“Credentials. The only credentials I have is that I’m the only pilot willing to fly you up there. You don’t like those credentials? Walk.” – The X Files
Biden doesn’t think of those kids as hostages, just a captive audience.
Warning up front: I’ve got family obligations on Thursday that involve traveling late, so I might not have time for any sort of post on Friday. If so, be back in full force on Monday.
The Mrs. went into the hospital last year for “having lungs that were as useful as used party balloons”, which I think was the technical definition. In reality, one doctor said he thought she had Legionnaires’ Disease, which is weird because she never hangs out down at the Legion even though she likes mustard and bologna (one of you will get this joke and really, really laugh)*.
The reality of the care The Mrs. got was that she sat in a bed, they gave her some antibiotics, and then sent her home until her lungs looked less like they were filled with Jim Beam® bottles that had gone through a wood chipper. The care was just fine. Then the bill showed up – for two days in the hospital, the cost was about $16,000, which included a (I kid you not) $2,000 COVID test, which was negative.
But it was $2,000.
No, I don’t dress that way.
Again, the staff was nice, the doctor competent, but the real hero was the antibiotics that The Mrs. took. I don’t recall the line item for those, but I assure you, it wasn’t the food that caused her lungs to allow sweet, sweet, oxygen to once again saturate her hemoglobin. It was the antibiotics. I tried to get her to take my homemade antibiotics made of lead, some of the fuzzy stuff I found in the fridge, and several unlabeled vials of chemicals that were in the house when we moved in.
She turned me down. But $16,000? What’s up there?
Well, liability and gatekeepers. The idea is that every job has some liability associated with it. And courts have ruled that if I own a hospital and hire the neighborhood kid who mows my lawn to do brain surgery, that things might not go well. Well, in 2022, they wouldn’t go so well.
In the past, however, being a doctor was a state of mind. The Mrs. gave me a nickname over 20 years ago: John Wilder, Civil War Surgeon. Most of the operations that the members of my family have had, from splinter extractions to blisters to the occasional tracheotomy using a ballpoint pen and some duct tape and super glue have been performed by me. I got my medical degree in . . . nowhere.
What was Morgan Freeman called before the Civil War? Morgan.
In a real sense, almost everything I’ve done was just a matter of first aid, most not really complicated, and all really easy once I determined that no matter how much the other person is yelling, it is good for them and doesn’t hurt me at all. That last sentence will amuse at least three of you, so at least the jokes are getting broader as we go along.
I would assess, that at current prices, that I’ve done at least $4,349,209 worth of medical work on my family. So, enough to buy two Happy Meals© and a Big Mac©. Some of it was especially hilarious, like the time Pugsley (then aged three) slid sideways along a wooden bleacher at a wrestling tournament and ended up with three cords of splinters in his butt. Actual conversation from the bathroom while we were in the handicapped stall (the bathroom was filled with people): “Listen, hold still,” (Pugsley screams as I pluck a four-inch-long splinter out of his butt) “It won’t take long if you stop fighting.”
I did like the comfy chair very much, though.
But if anything goes remotely wrong, my family can’t sue me. When anything goes wrong at a doctor’s office, they can get sued. So an entire labyrinth of credentials has been created. This does two things: it makes sure that doctors have achieved a set credential, and it also assures that doctors are in short supply, and thus their cost is huge.
And that’s the basis of credentialism. From doing hair to doing nails to being a cop or a firefighter or . . . a zillion other professions, there are a myriad of professional credentials required. Heck, there are even credentials required to embalm dead people, and it’s not like they can lose a patient.
Credentialism makes sure that every person involved in every chain has a string of credentials a mile long. I’ve been through lots of training courses where I didn’t learn anything, and (in some cases) an “eight hour course” involves a lot (I mean a loooooooooooot) of breaks.
The credentials are required, of course, so that the company doesn’t lose a multi-million dollar lawsuit, even if they don’t have a practical impact on the job. They’re all made so that in a courtroom a person on the stand can say, “yes, I had the eight hour training on not shoving a cotton swab so far into my ear that I could feel my brain”.
