More of the same. Seriously, please give us more of the same.

After the SCUBA trip, we spent the next three days doing the same thing we did for the last three days. It was perfect. We made friends with the bartender, fell asleep on the beach, and made plans to come back next month. And the next month, and the next month.

Even a bit of rain couldn't spoil things. In fact, the locals that were staying at the resort barely noticed, or quite possibly didn't notice at all.

But like all great trips, this one had to end, too.  We took one last walk along the beach, and stayed up super late, so that we didn't have to waste our last night sleeping.

It was a wonderful trip, and we couldn't ask for a better start to our marriage.  This is easy.

SCUBA!

Aimee and I have a new obsession.  We started SCUBA diving earlier this year, and we really can't get enough of it.  As soon as we got to the resort, we started asking around about who takes out dive groups.  It didn't take us long to find the excursion desk outside of the dining room.  Most of the tours were expensive and pretty cheezy (jeep tours and the like), but one of them was a legitimate SCUBA operation.  Sign us up!

We woke up at an ungodly 8 am on the morning of our dive, and we headed down to the hotel lobby.  We joined a German family sitting next to their well-organized dive bags, and a Canadian family that was just tagging along for the boat ride.

A few minutes later, an open-windowed mid-80s tour bus pulled up with about 20 people from the other nearby resorts.  Our first stop was a charmingly rundown jungle shack a few miles inland to pick up our flippers and dive gear.  Apparently, most of the people on the bus were just going to the beach; the Germans were the only other people picking up dive gear.

After a 30 minute drive, we pulled into a pretty textbook Caribbean beach town.  There were thatched huts lining the road along the beach, and lush, green trees went right up to the water.  Since we were diving that day, I didn't bring my camera, but I had a little disposable one that let me take a few photos of the town.  None of them came out particularly well, but this one gives a decent feel for the area.

For the sake of an entertaining blog post, I half-wish that I could tell you about the shoddy dive gear and a leaky boat.  But it was actually a pretty legit operation.  The gear was not unlike what we'd rent in the US, and the fiberglass fishing boat would have been right at home in an early-70s Bond movie.

The German family was getting their diving certification that day, so they went out from the shore.  But since Aimee and I had a wealth week of diving experience, we hopped on the boat with a local dive master, and he took us out to "The Wall."

The Wall turned out to be a fitting name for the dive spot.  It's a steep drop off in the ocean floor about a mile or so off shore, and it was a pretty amazing hub for sea life.  We dove down to about 40 or 50 feet below the surface, and swam for a few miles along the wall.  It was only mildly disconcerting that there was nothing below us, and an endless dark blue void to our right.

But the coral and fish were amazing.

The only mermaid that needs a breathing apparatus.

All in all, it was a great little side trip, until Aimee got eaten by a shark.

Tough day

By this point in the trip, our biggest concern was whether or not we were going to make it to breakfast on time.  Breakfast closed at 11:00.

After breakfast we did a bit of this:

And after lunch, we did a bit of this:

Perfect.

Blame it on the rum

There's something about putting on a wedding, travelling for 24 hours, and consuming quite a bit of rum that can take a lot out of a person.  We've never slept so well.  In fact, the only reason we woke up before noon was because Luis called us to set up a dinner reservation.  We were both pleasantly surprised at the level of customer service, and a little worried that our phone would be ringing at 10:30am.  We had big plans for the week.

But it didn't take us long to realize why Luis was waiting on us hand and foot.  After he met us for breakfast, he continued his tour around the property. He kept referring to some kind of a "special meeting".  He danced around our questions, but Aimee and I had travelled enough to know what was coming.

After buttering us up with another round of coconut drinks, he took us behind the curtain.  Now, mind you, up until this point, we had barely seen as much as a rotary telephone.  Once we landed in the DR, we assumed that we had left a certain degree of technical sophistication behind us.  But that all changed when Luis took us to a room that we never knew existed.  We had been all over that resort in the last 24 hours, but there was apparently a hidden room tucked away behind the palm fronds.  It was the Dominican platform 9 and 3/4.

So what was in this secret, buzzing room with the ten staffed computer desks?  Time share brochures.  Looking back, it was kind of genius.  We had barely been on the property for a whole day, and the grins were plastered on our faces.  It wouldn't have been hard to pry me from my $10,000, plus $500 monthly maintenance fees.  I mean, who wouldn't want to spent a week down here every year?

