The Consequences of Socialized Medicine

[Paul's Here 0]

Massachusetts' shortage of doctors that has resulted from their universal health care system has initiated some innovative health care techniques: seeing groups of patients at the same time. Bend over, everyone.

When Dr. Gene Lindsey arrived to see his 4 p.m. appointment on a recent Thursday, his nine patients already were seated on folding chairs arranged in a semicircle around a table of snacks. Lindsey, a cardiologist, shook each patient's hand, rolled up his sleeves, and, for the next 90 minutes, examined them, one by one.

As he listened to lungs and hearts, he discussed their personal medical details out loud.

Since July, Lindsey has been seeing his Harvard Vanguard Medical Associates patients only in groups, formally called shared medical appointments. It's part of an ambitious plan by Harvard Vanguard to ease physician shortages, and reduce patient and doctor dissatisfaction over constantly feeling rushed during appointments.

Many patients, it turns out, are willing to sacrifice privacy and modesty for improved access to doctors. Patients willing to see their doctor in a group visit generally can get appointments far sooner. And many pa tients have similar problems and questions, and can learn from one another in the group visits. If a particular examination requires that a patient disrobe, the doctor and patient move into a private room for that portion of the checkup.

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When one patient said she wanted to cut back on a medication, Lindsey addressed the entire group. "Who else takes diuretics?" he asked. Three patients raised their hands. He launched into a several-minute explanation of when it's OK to skip their medicine.

"People came to me with similar complaints and I had these canned speeches," Lindsey said later, explaining one way group appointments save him time.

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When patients arrived for their appointment with Lindsey last week, medical assistant Sally Gaudaitis took their vital signs and gave vaccines in a small exam room next to the conference room where the patients sat. Supervisor Jennah Bergin required them to sign a confidentiality form, promising not to discuss other patients after the visit and allowing the doctor to discuss their own medical histories in front of the group.

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Harvard Vanguard is just starting to study the impact on access. But, in one example, a waiting list of 400 to 500 patients for the group's gynecology clinic in Burlington was eliminated in several weeks when the practice started offering group visits this summer, said Dr. Zeev Neuwirth, vice president for clinical effectiveness and innovation at Harvard Vanguard.

Now cough!!

[ewv 0]

You forgot to include the spoiler notice

Warning: There are spoilers about this policy in this post by inserting:

[size=5][b]Warning: There are spoilers about this policy in this post[/b][/size]

Obama is bringing this and more changes to everyone. Please follow the Forum rules.

[jwoodswce 0]

...and this is the Republican "alternative" created by Romney?

[Paul's Here 0]

You forgot to include the spoiler notice

Warning: There are spoilers about this policy in this post by inserting:

[size=5][b]Warning: There are spoilers about this policy in this post[/b][/size]

Obama is bringing this and more changes to everyone. Please follow the Forum rules.

Sorry. I should have put it in the Horror movie section.

[Paul's Here 0]

Just noticed I forgot to put the link in my post: The doctor will see all of you now

[ewv 0]

...and this is the Republican "alternative" created by Romney?

It was the alternative to what the Democrat legislature was about to do on its own and is in fact worse than the Romney proposal. It could have been, and in the future will be, worse.

[styg50 0]

I grew up on a ranch, and this is exactly how you are supposed to handle herd animals.

I don't see what the problem is.

[Carlos 0]

I grew up on a ranch, and this is exactly how you are supposed to handle herd animals.

I don't see what the problem is.

We very well may see the day where your herd animals can receive better medical care than that other conceptual animal.

[PhilO 0]

I grew up on a ranch, and this is exactly how you are supposed to handle herd animals.

I don't see what the problem is.

Vaccinating lots of individuals "for the good of society" (rather than for the sake of each individual) is dubbed herd immunity in immunology. That collectivistic view of human health has been creeping into the culture for decades now.

[styg50 0]

I grew up on a ranch, and this is exactly how you are supposed to handle herd animals.

I don't see what the problem is.

Vaccinating lots of individuals "for the good of society" (rather than for the sake of each individual) is dubbed herd immunity in immunology. That collectivistic view of human health has been creeping into the culture for decades now.

We very well may see the day where your herd animals can receive better medical care than that other conceptual animal.

I agree guys, its serious, and it seems to be on pace for steady growth in the future.

