Emergency Doc and football mom (!) bearing witness to the US healthcare crisis
Joined March 2009
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mart michmd retweeted
Across the state it's been a lovely sun-filled morning with bright skies and gentle winds. As we near noon, however, we find energy production from wind is 0 (zero) and energy production from solar (lumped in with methane and wood) is <4%. The kicker: we're all paying for this.
mart michmd retweeted
With everything we are hearing right now about ticks this seems like good information to share.
“Here’s what I’ve learned after more ticks than I care to count.
First, whatever your uncle told you, forget it. No matches. No nail polish. No Vaseline. No soap on a cotton ball. All of those do the same terrible thing, they stress the tick out, and a stressed tick empties its gut back into the bite before letting go. Which, if you think about what that actually means for a second, is literally how Lyme and the rest get transmitted so you’re not speeding up its exit. You’re making it throw up into you.
Fine-tipped tweezers. Grip right where the mouthparts enter the skin, not the body, the head. Pull straight up, steady, no twisting, no jerking. It’ll feel like it’s resisting because it is, the mouthparts are barbed. Just keep the pressure on and it lets go in a few seconds. If a piece breaks off in the skin, leave it alone. Your body pushes splinters out. Digging around with a needle does more damage then the fragment ever would.
Clean it with alcohol or soap. Wash your hands.
Now here’s the part most people skip: don’t flush the tick.
Tape it to an index card. Clear packing tape right over the body, write the date and where on your body it was, and stick the card in a drawer. If you come down with anything weird in the next 30 days, rash, fever, joint pain, that flu-that-isn’t-flu feeling, that tick goes with you to the doctor. Some labs will test the tick itself, which is faster and often more reliable than waiting for antibodies to show up in your own blood. A dated tick taped to a card is one of the most useful things you can hand a doctor who’s trying to figure out what’s wrong with you.
The other thing worth saying out loud: if the tick was engorged when you pulled it, and you can’t swear it was off your body within 24 hours, call your doctor that same day. Don’t wait for a rash. Fewer than three out of four Lyme cases even produce the classic bullseye. A single preventive dose of doxycycline within 72 hours of a deer tick bite cuts the Lyme odds way down, and most docs in tick country will write that prescription without giving you a hard time, especially if you walk in with the tick taped to a card and a clear timeline.”
mart michmd retweeted
How did we get here?
How did we get to a place where New York State just issued a final permit for a designated and ecologically sensitive habitat that our own state's NYS Department of Environmental Conservation has admitted houses 10 of the 11 TOP grassland species of concern?
It's a masterful play in the art of usurping power from the public and storing it inside shadow bureaucratic bodies and "clean energy" propaganda that's designed to benefit foreign corporations.
Here is the timeline of how New York State was able to pull off siting Fort Edward Solar while breaking its own laws in front of the public:
Step 1: the Climate Act was passed in 2019 justifying mass environmental devastation in the name of "saving the climate"
Step 2: ORES was shoved through in a budget bill April 2020 while everyone sheltered at home, creating a shadow agency no one voted for
Step 3: Kathy Hochul stacked the DEC (and APA) with renewable energy salesmen and women, installing Amanda Lefton as the DEC Commissioner to stand down in the face of renewable destruction
Step 4: ORES defers all decision-making to foreign renewable developers, including allowing them to buy and redact the environmental "assessments"
Step 5: ORES takes in a $1,000 fee/MW for each complex, directly profiting from the size/number of projects it sites
Step 6: ORES agrees to issue a final permit to the foreign renewable developers 100% of the time, ensuring they recoup their investments and are able to exchange/sell the permit as many times as they want for 7-years thereafter
Step 7: The solar industrial complex lobbies NYS politicians like Senator Pete Harckham, Michelle Hinchey, and NYS Senator Rachel May to push through environmentally destructive legislation while pretending they care about the environment
Step 8: NYS distributes Environmental Protection Fund (EPF) money to conservation easement nonprofits and environmental advocacy nonprofits with strings attached: "support climate change infrastructure and messaging"
Step 9: Nonprofits like the Grassland Bird Trust withdrew their Appeal one-week before the Fort Edward Solar final permit to receive mitigation money from Boralex, effectively dismantling any perceived "opposition" to big solar and wind
Step 10: Solar conglomerates infiltrate town boards and leadership, paying off elected officials while pressuring landowners at their physicals doorsteps and handing out 40+ page contracts that are impossible to decipher without a law firm
Step 11: Solar conglomerates are actively funding political candidates at the local level in NYS to displace Upstate NYers that have taken public stands against solar complexes
And there you have it.