Also, a colon can completely change the meaning of a sentence: “Wilder ate his friend’s sandwich,” vs. “Wilder’s colon ate his friend’s sandwich.” See? It’s the small things.
Certainly, there are professions that require more training. The bridge disaster in Florida shows that people should have training when dozens of people can die in an accident. But, whoops! All the people involved did have training. And, yes, I’d prefer not to go to a doctor who got his training at Doctor Bombay’s Surgery School and Meth Laboratory. Yet, Sam Bankman-Fraud was allowed to steal and/or lose billions of dollars based on being weird, something-something crypto, sleeping on a beanbag, and being able to fool Tom Brady.
Maybe he should have had a credential? “Unable to fool Tom Brady”?
But this design of creating every job with a nearly infinite number of credentials is adding billions of dollars in cost to the systems that we depend on, from filling up a car with gasoline (the tank, not covering the passengers) to buying PEZ© at Wal-Mart®. Some of them add a great deal of value, but some just add friction to the system.
Just like $15,890 of The Mrs.’ bill. And I’m not letting her go down to the Legion anymore.
*This is a reference to a song. It’s by “Bubbles” and you can find it if you search for “youtube mustard and bologna bubbles”. Not one you’d want to play if your office is near HR.
Just paid $4000.00 for a CAT scan that literally took 5 minutes. This whole thing is not going in a good direction.
It isn’t. And it won’t stand. In fact, the entire thing will crumble soon enough.
I think you are on to something.
The near-universal appeal of Uncle Si on Duck Dynasty is that he doesn’t give a rip about credentials. He looks at a back-hoe and says “I saw somebody use one of those twenty years ago. It didn’t looks so hard.” Then he climbs into the driver’s seat and teaches himself how to use the tool. Train a poodle to retrieve ducks? No problem. Re-wire a motion sensitive light and RC truck to chase down hooligans…piece of cake.
I always figured that any antibiotic good enough for a five-million dollar race horse was good enough for me.
Veterinarians saved their patients centuries before doctors stopped using leeches.
Of course, back then horses were more valuable than people, and the people who owned them had swords they weren’t afraid to use.
Perfect examples. But what would a lawyer say?
John, one point about credentials as well is it is yet another revenue stream for the government at every level. Want to practice Snake cosmetology? Need a license. Move to another state? Need another a license – and, of course, your national license. And maybe your “Association of Snake Cosmetology” license as well.
At one time, credentials indicated a certain minimal amount of training and skill. It seems more and more, a credential is no indication of actual ability or talent or education (to your point about the bridge), just the ability to pass the credentialing test. The two should not be confused.
Exactly. Remember (this was a few years ago) the person who just showed up to be the “deaf person” interpreter at events in South Africa and didn’t know sign language? Wish they had credentials. Imagine the lives they would have saved. (hint: no one died)
Best wishes to the Mrs. for her continuing recovery. Of course, you shouldn’t worry if the YouTube show doesn’t happen this evening. Because, truth to tell, history shows that there’s a 70% chance that, at 9 pm Eastern, I will have become preoccupied with trivia such as paying bills or fixing the drain under the kitchen sink, or I’ll have drifted off to sleep over my last coffee of the day. You know, coffee — that stuff that people say they can’t drink after supper because it keeps them awake half the night? Ha! Puts me right to sleep.
She’s much better, and thank you for those kind wishes!! And the show was fun to do – it brightens her life and mine each week. Even if she can’t talk.
Me? I’m feeling better now. And I’m not working next week, so even better.
Actually, no, you can’t always sue your doctor because some doctors are in Tennessee. It’s not quite illegal (yet) to sue a doctor in Tennessee, but as a practical matter, it’s impossible to find a lawyer who will sue a Tennessee doctor because the “bar is set so high.” Don’t ask me about that time a highly credentialed doctor managed to punch a hole in my mother’s throat…. But no, we didn’t sue. Be careful with the ENT docs in Oak Ridge is all I can say.
Want to see what massive government deregulation looks like? Come live here. Some of it is pretty great. Other parts … you have to live it to believe it.
Wow!
I think federal deregulation is (generally) good, because what works in Alaska doesn’t always work in Alabama.