I was wondering about what was being lost in the above example of medical care. I thought for a while about the issue of privacy, and how the article goes out of its way to indicate that modesty is observed if someone has to disrobe. But what the article skips over seems to be the lack of qualified doctors. Fewer doctors with larger workloads. The article indicates both halves of this formula, but fail to connect them in the crucial statement of socialized medicine: the type of independent mind that would work to become doctor, is one of the least likely to accept a position of priveleged servitude. In short, if you have what it takes to be a doctor, chances are you won't make a very good slave. The attitude of the doctor in the article is a good example of this. Despite the wideranging implication of needing to treat 10 patients at a time he saw it as a challenge he could successfully do, and he felt that it made him more productive because of nuances of the insurance payments, where he would make more money in less time.

Obviously, when insurance companies catch on, and government force gets involved, he WON'T be more productive any longer. He will end up treating more patients more efficiently than ever, and not getting paid for the increased productivity. And when the doctor wants to go back to individual visits, where he actually got paid for his time, he will be forbidden to, and he will find himself choosing between servitude and his career.

Same story as always, the producers are told to do more and more until they have the sense to shrug. At that point, I would say it is the herd who is in danger of not getting satisfactory medical care. The conceptual animal will have the upper hand because he will be able to trade with the doctor. Any one in the herd who wants similar benefits is going to have to come to grips with some rational principles, even if all they figure out is that they need to pay for what they get...

[Carlos 0]

The article indicates both halves of this formula, but fail to connect them in the crucial statement...

That one statement could succinctly describe just about every problem on earth and it's accompanying inadequate media discussion!

[Paul's Here 0]

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Same story as always, the producers are told to do more and more until they have the sense to shrug. At that point, I would say it is the herd who is in danger of not getting satisfactory medical care. -------------

See the Taggart Tunnel scene in Atlas Shrugged.

[Paul's Here 0]

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Obviously, when insurance companies catch on, and government force gets involved, he WON'T be more productive any longer. He will end up treating more patients more efficiently than ever, and not getting paid for the increased productivity. And when the doctor wants to go back to individual visits, where he actually got paid for his time, he will be forbidden to, and he will find himself choosing between servitude and his career.

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Or the patients will be forbidden to go back to a system of individual treatment because of the increased social costs. And the patient will find himself choosing between his slave and his life.

[Arnold 0]

Perhaps one day someone in power will come to the conclusion that not only does everyone have a 'right' to education and health care, but something even more vital to life, food. So, as they do with socialized medicine, what will be required is to sign the bill at a 'feeding centre'.

Soon after establishment though, it would be seen that people were ordering very expensive meals, such as lobster, and that lines outside the better restaurants had become so long that one had to reserve days ahead. The expense, getting to the government would result in meals being regulated to what was considered adequate by the health department, and the amount one could sign for would be limited. The feeding centres, not being able to charge more than allowed, and having no shortage of customers, would have every incentive to make a profit in the only way left to them - quality. No private restaurants would be allowed, as that would grant privileges to the wealthy. Needless to say, with free food being given out, there would be little incentive not to waste. Waiting times would be dreadful, and there would be little choice in the type of company one wanted to eat with. A uniform blandness would make dining choices of little consequence.

I think most people could imagine the preceding, yet as has been mentioned above, cannot make connections to principles when the concrete changes.

[Stussy88 0]

Perhaps one day someone in power will come to the conclusion that not only does everyone have a 'right' to education and health care, but something even more vital to life, food. So, as they do with socialized medicine, what will be required is to sign the bill at a 'feeding centre'.

Soon after establishment though, it would be seen that people were ordering very expensive meals, such as lobster, and that lines outside the better restaurants had become so long that one had to reserve days ahead. The expense, getting to the government would result in meals being regulated to what was considered adequate by the health department, and the amount one could sign for would be limited. The feeding centres, not being able to charge more than allowed, and having no shortage of customers, would have every incentive to make a profit in the only way left to them - quality. No private restaurants would be allowed, as that would grant privileges to the wealthy. Needless to say, with free food being given out, there would be little incentive not to waste. Waiting times would be dreadful, and there would be little choice in the type of company one wanted to eat with. A uniform blandness would make dining choices of little consequence.

I think most people could imagine the preceding, yet as has been mentioned above, cannot make connections to principles when the concrete changes.