After the 8-month journey I have been on, this is the timeline. These are the steps. This is the playbook.
If you still believe any of this is for the environment, you and I have nothing in common.
This is coming for every single town and county in New York State and beyond.
It stops with Fort Edward. – at Saratoga Springs, NY
mart michmd retweeted
Another day, another ridiculous battle to destroy our farmers and their farmland.
New York’s decision to craft their own lax standards for ‘prime farmland’ to fast-track solar developments is a direct attack on American agriculture. In 2020, the exact year they stood up their Office of Renewable Energy Siting, they worked with @Cornell to downgrade soils that were long considered prime. This wasn’t an accident. It was engineered to fast-track solar projects on our best farmland.
For our farmers and ranchers, land is far more than acreage on a map. It is the ground that holds a family’s history. It is a generational heritage and legacy.
Our great ranchers and farmers feed this nation — we cannot allow prime soils to be paved over for unreliable energy that displaces our producers. Farm security is national security. @USDA stands with American agriculture, not green new deal mandates that sacrifice our farmland.
Thanks @johnrich for bringing this to our attention! We are on it.
There's a 911 in Upstate New York!! Ain't that right @GovKathyHochul ?? Kathy, why do you hate Upstate farmers so much? Let's see what America has to say about this, shall we? If you stand with American Farmers, hit REPOST. Volume UP!👇
mart michmd retweeted
MacArthur Park Update:
Christopher Barret Johnson, a 42-year-old Culver City resident who works for the nonprofit People Assisting the Homeless (PATH), which distributes syringes to drug users at L.A.’s MacArthur Park and elsewhere, was arrested today on a federal criminal complaint charging him with possession with intent to distribute fentanyl.
On May 5, law enforcement pulled Johnson over near MacArthur Park after he abruptly made a U-turn in front of them in his BMW. LAPD officers saw methamphetamine in a plastic baggie in plain view in Johnson’s car. Additional searches of Johnson’s person and his BMW resulted in the seizure of at least 142 grams of fentanyl and nearly 46 grams of methamphetamine.
If convicted, Johnson faces a mandatory minimum sentence of five years in federal prison and a maximum of 40 years.
His initial appearance is expected tomorrow afternoon at the Roybal Federal Building in DTLA.
Residents and businesses in MacArthur Park and elsewhere have long complained about the wisdom of distributing syringes to homeless drug addicts where law-abiding citizens live and work.
They call these policies “harm reduction.” I consider them “harm enabling.” Giving drug-addicted users needles to shoot up meth and fentanyl is never a good idea.
mart michmd retweeted
Scientists have created one of the most detailed 3D reconstructions of a human cell (eukaryotic cell) ever produced.
This groundbreaking model, often termed a "Cellular Landscape Cross-Section Through a Eukaryotic Cell," combines data from X-ray tomography, nuclear magnetic resonance (NMR), and cryo-electron microscopy to map molecular structures in extreme detail.
mart michmd retweeted
.@HamlinIsland helped set a GUINNESS WORLD RECORD on Saturday 👏
Nearly 1,300 people showed up in Pittsburgh to complete CPR training in one hour! Remember, you don't need special training to save a life with Hands-Only CPR.
@GWR x @American_Heart
mart michmd retweeted
🦬🔴Highmark Stadium Seat Giveaway 🔵🦬
To enter:
1. Follow @BrandonSteiner and @CXSTUFF
2. Like this post
3. Tag someone you think deserves these seats and why
4. Share this post
#buffalobills #bills #highmarkstadium
mart michmd retweeted
JUST IN: Tim Tebow shows senators a map of the United States showing every single location where someone is downloading, sharing, or distributing CSAM.
“We are losing the battle, and we are losing the war, and boys and girls are suffering for it…”
“Every red dot that is on there is someone that is downloading, sharing, or distributing [CSAM].”
“55% to 85% of them are also hands-on offenders, and we know that your average offender has thirteen victims in their lifetime.”
“The scale of harm right here in America is, to a certain extent, hard to comprehend, but that's why we're here.”
mart michmd retweeted
LASIK eye surgery cost $2,200 per eye in 2000. Today it's around $1,000 per eye despite 24 years of inflation. Meanwhile, an MRI that cost $1,200 in 2000 now costs $3,000+. The difference? LASIK operates in a free market with no insurance interference and minimal regulation.
