Tuesday, April 7, 2009

An Antiques Roadshow Transcript From the Future

The Disease Management Care Blog really enjoys watching PBS' Antiques Roadshow. Who would have thought such obscure items could command such big bucks? And the owners are so, garwsh, surprised at the appraisals, while the appraisers seem so familiar with the intimate historical details of each piece.

With apologies to A.R, the DMCB visits a show from the future...


Appraiser: Can you tell me about this piece?

Guest: Well, Bernie’s grandfather and namesake was a physician back in the days of the Obama Presidency. Ol’ Dr. Bernie wouldn’t throw nothing out. We found this case buried under a pile of unpaid bills, government correspondence and booklets on the practice of bariatric medicine and how to start a tattoo removal business. We found this metal case in the back of his office. We plugged it in and turned it on, but all it did was make blinky light and noises.

Appraiser: This is a desktop personal computer outfitted with other electronics that were designed to create what back then was called an ‘electronic health record.’ Were there a lot of wires coming out of the back?

Guest: There sure were a lot of wires laying around.

Appraiser: That’s a pity. It’s rare to find these boxes still attached to the wiring. It was common for physicians or their office staff to yank the computer cases away from the wall, rupturing the connections. See those dents here and here?

Guest: We were hoping you wouldn’t notice.

Appraiser: Those dents are actually quite common. In addition to pulling the cases out and throwing them about their offices, it was not uncommon for physicians to kick, punch or lash them with an exceedingly rare device nowadays called a ‘stethoscope.’ If you were a physician back in the early 2000’s, you were encouraged by the government to invest in these devices based on a widespread belief that they saved money and made physicians better. Notice the engraving on the back here? This was used by the government auditors during their visits to all the clinics to make sure the devices were ‘certified.’ Also, take note of the large size of the hard drive, which, for back then, handled a huge amount of information - such as instructions on how to bill the patient, suggestions on how to treat the patient, when to refer the patient and how to contact the government with additional questions on how to bill, treat or refer the patient.

Guest: So, like, how much money can we get for this?

Appraiser: To answer that question, some history may be in order. Once these boxes made it into all these doctors’ offices, the government also developed a public health insurance option based on assignment to a type of provider called ‘primary care.’ Coverage was based on what was then labeled comparative effectiveness research (‘CER’). It didn’t work too well. Patients continued to demand total body imaging studies and stomach banding. Physicians interpreted CER studies to support the stenting of every known artery for every known condition. Costs ballooned, quality stalled and, thanks to the leadership of Treasury Secretary Geithner, China's government had to bail out some hospitals. In response the government’s Social Central Repository of Health Excellence Decision Making (SCRHEDM, pronounced ‘screwed-m’) issued more approval algorithms, regulations, guidelines, emails, web-links and directives that bloated hard drives and spammed in-boxes. Doctors abandoned medicine, leading to the specialty of 'allopathic cosmesis.'

Guest: So, like, how much money can we get for this? I'm in a hurry and have to see my nurse for a check up.

Appraiser: Unfortunately, not much. When you consider how much the doctors and government spent on these devices and how much you can get for this antique, its only value is that it's a reminder of one of the largest evaporations of government capital in history – only exceeded, of course, by General Motor’s ill-fated development of the plastic ‘GreenGo’ Car. That was created during the Pelosi Presidency and designed to be powered by wind, solar and chardonnay rated less than 92 points. I estimate you can get about a thousand yuan.

Guest: Well, I'm out of here. Thank goodness President Meghan McCain got elected.

Appraiser: Indeed!

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