Of course there is also the college degree credentialism. How many corporate jobs really require you to have a 4 year degree and in truth how many non-technical 4 year degrees confer any sort of useful education? The answer is awfully close to zero. People are easily impressed by academic credentials, which explains why cat ladies on Twitter unironically put “M.Ed.” after their name as if getting a master’s in education is anything to brag about.
In all fairness, the M.Ed varies in difficulty.
M.Ed in any of the REAL sciences? Probably indicates they know stuff.
M.Ed in Computers/Technology. Same.
Most of the Curriculum Master’s? Not worth it.
Anything LIberal Arts/Humanities? Worthless.
If I were trying to judge the worth of ANY degree, I’d ask them how it would, specifically, help them do their job.
Most jobs don’t need degrees/credentials (Unless there is a technically-based test attached, which MOST people – even those with the degree – don’t pass. LIke nurses licensing exams.)
Griggs. I should have mentioned Griggs.
You have earned your doctorate in comedy with the colon joke. It’s completely useless, you don’t get a diploma to hang on the wall, but if someone asks me, I’ll swear you’re a doctor.
Ha! I’m no doctor, but I am, John Wilder, Civil War Surgeon.
Credentials are one of those things that sound great, in theory. But inflation has watered down the product there, just like everywhere else.
One trivial example among many others: Wound Care certification for registered nurses. I can’t speak for every program, but back in the oughts when my wife became wound care certified in New York state and added “WCC” to the lengthy list of alpha-babble following “RN” on her business cards, it entailed a week-long 40 hour course. In an auditorium. With lavish breaks.
Through those 40 hours, she never donned surgical gloves. Never touched a gauze pad. Never stained her fingers with Betadine. Never had to see a live patient wince or cry out in pain. Instead, they sat on comfy chairs and viewed slides from an overhead projector as some previous graduate of the course droned on from prepared notes about all the wonderful care they would henceforth be qualified to render without so much as a minute of hands-on training.
And all for the bargain price of just $1895, payable in quarterly installments. I sure hope the guy or gal who someday saws open my breastbone to perform valve replacement surgery went through somewhat more rigorous prep and has a few procedures under his belt already.
But the hospital can’t be sued, because they hired someone with the proper credentials!
Medieval guilds worked in much the same way. Organized crime and government overlap so much in some areas as to be indistinguishable.
Didn’t both start in Italy?
No. You paid $4000 for the use of a machine that cost millions of dollars, and for the regular maintenance and calibration it requires so you don’t get cooked into radioactive stew,and the shielding for the room so the people down the hall don’t get cooked into radioactive stew, and for the radiologic technician, with years of both school training and practical experience not to cook you to radioactive stew, and do the scan properly, and for the special construction and wiring to allow the hospital to operate the CT scanner, and to cover them for liability to 10 figures, in case, at any point in that process, something went wrong.You could get the same scan for $100, if you’d agree to submit to binding and capitated arbitration, and forgoing a lawyer looking for a Lotto jackpot payday, in case you got a hangnail while being slid onto the table, but you won’t do that.
You want Lotto jackpot lawsuit payouts? Enjoy your $4K CT scan bills.
You weren’t talking to me, but the Therac-25 gives a great example. Which no certification would have helped. It mostly worked, unless the tech was really good at the keyboard. If they were good? Zap. More radiation than the Demon Core.
Actually, I laughed and laughed at the Morgan Freeman joke.
But your bill wasn’t for antibiotics. See the reply (which was intended in reply to Anonymous at 9:19AM, (but the web access at work is wonky).
Certifications are a bare shred of the problem. Your antibiotic dose probably billed at cost would be $100-200. The rest is the price of the licensed nurse to deliver it, the pharmacist to verify that it’s the right dose, route, and appropriate, and that your wife wasn’t allergic to it, nor going to have any untoward reactions, and a pharmacy tech to pull the right bottle or bag and load it into the right box at the main station, or tube it up from the pharmacy. And for your share of that room. And, yet again, the liability premium oif anything pear-shaped happened. Antibiotic expired? Extravasated? Allergic reaction for the first time? You forgot to tell them about THAT allergy? Air embolus in the tubing and your wife (oopsie) died? That’s what you’re paying to have not happen, and paying to amortize in case it does.