When patients pay directly, providers must compete on price and quality. LASIK clinics advertise prices, offer financing, and constantly improve technology to attract customers. Compare this to hospital procedures where prices are hidden, patients never see bills, and insurance companies negotiate opaque rates that somehow always increase faster than inflation.
Cosmetic surgery follows the same pattern. Breast augmentation, rhinoplasty, and other elective procedures have become more affordable and safer over decades. Surgeons invest in better techniques and equipment because they must satisfy paying customers, not insurance bureaucrats or hospital administrators focused on maximizing reimbursements.
The lesson is clear: remove third-party payment systems and excessive regulation, and you get Austrian economics in action. Prices fall, quality rises, and innovation accelerates. Healthcare costs aren't rising because of aging populations or new technology—they're rising because we've destroyed the price mechanism that makes markets work.
mart michmd retweeted
They Passed Over American Doctors
The biggest lie in the U.S. healthcare debate is that we do not have enough American doctors. The truth is simple. We produce them. We just refuse to train them.
In 2024 nearly 20 percent of U.S. medical school seniors failed to match into a residency. That is 8,869 qualified graduates who spent years in school, passed their boards, took on massive debt, and still never got the one thing they need to practice medicine.
At the same time more than 9,700 foreign trained doctors matched into U.S. residencies in 2025. Many hospitals prefer them because they accept lower pay, longer hours, and have no leverage to complain. You cannot practice medicine in the United States without residency. So if Americans are locked out, someone else will fill the spot.
The choke point is not medical school. It is the federally funded residency cap. Congress has not increased these slots fast enough while medical school enrollment has exploded. The result is a rigged bottleneck that leaves American doctors unmatched while taxpayer dollars train replacements from overseas.
The Resident Physician Shortage Reduction Act of 2025 would add 14,000 residency slots over seven years. Even that will not undo years of damage, but it is proof that Washington knows the system is broken.
Until Congress expands residency slots at the scale required, the United States will keep graduating qualified doctors who never get to practice. Then hospitals will turn around and say there is a physician shortage and use it as an excuse to import more foreign labor.
It is not a shortage. It is policy.
Citations
• AMA, Biggest Match Day Ever, 2025 data
• AAMC, Medical School Enrollment Growth vs Residency Bottleneck
• Educational Commission for Foreign Medical Graduates, IMG Match Statistics 2025
• Norton Rose Fulbright, Congressional Inquiry into Residency Accreditation and Matching Practices
• People Magazine, U.S. Graduate Denied Residency, 2024
mart michmd retweeted
A physician needs prior authorization to prescribe a $40 medication.
A home health agency in Brooklyn needs nothing to bill $1.27 billion.
Same Medicaid system.
Same taxpayer dollars.
One of them faces audits, board certification, peer review, and utilization management.
Guess which one.
mart michmd retweeted
Calling this a “scandal” is like calling a casino a “charity that occasionally takes your money.”
The PBM model isn’t broken; it’s doing exactly what it was designed to do.
It creates opacity and extracts value.
The most expensive part of a prescription isn’t the drug; it’s the series of invisible hands it passes through….
🚨 SCANDAL IN TENNESSEE: How a PBM "Stole" $30,000,000 from Taxpayers 🚨
A bombshell audit by the Tennessee Department of Commerce and Insurance has just exposed the shady underbelly of Pharmacy Benefit Managers (PBMs). The target? Express Scripts.
The findings are a wake-up call for anyone wondering why healthcare costs are spiraling while local pharmacies are disappearing.
The Breakdown:
1. Favoritism & "Self-Dealing" 💊
The audit found that Express Scripts was paying its own pharmacies significantly more than independent ones for the exact same medications. Out of 2,318 drugs reviewed, Express Scripts played favorites on 568 of them.
2. The $30 Million "Spread" 💸
Ever heard of Spread Pricing? It’s when a PBM charges the state one price for a prescription but pays the pharmacy a much lower price—and pockets the difference.
Tennessee was charged $30,000,000 in "spread" across 753,000 prescriptions.
That’s an average of $40 per prescription "stolen" by the middleman.
3. Breaking Tennessee Law ⚖️
Tennessee law requires a minimum dispensing fee for low-volume pharmacies to keep them afloat. The audit found that in 100% of cases tested, Express Scripts failed to pay this fee.
4. A Broken Appeals Process 🚫
When pharmacies tried to appeal these violations, Express Scripts mismanaged the process 95% of the time. Essentially, they were the judge, jury, and executioner of their own rules.