Since Aimee's mom booked us the hotel using her own timeshare points, the hotel staff thought that we were already at a place in our financial lives where that proposition wasn't laughably ridiculous.  We had to spend the next 30 minutes convincing them that "medical student" was a far cry from "doctor", and this week--while a wonderful treat--was not our usual method of travel.

Aimee, who had spent two weeks a year attending these timeshare sales pitches throughout her childhood (and is watching me type this right now) insists that she never would have allowed me to say "medical student", but I guess that this will have to be the first disagreement of our marriage.  Not a bad one.

But we made it out of there with our wallets intact, and were off to spend our first full day on the beach.  That was enough work for one day.

Yes, this place will definitely do

The taxi pulled into our hotel around 2 or 3 in the afternoon, and the place couldn't have been more spectacular.  It wasn't spectacular in the over-polished Vegas sense; it was more like "we're not really trying to make this place look beautiful, because we don't have to try very hard".  It was the kind of place that dropped jaws when it opened in the late 1970s, and not much has changed since then.  It was perfect.

We wanted an easy vacation, and that's exactly what we got.  When the taxi pulled into the hotel, we were immediately whisked away to the VIP registration desk.  I'm still not quite sure why our registration was waiting for us in the VIP area (or how we qualified as VIPs), but I have a hunch that everyone checks in at the VIP area.  The regular registration desk was probably just be a prop that made us all feel a little privileged as we walked past it.  Keep in mind that most of our recent travel has been more SOS than VIP, so we were a little surprised by all of the coddling.  But we weren't going to fight it.

As the hotel employee wrapped up the registration process, she introduced us to Luis, one of the resort's hospitality ambassadors.  We would get to know Luis pretty well over the next 24 hours, but we'll get to that later.  First, we needed a drink.

We knew that the resort's main restaurant would be our room away from room for the next week, and we couldn't have been happier with what we saw.

The restaurant is a massive thatched-roof hut that looks right out onto the water.  You just couldn't ask for a nicer view.

The rest of the day was spent with us grinning ear to ear as we toured the facility.  Of course, the coconut drinks didn't hurt.

We could get used to this.

This place will do

Our overnight flight was a piece of cake. The wedding-induced sleep deprivation made sleeping on the flight easier than usual, and we awoke for a mid-morning landing in paradise. 1970's paradise, to be more specific.

The open-air terminal felt like it was built in the heyday of Caribbean weekender tourism. The airport is nestled between rolling hills and plantain fields, and I half expected to see Pan Am planes landing in the background.

Don't mind that guy in the foreground. He doesn't fit the narrative.

Aimee and I were definitely in travel mode, and neither one of us were excited about the customary Latin American tourist hustle that we thought would greet us when we walked out of customs. But there was nothing. No one trying to sell us crap that we didn't need. No one looking to shuttle us into their cousin's available guest room. No one herding us into their nearby restaurant. We couldn't even catch a cab. We had to ask, like, three airport employees where the taxi stand was. It was wonderful.

The airport was no anomaly. While the country is definitely dependent on tourist money, they go about it a lot more calmly than other places that we've visited.

We did eventually find ourselves a cab, and had a nice conversation with the driver. He had lived in New York for twelve years (as did apparently everyone else on the island), but as a testament to New York's all-encompassing cultural pockets, he didn't speak a word of English.

The driver took us to the local bus station, since our hotel was an hour or two away from the airport. The taxi driver offered to take us all the way to the hotel for $80, but we knew that there had to be a bus out of town. And I took a moment to be thankful that I had just married someone who thought that the bus was clearly the better choice. "It's all part of it," she said. Plus, the bus cost $3.

Not my best photo, but here's the bus station:

I was barely awake for a combined 10 minutes of the bus ride, but what I remember was beautiful. We both noticed the lack of garbage on the side of the road. And there was definitely poverty, but it wasn't the kind of poverty that usually lingers outside of most other Latin American tourist sites.

But it was like every other Latin American country in that it was nearly impossible to know where our bus was heading, and which stop we had just left. Would it kill them to put up a sign or two?