As above, forswear Lotto paydays, and cost drop back dow from space, to just the troposphere.
Pay Civil War prices, get Civil War medicine.
Want 21st century medicine? Life saving antibiotics are yours, for $4000.
Which, BTW, is what is being billed to your employer (or hers) and you’re paying a sliver of that, which is also paying for Julio, Wang, and Achmed, who are hospitalized down the hall without any insurance, possibly not even in this country legally,and for the grandma, who has Medicare, which is paying 3¢ on the dollar for every dollars’ worth of care. And every other old phart who cost-shifted their golden years onto their kids and grandkids, and everybody else’s, even if they didn’t have any kids themselves.
Socialism, plus predatory lawfare, is a lethal stew.
Thank FDR, and the ATLA.
You make my point for me.
I get milk at the store every so often. It doesn’t cost $6,000, though people have to make sure it’s sterile, cold, and the date is right.
As to me not being allergic? That’s up to me. Other industry does this all very, very well without inflating costs at 15% plus per year. Medical is different, because doctors and hospitals have a lot of money, and lawyers (on both sides) have developed an extensive kabuki theater that (in some cases) trains people very well, but in others is just a checkmark in the “you can’t sue me for this folder.” People buy antibiotics intended for fish tanks and avoid going to the doctor for decades.
Modern medical folks do wonders (IMHO) not because of the system, but in spite of it. Your posts at your place prove this again and again. You people are frigging heroes. But the system built around it? Awful.
The socialism aspect? Spot on. Lasik and breast augmentation surgery? Dropped in price. Why?
Insurance and Medicare and Medicaid don’t cover it.
This. With bells on.
Mom and grandma were saved by a pure quill miracle that brought a nurse and her doc husband into the neighborhood.
No hospital, no lawyers, and they paid with a cow.
That said, you cannot trust the nurse and docs in any major hospital system. Sorry Mr. Aesop, but “your” pro team have killed, tortured, and abused my family because Corporate Said So.
*In the sense you are embedded in it.
The last ones (nurses and doctors) that The Mrs. had were good and gave her appropriate choices. The reason? No beds in the hospitals. More on that in the podcast (if I remember to bring it up).
I have no beef with that.
If we make them equal by force, if we put the principle of equality in the basis of our social political structure, it’s the same thing as building a house on sand. Sooner or later, it will collapse. And that’s exactly what happens. And we as Soviet propaganda makers are trying to push you in the direction which you go yourself. “Equality, yes, equality. People are equal. Land of equal opportunities.” Is it true or not? Think about it. Equal opportunities, should there be equal opportunity for me and for a lazy bastard to come here from some other country and immediately registers as a welfare recipient?
Yuri Bezmenov
Equality is the outcome of democracy, and why being a republic is important.
Love the quote. Thanks.
Credentials, yep just a tax on the people. Don’t believe me, why weren’t they required a 100+ years ago when med students eventually became to be called Doctor. Yes just like now some of them were good and some were bad. Ask me about my clown show observation last July. False alarm but it was still a clown show.
CPAP. Why does it cost $4,000 (after a six month wait) to but a piece of equipment that can’t hurt you?
Oh, yeah.
‘In a real sense, almost everything I’ve done was just a matter of first aid, most not really complicated, and all really easy once I determined that no matter how much the other person is yelling, it is good for them and doesn’t hurt me at all.’
Buddhists sit zazen for many decades before solving that koan, Grasschopper.
Upon close examination, I am not sure the writhing and whatnot is ‘good for them’ however if thinking so makes you feel better, I got yer back.
Sorry – it wasn’t the writhing that was good for them, but my tender rending of flesh to help them, and the inserting of (sometimes painful) sterilizing compounds and antibiotics. Alcohol is worse than salt in a wound.
The screaming and writhing? That’s just a bonus.
Credentials are the new clown horn. (honk,honk!)
They will be as common as Bazooka comics or Cracker Jack prizes in fundamentally transformed FUSA or West South Africa.
Keep your morale up by laughing until your side hurts by any means necessary.
Just don’t be like the clown Depape (spell?) and hammer in the morning while in your underwear!