We already do more or less, with various welfare payments. The only difference is that the state doesn't try to provide the food, contenting itself with lecturing us about fat, salt, transfats, calories, fruit, vegetables, alcohol blah. blah...

(And is it me but can you look at people like Bill Clinton or John Prescott and take any government advice on nutrition seriously?)

[Paul's Here 0]

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I think most people could imagine the preceding, yet as has been mentioned above, cannot make connections to principles when the concrete changes.

Such is the result of pragmatism on people's thinking. Each new concrete is unrelated to other concretes, with no unifying principle or explanation.

[Carlos 0]

(And is it me but can you look at people like Bill Clinton or John Prescott and take any government advice on nutrition seriously?)

Well, Clinton taught us that smoking is ok if you don't inhale, and cheating on your wife is loads of fun so long as a Republican doesn't catch you doing it.

I think the larger story to take from this is how preposterous of a notion it is that the government should be the moral voice overseeing our lives. I mean dear god, look at someone like Ted Kennedy, who did everything short of flat out murdering a young woman (while drunk and driving a young woman home, he swerved off a bridge into a body of water. He escaped from the car but she didn't; afraid of getting in trouble, he never called for an ambulance or police to help save the woman, and deliberated on what to do for the night. The next day a rescue diver found her dead in the car; apparently she had stayed alive for several hours breathing an air-pocket, but eventually suffocated.)

[Stussy88 0]

(And is it me but can you look at people like Bill Clinton or John Prescott and take any government advice on nutrition seriously?)

Well, Clinton taught us that smoking is ok if you don't inhale, and cheating on your wife is loads of fun so long as a Republican doesn't catch you doing it.

I think the larger story to take from this is how preposterous of a notion it is that the government should be the moral voice overseeing our lives. I mean dear god, look at someone like Ted Kennedy, who did everything short of flat out murdering a young woman (while drunk and driving a young woman home, he swerved off a bridge into a body of water. He escaped from the car but she didn't; afraid of getting in trouble, he never called for an ambulance or police to help save the woman, and deliberated on what to do for the night. The next day a rescue diver found her dead in the car; apparently she had stayed alive for several hours breathing an air-pocket, but eventually suffocated.)

Yep, anyone who has ever voted for Ted Kennedy shows themselves to be willing to forgive a murderer because of their own prejudice. Revolting.

Clinton showed us that it is better to lie and lie and lie again than be truthful. Of course he inhaled, it DOESN'T depend on what you definition of the word is, is, a oral is sex and no Hilary, no-one was shooting, you didn't mis-speak, you lied. And again anyone wiling to forgive lies like this shows themselves to be morally bankrupt.

[ewv 0]

Washington DC Examiner editorial update on the Massachusetts health "insurance" debacle:

Universal coverage? First, look at the disaster in Massachusetts

By Examiner Editorial

- 1/11/09

To much fanfare from both right and left in 2006, Massachusetts became the first state in the nation to require all residents to buy health insurance. A new state health insurance clearinghouse was created, with taxpayers subsidizing those who couldn’t afford to buy coverage. Then Gov. Mitt Romney, a Republican, promised that “every uninsured citizen in Massachusetts will soon have affordable health insurance.” Yet just two years later, Romney’s much-heralded “solution” — touted by many as the model for a national program — has become an embarrassing flop.

Just a year after the universal coverage law passed, The New York Times reported, state insurers were already jacking up rates to twice the national average. According to Dr. Paul Hsieh, a physician and founding member of Freedom and Individual Rights in Medicine, 43 mandatory benefits — including those that many people did not want or need, such as invitro fertilization — raised the costs of coverage for Massachusetts residents by as much as 56 percent, depending upon an individual’s income status. So much for “affordable” health care.

...

Government mandates — even those originally billed as “market-based solutions” — always turn into a “rights-violating road to disaster,” Hsieh says. Barack Obama’s health policy advisers should take a good look at the smoldering wreckage in the Bay State before trying to impose any such “universal coverage” on the rest of the nation.

Full article

[JohnRgt 0]

Here's a related article from the previous issue of The Objective Standard.

[ewv 0]

Posted at the National Center for Policy Analysis, which has been finding Obama health control.

March 1, 2010

THE MASSACHUSETTS "MODEL" MOVES TO PRICE CONTROLS

Natural experiments are rare in politics, but few are as instructive as the prototype for ObamaCare that Massachusetts set in motion in 2006. The bills for "universal coverage" are now coming due, and it appears the state political class is prepared to do lasting damage to one of America's top-flight health care systems, says the Wall Street Journal.