We still had one quick cab ride from the arrival station to our hotel, but it was easy. After a mildly panic-inducing moment of unrecognition, the driver did know our hotel. Which was nice, since aside from a print out of an emailed confirmation receipt, we knew absolutely nothing about where we were going.

But things would work out just fine.

The Honeymooners

The last week has been one giant nap on the beach.  Married life sure is nice!

After a wonderful wedding (and a very busy week leading up to it), Aimee and I were more than due for a vacation.  But we knew that this would be the case, so we actually finished planning the honeymoon before we even started planning the wedding.

And by "planning", we mean "booking the hotel room".  That's about as far as we got, since we had absolutely no time to research where we were going during the months leading up to the wedding.  This was, by far, the least prepared that either one of us has ever been for a trip.  But this certainly wasn't going to be one of our more difficult adventures.

Aimee's parents let us use some of their timeshare credits to book a week at an all inclusive beach resort in the Dominican Republic.  That's correct, a Club Med-type operation where the rum flowed freely, the food was always waiting for us, and the closest thing we were going to get to an adventure was trying to figure out which guests were Canadian and which were from Germany.  We decided early on that we needed to avoid our normal travel M.O.  We needed a vacation.  So with a hotel room booked by Aimee's mom, and a flight booked by my dad (getting married sure has its rewards), we tossed a few bathing suits into a duffel bag and dusted off our passports.

We finished off the wedding weekend by visiting the All Souls Procession with some out-of-town friends and family.  We left the festivities around 7 pm, and made the drive up to the Phoenix airport.  Our excitement to travel was mildly tempered by sheer and utter exhaustion, but that didn't make much of a dent.  We were pretty thrilled to be heading off on another trip.

The flight from Phoenix to New York was easy (especially since Aimee and I were awake for a combined 20 minutes of it), and we arrived sometime around 5 or 6am.  Our layover wasn't long, but we did have time to find an ATM.  We realized on the flight over that we had about $15 in cash between the two of us.  I'm telling you, "underprepared" doesn't even come close.

The Jet Blue info screen at the departure gate said that the weather in the Dominican Republic was 83 degrees with 100% humidity.  When I read that last part to Aimee, she immediately responded with, "Oh, God.  It's Cuba all over again."

[Aimee was referring to, ahem, a great Cuban restaurant in Tucson that never uses its air conditioning.  Not the country.  Definitely not the country.]

But humidity-be-damned, we were very, very excited to be getting on a plane to the Dominican Republic.  The four hour flight from JFK was equally uneventful, except that we did have our first chance to check "married" on an official document.

Even before we landed in the DR, this trip was shaping up nicely.

-M

The Miracle of Flight

I have been to heaven, and it is the Udvar-Hazy Center of the National Air and Space Museum.  It's a free-standing aircraft hanger near the Dulles International Airport.  It's only for the truly nerdy.  But, wow, is it amazing!

Politics, schmolitics.  This was the part of the trip that I was most excited about.  If medicine doesn't work out, I'd really like to become an astronaut.

I took a bus out to the Dulles airport, and I looked for the shuttle to the Udvar-Hazy center.  It was already 3:00 by that point (my flight left at 5:30), and I was starting to get a little antsy.  But skipping the museum was not an option, so I flagged down a cab.

We pulled up to the museum around 3:20.  I paid the driver, and made a beeline to the entrance.  Like all Smithsonian museums, this one is free.  So after a quick bag check, I was up an running in the coolest museum ever conceived.

The Udvar-Hazy center grew out of an unused Dulles aircraft hanger that was used to store airplanes and spacecraft that were too big to fit in the Air and Space museum on the National Mall.  It's gigantic. This is what you see when you walk into the building.

Excitement overload.  I can count on one hand the amount of times that I've been as happy as I was when I took this photo.

And then you turn to your right and you see this: an SR-71 Blackbird. Nerd heaven.

Almost 40 years after it was created, it is still the fastest, and one of the most advanced airplanes ever built.  And certainly one of the more bad-ass ones, too.

There's also a pretty amazing helicopter wing, featuring one of the infamous Hueys that will forever be associated with the Vietnam War.

And even the area dedicated only to aircraft engines is three times the size of my house.

