ there to tread my study floor
And to randomize the paper piles I’d left there by the score,
Thus to haunt me evermore.

Bureaucrat and politician, why this hated apparition?
Were they real or was I dreaming up this awful metaphor?
In the midst of my confusion both the specters made intrusion,
Real or simply some illusion, boldly entered through my door.
In response my sphincters quivered and my ears began to roar
While sweat poured from every pore.

Warily came my petition, “Specters, tell me of your mission,”
“Is your message helpful or the settling of some ancient score?”
First to speak, the politician, brooding but without contrition,
Told me of a new transition we must all be planning for.
“You will now become a business, not like practiced here before.”
“Heed these words, then I have more.”

“Services will still be rendered, patient care nor access hindered.”
(Just as past reforms have hindered neither one of these before.)
I experienced palpitations and more gastric perturbations
At the pregnant implications that his message held in store.
And our funding, too, would flatten as we opened up the store.
At this thought I cursed and swore.

Frightened, filled with apprehension, helplessly I turned attention
To the bureaucrat now lounging on the couch beside my door.
“Bureaucrat, Oh, please unfetter regulations by the letter,
Or it’s hopeless to be better, better than we were before.
Patients all will lose their patience and abandon us, wherefore
We’ll go broke forevermore.”

Solvency requires recruiting healthy patients, thus diluting
Those who need our services, else our premiums will soar.
If we’ve really started thinking, we want no one who is drinking,
Smoking, shooting, growing, shrinking, never mind a matador.
We must find someone who’s young and never once been sick before.
Those are rare among the poor.

Ponzi schemes are necessary; cutting costs is secondary;
We must sell our services to folks we’ve never served before.
There’s no profit fantasizing, what we need is merchandizing,
Making deals, no moralizing; that’s how you run up the score.
Capitation plans survive on patients healthy to the core.
Only these and nothing more.

But the bureaucrat was snoozing, neither listening nor musing,
So I had to loudly ask the question I had asked before.
(Bureaucratic soporific has, if I may be specific,
Proved beyond all scientific doubt to cause us all to snore.
And, if we did not awaken, we would be condemned to more
Of the same forevermore.)

Blanketed by regulations, cozy contraindications
To activity, the specter once again began to snore.
“Bureaucrat!” I cried imploring, “For the love of God, stop snoring.”
“Everyone must start exploring ways we can complete this chore.”
“We must start our business planning lest the wolf blows down the door.”
“Failing this, we’ll be no more!”

Laughing then, the politician exited, an old tradition.
He would watch his plans unfold from somewhere on a distant shore.
Distance equals insulation, if not outright abdication,
And, of course, there’s exculpation if mistakes mount by the score.
Maybe he could raise our patient base if he would start a war.
At that thought I swore once more.

Still the bureaucrat is sleeping on my sofa, never peeping,
Like a bum upon a park bench with newspapers covered o’er.
And the meaning of his resting? Does it mean the gods are testing
My resolve, or are they jesting with this cosmic metaphor?
I can draw but one conclusion: when assigned to any chore,
He shall snore forevermore.

Stephen Baird, M.D. ©1994-2016
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