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I've just seen an article from the American Academy of Family Physicians that more and more solo and small practices are closing.

Call your Congressperson, because the thing that is most likely to close my small clinic and clinics near you is the latest healthcare bill passing.

That is, to be even more specific, the thing that will most likely close MY one doctor clinic is THAT I WON'T BE ABLE TO AFFORD HEALTH INSURANCE.

Really? Oh, yes.

I was sick for ten months, June of 2014 until April of 2015. I managed to hire a physician's assistant by November of 2014 and I returned to work April of 2015. I was only allowed to work half time initially, for a year. Actually, quarter time. Because the latest article on primary care has average salaries. What interests me is that every doctor they interviewed who is earning the "average" is working 60-70 hours a week.

So when I returned to work I was allowed to work half days. That is, four hours a day. So, 20 hours a week. One third to one quarter time.

Also I was paying for my own insurance and I had a $5000.00 deductible. Which I had to pay in both 2014 and 2015. I also had to spend retirement money and savings to keep the clinic open. Negative earnings and using up savings in 2014 and 2015 and 2016. I worked 20 hours a week for a year. And guess what? My income for 2015 qualified me for Obamacare in 2016.

No deductible. By April of 2016 I am released to "full time". But I have learned my lesson. My sister died in 2012 and my father in 2013 and these deaths were the trigger for me getting sick. I can't retire yet. I have burned through savings for three years. I choose to work 40 hours a week.

This means that I stop seeing patients by 2:00 pm. I still do an eight hour day because there is at least three hours of phone calls, insurance prior authorizations, lab results, x-ray results, specialist letters -- like yesterday. The specialist says the patient should have an MRI. But the patient is a veteran. So the specialist says I should order it. That means filling out the paperwork for the VA authorization, mailing the order to the patient, calling the patient to remind them that triwest will throw my order away unless the patient calls to get the test authorized within ten days. Yep. And the specialist gets paid 3-4 times what I make. How nice.

I also choose longer visits. The local hospital kicked me out of their clinics because I protested about a daily patient quota. I was not diplomatic. And I don't care, because two years later they decided I was right and lowered it. And I like my private clinic better.

BUT if Congress passes this healthcare bill and I return to over $1000.00 per month health insurance for me and a 19 year old daughter, and with a $5000.00 deductible.... I don't know. I think I will run a Go Fund Me and ask President Trump and my Congresspeople to donate to pay my health insurance and keep me open.

And by the way: I think Congress should have the same health care as their constituents. Give the ones over 65 medicare and the ones under 65 medicaid. Let them experience what older Americans and disabled and poor experience. And don't let them bypass it with cash, either.

Call Congress. Stop the bill. Thank you.

So what is in the pending healthcare bill? Nobody really knows -- not even the people who are writing it -- except that it's bound to contain a bad mix of bureaucracy and horse trading.

Roughly seven and a half years ago, Mike Pence--now Vice President of the United States -- tweeted: "It's simply wrong for legislation that'll affect 100% of the American people to be negotiated behind closed doors." There was a reason the Democrats negotiated much of the substance of Obamacare in closed-door meetings. It was because they didn't want the public to see members of Congress having their votes blatantly bought by largess for their districts and favors for their friends. Most famously, Bernie Sanders' vote was cajoled by the addition of $10 billion for health clinics in Vermont, a benefit not extended to, quite frankly, much needier states. The Republicans simply put this on steroids for their own healthcare drafting process. This is in a sense similar to what happened with the judges. Democrats were miffed that Republicans were stonewalling Obama Cabinet nominees, so they changed the rules to eliminate the filibuster for them, allowing nominees to pass with 51 votes. Then the Republicans turned around and extended that to Supreme Court nominees as well. The same now goes for lawmaking -- the Republicans have simply taken the process the Democrats carried out, dispensed with the hearings (which are, often, simply a formality or public relations exercise, and contrary to appearances have far less influence on the final outcome of legislation than lobbyists acting in private) and kept the entire process behind closed doors.

And what is it that's going on behind closed doors? In this instance, the Republicans have a preciously slim 52-vote majority in the Senate -- something of an odd position to be in. The "majority rules" atmosphere means that this slim margin gives the Republicans absolute control over what Congress does, but only insofar as they can bring their party together. If all of the Republicans can get behind something, then Democrats are literally powerless to do anything about it. But this means as well that every single Republican knows that they can gum up this bill by not voting for it, and those who have something to gain by forcing the buying of their vote will be glad to do so. And that means earmarks, pork projects, little extras stuffed in to the benefit of one especially big campaign donor or another. And this doesn't even mean spending necessarily. For the purists, we don't know what if anything it does about contentious social issues like contraception and vaccination, medical rights of gay couples, or religious objections to various medical procedures. For the less pure, there are myriad manipulations of legislation available. For example, if a Senator has a buddy who owns a hospital which happens to have, let's just throw out there, an extra-large storage room for urine samples. That Senator will then get put in the bill a requirement that some certain kind of funding can only go to hospitals with a storage room for urine samples of X size (which just happens to include his buddy's hospital, and exclude its competitors). Rationalization for arbitrary and meaningless measures like this can easily be dreamed up after the fact. And it is really this sort of favor-buying which makes bills like these a bureaucratic mess, more than any effort to legitimately improve access to markets or the like.

So what will be in this bill? It will undoubtedly clock a book's worth of pages into which such provisions are well hid. So we might not know for years down the road. By which time, things always being cyclical, the other party will have taken over again and reversed this with whatever their new, similarly bought program is.

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