One of the more sobering displays was this innocuous-looking chrome flyer.

Which you may recognize if I show you the other side.

This is the B-29 Enola Gay, the first of just two airplanes to ever drop an atomic bomb in combat.  Powerful stuff.

I couldn't believe how many amazing stories were packed into the aircraft hanger.  The Enola Gay, the first commercial passenger jet, and even an ultralight flyer used by police in Monterey Park.

There's cool, and then there's this:

It's an Air France Concorde, the first, only, and infamous supersonic passenger jet.  These things cost over 20 million dollars, and one is just sitting there, free for all to explore.

But even the Concorde couldn't stand up to what I saw next: the space hangar.

It was literally jaw-dropping.

The centerpiece of the space hangar is of course the awesomely-named Enterprise.  If you get the reference, I wouldn't brag too much about that.  If you don't here's a hint:

This photo was taken during the dedication ceremony in 1976, and despite decades of awe-inspring imagery, this might just be the coolest photo that NASA has ever taken.  A letter-writing campaign by Trekkies convinced President Ford to override NASA's original choice (Constitution) in favor of the name of Captain Kirk's ship.

The space shuttle is clearly the biggest draw of the space hangar, but there are plenty of other amazing artifacts chronicling the history of human spaceflight.  My personal favorite is probably this only-in-the-60s Mobile Quarantine Facility.  I could so easily live in this thing.

But back to reality.  You may recall that my trip to the Udvar-Hazy Center was a tight squeeze.  My flight was scheduled to leave at 5:30, and I didn't even arrive at the museum until 3:20.  I did my best to move through the exhibits quickly, but my inner 13 year-old is very strong, and he did everything he could to make me read every single sign about every single airplane.

Around 4:15 I had made an acceptable pass through the museum, and  had convinced 13 year-old Myles to leave by promising that we'd visit the museum again on our next D.C. visit.  So I asked a security guard where the shuttle picked people up yet, and his first reaction was a facial expression that could only have meant, "what shuttle?"  Then he seemed to realized that there was, in fact, a bus that occasionally came by the front of the building.  But he cautioned me that the bus ran on a pretty unpredictable time table, as if I had a second option (although I did consider asking several museum visitors if they could give me a ride to the airport).

4:15 became 4:30, and 4:30 became 4:45.  By 4:50, I could feel my blood pressure rising, and there was no bus in sight.  But then, to my relief, a white and red minibus pulled up. I asked the driver if she was going to the airport (keep in mind that I had already nearly boarded two senior-citizen tour busses in the hope that they were the airport shuttle).  But this was the one, and I paid the surprisingly low fare of $0.50.  The driver waited around for a few minutes to see if any other passengers showed up, as if one of the other five people in the museum was also late for a flight.  But perhaps after noticing my exploding neck veins, she put the bus in gear, and we headed towards the airport.

It was about 5:05 by the time that we pulled into the terminal, and I sprinted to the ticket line.  Since Southwest doesn't have a huge presence at Dulles airport, there was no one else in line.  The ticket agent gave me a boarding pass, but didn't really think that I had a prayer of making the flight.  I have never missed a flight in my life, and the irony of missing my first one because I wanted to look at some airplanes was not lost on me.

But after pleading with security agents to let me into the express line, I was cleared quickly, and booked it to the gate.  I don't think I've ever moved that quickly, and certainly not in dress shoes.  I made it to the gate just as the last passengers were getting on the flight.  In fact, one of the other conference attendees called out my name from behind me in line.  We exchanged pleasantries, I explained away the profuse sweating, and we found ourselves some seats.

But just as I was patting myself on the back, the pilot came on the PA and casually mentioned that we had fuel dripping out of the right wing (and made sure to note that it was occurring at the rate of one drop every ten seconds).  He said that it was probably a minor issue, and the mechanics were on their way.  But, again, Southwest doesn't run a lot of flights out of Dulles, so the mechanics had to come from Baltimore.

After sitting on the plane for about an hour, I knew that I had already missed my connecting flight in Chicago.  And I also knew that it was the last Chicago to Tucson flight, since I had already looked into contingency plans if I missed my outbound D.C. flight.  So I knew that I would be spending a night somewhere besides my bed, and the only things left to figure out were where I was going to be sleeping, and how much it was going to cost me.