Last month, Democratic Governor Deval Patrick proposed hard price controls across almost all Massachusetts health care:

* State regulators already have the power to cap insurance premiums, which Patrick is activating.

* He also filed a bill that would give state regulators the power to review the rates of hospitals, physician groups and some specialty providers.

* Those that are deemed too high "shall be presumptively disapproved."

The administered prices of Medicare and Medicaid already shift costs to private patients while below-cost reimbursement creates balance-sheet havoc among providers. Now the governor wants to import these distortions to save the state's heavily subsidized insurance program as costs explode, says the Journal.

Ironically, former Governor Mitt Romney (like President Obama) sold this plan as a way to control spending. As with all new entitlements, the rolling cost crisis began almost immediately, says the Journal:

* For fiscal 2010 taxpayer costs are $47 million over budget, in part due to the recession, and while the $913 million Patrick requested for 2011 is a 5 percent increase over 2010, spending has grown on average 6.7 percent per year.

* Meanwhile, average Massachusetts insurance premiums are now the highest in the nation; since 2006, they've climbed at an annual rate of 30 percent in the individual market.

* Small business costs have increased by 5.8 percent.

* Per capita health spending in Massachusetts is now 27 percent higher than the national average, and 15 percent higher even after adjusting for local wages and academic research grants.

All of this is merely a preview of what the entire country will face if Democrats succeed with their plan to pound ObamaCare into law in anything like its current form. Massachusetts is teaching the country a valuable lesson in how not to reform health care, if only anyone would pay attention, says the Journal.

Source: Editorial, "Back to the ObamaCare Future: The Massachusetts 'model' moves to price controls," Wall Street Journal, March 1, 2010.

For text:

http://online.wsj.com/article/SB1000142405...4139286892.html

[ewv 0]

Nearly One-Third of Doctors Could Leave Medicine if Health-Care Reform Bill Passes, According to Survey Reported in New England Journal of Medicine

Tuesday, March 16, 2010

By Christopher Neefus

(CNSNews.com) - Nearly one-third of all practicing physicians may leave the medical profession if President Obama signs current versions of health-care reform legislation into law, according to a survey published in the latest issue of the New England Journal of Medicine.

The survey, which was conducted by the Medicus Firm, a leading physician search and consulting firm based in Atlanta and Dallas, found that a majority of physicians said health-care reform would cause the quality of American medical care to “deteriorate” and it could be the “final straw” that sends a sizeable number of doctors out of medicine.

More than 29 percent (29.2) percent of the nearly 1,200 doctors who responded to the survey said they would quit the profession or retire early if health reform legislation becomes law. If a public option were included in the legislation, as several liberal Senators have indicated they would like, the number would jump to 45.7 percent.

The medical journal published the results in its March and April edition, saying: “While a sudden loss of half of the nations physicians seems unlikely, a very dramatic decrease in the physician workforce could become a reality as an unexpected side effect of health reform.”

...

“I think the reason it hasn’t become a big issue in the political debate is maybe because no one else has really thought about the effects of health reform on the physician workforce. Or, maybe people didn’t want to think about it,...

Full article

"Key findings" of survey

[alann 0]

I would guess that the Congressional leftists don't give any thought to doctor attrition because:

[a] they don't believe it will happen, or

they welcome it, on the premise that that would just get rid of the "greedy" doctors, the ones that are in it "for the wrong reasons;" i.e. they want to make money.

The first premise I've heard about businessmen before and after every punitive tax or regulation or other intrusion: "They'll just adjust and everything will be back to normal." The leftists crowing about the Republicans who now defend Medicare as part of their core "Conservatism" is another example. The New Normal. You load up brick after brick on the horse and it just keeps going until you break its back and it drops dead.

The second premise I think underlies a lot of the class hatred-&-envy agenda. They are not interested in quality medical care, only that everyone (that is, the needy) will receive it. If anything, the anti-affluence intellectual elitist would rejoice at the wealthy being forced to accept mediocre care, as a sign of equality.