📉 The Impact
This isn't just about money—it's about the degradation of healthcare. When PBMs squeeze independent pharmacies and inflate costs, the patients and taxpayers are the ones who suffer.
💡 The Solution?
The audit’s current recommendation? "Review your policies." (Yikes.)
But there’s a better way. We are cutting out the middleman entirely to provide transparent, fair pricing that is often cheaper than using insurance.
It’s time to fire the middleman.
mart michmd retweeted
Physician consolidation isn’t some isolated trend or voluntary lifestyle shift. The data shows it’s the downstream consequence of consolidation that happened first among insurers, then among hospitals.
Insurers consolidated first
AMA’s Competition in Health Insurance reports lay it out clearly:
- 73% of U.S. metro areas are now highly concentrated insurance markets
- Nearly half are dominated by a single insurer holding ≥50% market share
- In Medicare Advantage, most counties are effectively controlled by one payer with real pricing power
For independent practices, that means negotiating in markets where leverage barely exists. Smaller groups get take-it-or-leave-it contracts, aggressive utilization management, and relentless downward pressure on professional fees.
Hospitals responded by consolidating
Over the last two decades, most U.S. hospitals have joined large health systems. Mergers and affiliations have dramatically reduced the number of independent contracting entities and “local” hospitals. This scale gave hospitals referral control, balance-sheet strength, and, perhaps most importantly, access to facility fees and site-of-service differentials that insurers couldn’t easily erase.
Hospitals could absorb insurer pressure in ways small physician groups never could. They had size, diversified revenue, and billing structures that let them extract higher total reimbursement even as professional fees stagnated or fell. Hospitals were riding their guaranteed inflationary updates with physicians left in the dust through downward pay related to budget neutral adjustments.
Physicians consolidated last, often because they had no real choice
IQVIA OneKey data tells the story:
- 62.2% of physicians were employed by hospitals or corporate entities in 2019
- By January 2024, that number jumped to 77.6%
- More than 5 percentage points of the increase happened in just the last two years
- The recent surge has been driven primarily by hospital employment, not independent corporate groups
Fewer than one in four physicians now practices independently. This wasn’t about wanting to be employed. In many markets the math was brutal. Insurers could suppress rates for small practices while hospitals could offer meaningfully higher take-home pay by leveraging facility fees, site-of-service shifts, and system-wide contracting leverage. Employment became the only realistic path to income stability and administrative survival.
At the end of the day, as insurers and hospitals accumulated market power, physicians were forced to consolidate to stay viable and many ultimately gave up ownership in the process.
We are at an inflection point today due to structural changes, not ideological underpinnings. Physician employment is the end-stage response to a market that had already consolidated around them.
Tomorrow we’ll look at what this level of consolidation actually does to prices, quality, and competition once real alternatives disappear.
@IndeMedAction
mart michmd retweeted
The level of consolidation in our health system helps explain why Americans feel anxious about their health care – because the coverage they have, the drugs they rely on, and the doctors they can see, are increasingly controlled by the same corporate families.
mart michmd retweeted
Have you ever heard the Declaration of Independence read out loud?
You should. It’s the greatest break-up letter ever written.
At just 33 years old, Thomas Jefferson, with cold moral clarity, told the British government to pound sand:
“Whenever any Form of Government becomes destructive of these ends [life, liberty, and the pursuit of happiness], it is the Right of the People to alter or to ABOLISH it.”
The power of that line isn’t just what it says. It’s how it’s said.
Jefferson wasn’t writing from a place of outrage. He was transmitting conviction — moral clarity delivered from a steady frame of mind.
It’s said Jefferson revised the Declaration of Independence with the help of Franklin and Adams dozens of times before it was finalized.
And that deliberate, cutting language paired with emotional steadiness is precisely why the words still land nearly 250 years later. 🧵
mart michmd retweeted
This is absolutely mind-bending. By locking the camera to a fixed point in the sky rather than the ground, this stunning timelapse perfectly visualizes Earth's rotation.🌍🌌
It really puts our movement through space into perspective.
mart michmd retweeted
NEW: Insurance giants are hiding billions meant to lower Americans’ drug costs.
Our year-long investigation details how CVS, UnitedHealth, and Cigna created shell companies to evade reform efforts and hide payments received from drugmakers.
Cc: @mcuban
mart michmd retweeted
This barely made the news — but it’s huge. Eli Lilly just dropped CVS Caremark as its PBM. If Big Pharma starts cutting out the middlemen, everything changes. #healthcare #pbm #pharma