When they finally called off the flight (about two hours later), I got off the plane and called Southwest's 800 number.  There was no way I was going to stand in line with 100 angry passengers that were harassing an already exhausted gate agent.  But the Southwest phone agent couldn't do anything, because the flight hadn't technically been canceled yet, only indefinitely delayed.  But the other conference attendee that I ran into in the boarding line had the good idea of going out past security and talking with the ticket agents in the front of the airport.

We got there just in time.  Because this was the last Southwest flight out of Dulles, the agents were packing up to go, and didn't have any idea about the chaos going on at the gate.  And since we were the only people that walked out of security, the ticket agents had all the time in the world to book us on flights the next day.  They even gave us a meal voucher for a not-bad dinner in the airport restaurant.

The only problem was the hotel.  We had already convinced Southwest to pay for our hotel rooms, but there were none available near the airport (our flight was not the only one that was canceled that day).  So I asked them if I could get a Southwest credit in exchange for the cost of the hotel, and I would go out on my own and find one on my own (thinking that I would just go back into town and stay with my friend).

I would have taken a $100 credit, they offered $200, and I was as happy as a clam.  And to sweeten the deal, I found a $60 hotel room on Hotwire that was only a few miles from the airport.  Not a bad deal.

After just a few hours of sleep, I was back up and at the airport. Things went off without a hitch, and I only loved D.C. more because of the delay.  I'll be back soon.

-M

On the town

I woke up early on Wednesday to see as much of the city as I could before I flew out that evening. I headed down to the National Mall to meet another friend there for breakfast. Not surprisingly, there were a ton of runners down there at 7am. I’d catch fragments of conversations as small groups of them ran past my bench. Somehow, things like “youth civic engagement” and “my junior year at Penn State” didn’t seem odd coming from people in shorts and spandex. This really is a unique town.

After a greasy spoon breakfast at Lincoln’s (across from the similarly-linked Ford’s theater), I headed to the National Museum of Natural History.

Holy crap, this place is cool.

Say, friend, did you know that the original mammal that--after millions of years--became the primates that became the humans looked remarkably similar to a house mouse?

Or do you know what a monotreme is? I didn’t either. It’s a mammal that reproduces and defecates out of the same whole. There are only two species known (platypuses and something called the echidna), and that’s probably a good thing.

The pygmy marmoset (far left) is too small to digest complex foods, so it sinks its front fangs into trees a sucks out the sap. (These are preserved animals, but the National Zoo has the real deal.)

And apparently, panthers have two-way mirrors in the front of their eyes that let light in, and keep reflecting in back into their retinas to dramatically improve their night vision.  Amazing.

Of course, what visit to the Natural History Museum would be complete without dinosaurs!

By the way, this museum also houses the Hope diamond. The Hope diamond is a giant diamond now worth about $3,000,000.  It was likely mined from India in the 1500s.  It has a long and storied history, and was once part of the French crown jewels.  Rumor (and wikipedia) has it that Louis XIV granted a noble title to the lucky trader that sold him the diamond.

It was recently set into that (semi-tacky, but who the hell am I to say) necklace.

After a great couple of hours in the Natural History Museum, I walked across the mall to the National Air and Space Museum. I want to live there. Seriously.

I knew that I was going to have a great time as soon as I saw the two Cold War missiles in the lobby.

They looked like they were leftovers from a James Bond movie set. I think everyone would have felt better if they knew that the rockets were never intended to fly. They were apparently designed for the sole purpose of looking bad ass. Seriously, Soviet Union, did you really need all of those letters on the side of your rocket?

And speaking of bad ass, my next move was to look up.

Keep in mind that this was all happening within the first 30 seconds of me being in the museum. It’s the happiest place on earth.

The museum is broken up into different sections, each representing important sectors or themes in the aviation industry. The civil aviation room chronicles the history of commercial flight, and has amazing exhibits from Eastern Air, TWA, and Boeing, amongst many others.

And this little gem was in the WWI room.

If that’s a computer, then I overpaid for mine.

One of the most jaw-dropping exhibits is the actual Wright Brothers plane. The actual one, not a mock-up, not a replica, but the actual first-ever airplane.