I believe that some of these doctors will adjust, because it's the only thing they know and the economy may remain structurally depressed for a long time so that lateral career movement may be more difficult, but many will leave medicine, and it will only hasten rationing. But the AMA, a tool of the Feds already, will just grow a degrading workforce of less-qualified doctors to take their place and ration to compensate for diminshing services. This has already happened for years since the growth of HMOs. There are certainly still talented doctors, but most have moved to elective medicine, or sub-specialties, or to product development (i.e. out of the field and into the infomercials).

Russia had plenty of "doctors;" they just had nothing to work with and become glorified nurses. A Russian friend told me, in the '80's, that it was considered to be one of the least prestigious of occupations and, according to my friend, was relegated primarily to women.

As a biology graduate student in the '70's, I still remember the pathetic "descriptive" biology that passed for research in Russia when the head of the Moscow Science Institute presented . . . a bunch 'o data on methylated salmon DNA, with one picture, fact, and number after another and absolutely no idea if any of it meant anything at all. We had all shown up because quatenary structure of DNA, mediated by the selective methylation of base pairs controlling the folding of the molecule, was a hot topic at the time. Apparently, the Russians read about that and tried to ape significance by "measuring" it quantitatively. Beyond that, beyond the pose of currency and significance, actual understanding was immaterial. For about a week afterward, we were parodying this presentation, writing numbers up on the board, showing irrelevant pictures of fish, answering questions with another number, another picture, a pensive frown, a "zis iz good qvestion!"

We have much to look forward to. I have a job or I'd join a march on Washington. I can only think that maybe, if the House Reps could see their angry constituents as often as they are visited by the bully President, maybe they'd think twice.

[ewv 0]

http://www.nationalcenter.org/NPA606.html

# 606 March 2010

ObamaCare Would Drive Doctors Out of Business

by Matt Patterson

If ObamaCare passes, you may lose your family doctor. Oh, and good luck finding a new one.

That's the stunning conclusion of a new study by the Medicus Firm, as reported by the New England Journal of Medicine. Medicus, a national physician search firm, surveyed 1,195 practicing physicians about the health reform plans pending in Congress. The doctors, representing a wide range of specialties and career levels, were asked to assess the possible impact of ObamaCare on their careers, including "income, job satisfaction, and future career plans."1

The bottom line of that investigation, titled Physician Survey: Health Reform's Impact on Physician Supply and Quality of Medical Care, is summed up by Medicus managing partner Steve Marsh: "What many people may not realize is that health reform could impact physician supply in such a way that the quality of health care could suffer. The reality is that there may not be enough doctors to provide quality medical care to the millions of newly insured patients."2

Why? Put simply, doctors fear that ObamaCare would make the business and practice of medicine more trouble than it's worth. The surveyed physicians foresee in their future under ObamaCare a decrease in income coupled with an increased work load, a toxic combination of new regulations and taxes plus millions of newly insured individuals swelling their patient rosters.

The doctors assessed the possible impact of several iterations of ObamaCare. For example, 72 percent felt their income would decrease under a health reform bill that included a public option, while 50 percent predicted a decrease in income under a health reform regime without a public option.

Not surprisingly, "an overwhelming 63 percent of physicians prefer a more gradual, targeted approach to health reform" as opposed to the massive, one-size fits all plans favored by the President and Congressional leaders.3 An astonishing 46 percent of responding primary care physicians claim they would leave or try to leave medicine as a result of ObamaCare, gravely exacerbating the existing shortage of primary care doctors (according to the American Academy of Family Physicians, the number of U.S. medical school students choosing primary care has already dropped 52 percent since 1997).4

The Medicus results echo a similar Investors Business Daily poll of over 1,000 practicing physicians, 65 percent of whom expressed opposition to the President's health reform plan, and 72 percent of whom doubted the administration's claim that the government could significantly expand coverage and provide better care at lower cost. The IBD poll, conducted in September of 2009, also found a startling number of physicians, 45 percent, who would consider quitting if ObamaCare becomes law. The grim conclusion of the IBD survey: "Two of every three practicing physicians oppose the medical overhaul plan under consideration in Washington, and hundreds of thousands would think about shutting down their practices or retiring early if it were adopted."5

If ObamaCare would drive practicing doctors out of work, it would also devastate efforts to recruit new physicians. After all, how do you persuade talented young people to enter a business that promises high taxes, regulation, risk and stress - without commensurate compensation? For the average health care consumer, the result of this shrinking pool of physicians would be long waits and rationed care, to say nothing of overworked, unhappy doctors.

(And let's not forget the 78 million Baby Boomers, many of whom are already beginning to retire and will need increased medical attention in the coming decades, putting massive additional demands on our already overburdened system.6)

It is true that the American Medical Association (AMA) last year threw its support behind Obama's plan.7 But the AMA's support was bought and paid for: As the L.A. Times put it, "Of all the interest groups that have won favorable terms in closed-door negotiations this year, [the AMA] may have taken home the biggest prizes, including an agreement to stop planned cuts in Medicare payments that are worth $228 billion to doctors over 10 years."8 Even so, the sweeteners used to lure the AMA failed to tempt other prestigious medical organizations, including the American College of Surgeons and 18 other specialty groups who continue to oppose the President's health care overhaul.9

Our nation's physicians are loud and clear: ObamaCare could "result in a significant decline in the overall quality of medical care nationwide."10 Obama and his allies have refused to listen to the American people, who by wide margins continue to oppose their health reform plans. Will they also ignore our family doctors, almost half of whom warn that they would quit if forced to labor under the burdens of state-managed care?

Sadly, the answer is: Probably.

Matt Patterson is a policy analyst for the National Center For Public Policy Research and a National Review Institute Washington fellow. His email is mpatterson@nationalcenter.org.

Footnotes:

1 "Physician Survey: Health Reform May Lead to Significant Reduction in Physician Workforce," New England Journal of Medicine, March-April 2010.

2 Ibid.

3 Ibid.

4 Janie Lloyd, "Doctor shortage looms as primary care loses its pull," USA Today, August 18, 2010, downloaded from http://www.usatoday.com/news/health/2009-0...-shortage_N.htm on March 11, 2010.

5 Terry Jones, "45% Of Doctors Would Consider Quitting If Congress Passes Health Care Overhaul," Investor's Business Daily, September 15, 2009, downloaded from http://www.investors.com/NewsAndAnalysis/A....aspx?id=506199 on March 15, 2010.

6 Janie Lloyd, "Doctor shortage looms as primary care loses its pull," USA Today, August 18, 2010, downloaded from http://www.usatoday.com/news/health/2009-0...-shortage_N.htm on March 11, 2010.

7 Kim Geiger and Tom Hamburger, "Healthcare reform wins over doctors lobby," L.A. Times, September 15, 2009, downloaded from http://articles.latimes.com/2009/sep/15/na...-lobbying-ama15 on March 16, 2010.

8 Ibid.

9 Scott Gottlieb, "What Doctors and Patients Have to Lose Under ObamaCare," Wall Street Journal, December 23, 2009, downloaded from http://online.wsj.com/article/SB1000142405...2408387548.html on March 16, 2010.

10 "Physician Survey: Health Reform May Lead to Significant Reduction in Physician Workforce," New England Journal of Medicine, March-April 2010.

[Ed from OC 0]

United States of America. (1776 - 2010)

So we are now over the line, no longer a capitalist-leaning mixed economy. We are the EU of America, a socialist state.

Given today's horror, what next? I mean that question in three senses:

1. Legally/politically

I'm missing something basic about reconciliation. The Senate voted against funding abortion; the House, for it. How do these get "reconciled?" (Of course, this is just one of many issues of disagreement between the bills, but it's representative.) Is there anything the GOP can do procedurally to stop the bill from reaching Obama, who will sign it into law? What happens with the 35+ states who have voted (or who are likely) to sue the federal government? Can they stop it, or will this be brought after it becomes law?

2. Activism

What now? For Objectivists, more of the same: get the word out. Educate. Go after the most likely targets. More broadly, I think the near-term hope lies with the Tea Parties. They need a leader, and a message. The American revolution took decades to escalate, and had many fathers with differing opinions. That gives me hope (though far from certainty) that the mess of today's Tea Parties can turn things around.

3. Practical consequences and actions

Given that nobody knows what's really in the bill, or what will concretely happen, what actions should be taken to contain the damage to one's own life and health? If debating about getting Lasik surgery, for instance, should one get it now, or wait for the details to emerge on health care?

I spoke with a friend this evening about possibly leaving the country -- not immediately, but just recognizing for the first time that that was a possibility in the next few years. I'm not there yet, but boy, is the desire strong to give up and "Go Galt" as they say.

Thoughts, anyone?