I could have easily written it off as a replica if I didn’t notice the armed guard at the exhibit entrance. This thing is priceless.

There were also great exhibits on spaceflight and military aircraft, but I’ll save that theme for the next post. It’s a good one.

M

These hallowed halls

I promised that there would be poop jokes in this post, and I’m sorry to say that I don’t have any at the moment. But I do have a lot more travel photos.

Impressive, isn’t it? Seeing this in person should be required for all Americans that can afford the trip. And we should all kick in to pay for the people that can’t afford it. Both the structure--and what it represents--is an amazing sight.

The actual Capital building is just used for meetings of the House, Senate, and certain committees. Most of the action actually happens in the five or six office buildings that surround it. These house the offices of the Senators and Representatives, and are where they spend most of their time.

Some are traditional, and some are modern, but they all have an amazing feel to them. Forty year old lobbyists walking past twenty year old staffers, while the sixty year old Congress people hide away in their back offices. People are moving and things are happening!

This is the main lobby of one of the older office buildings.  It's where both parties hold a lot of their impromptu press conferences, and you can see a TV camera set up in the top left corner.

This is one of the many hallways coming out from the lobby above.  The two doorways with flags in front of them lead to Senators' offices.

This is one of the newer, but equally impressive office buildings.  This one houses the offices of Harry Reid, Jon Kyl, and Al Franken, amongst many others.

We met with the offices of Representative Flake (R-Phoenix), Senator McCain, and Senator Kyl. We didn’t get face time with any of them, since votes were happening during our appointment times, but we did meet with the health staffers for all three. And to be honest, that’s what we were hoping for. Things like payment formulas and residency funding are kind of wonky, and our elected representatives don’t have time to learn about all of them. So they have specialized staff members (health, finance, military, etc.) that are experts in these subjects. They meet with the various interest groups, and compile a summary for their bosses.

Not surprisingly, the health staffer for Rep. Flake could care less about what we were talking about (he’d rather talk about abolishing Medicare than about allocating a specific pool of money within it). But the health staffers for both Senators McCain and Kyl were remarkably receptive. They were well informed, and knew about the issues that we were trying to address. While we didn’t see eye to eye on all issues, we all agreed that the residency funds need to be more diversified. It was a very pleasant surprise to have their support on that issue.

After our three meetings, the rest of the Arizona delegation (a doctor and a resident) all struck off on our own to take advantage of our time in D.C. I spent the afternoon visiting a friend who served with Aimee in the Peace Corps. He has a very impressive job coordinating public relations for Senate Dems, and he reports to none other than Harry Reid. When he told me nonchalantly to just meet him in Harry Reid’s personal office, my eyes almost popped out of my head. I was actually kind of nervous walking over to meet him. “What if Senator Reid is there? Should I say hi? Should I talk about Medicare payment reform, or should I just say how nice the weather is?” But for better or worse, Senator Reid was in meetings all afternoon, so I didn’t have the chance to make an ass out of myself in front of the majority leader of the United States Senate.

But I had a great time meeting with my friend. He has an all access pass to the Capital building, and gave me a pretty incredible behind-the-scenes tour of the operation. I even got to see Al Franken reading the newspaper on the Senate podium. Apparently, whenever the Senate is in session, there needs to be a Senator presiding over it, even if nothing is going on. It’s clearly a pretty boring gig to sit on the podium (while all of your colleagues are off in meetings) so the junior Senators rotate through the job in two-hour shifts. And I had the luck of being there during Senator Franken’s turn. And for everyone who solely remembers him and Stuart Smalley and the guy that wore nothing more than a diaper on live television, he’s actually a remarkably astute policymaker. After all, you don’t have to be smart to be a Senator, but you do have to be smart to be funny. Seinfeld/O’Brien 2016. We could do worse.

Lobby Day!

Did you know that the Senate has its own barber?

I don’t know what to say about that, or even if anything needs to be said, but it was pretty cool.

Now, you might ask what I was doing in the basement of the Senate office building. I spent most of Tuesday lobbying on behalf of Family Medicine, and we had three major points to make:

The current equation that Medicare uses to pay physicians in flawed. It was passed in 1997 as one of Newt Gingrich’s signature bills, right after his party took over the house. The House Republicans weren’t happy with how much money Medicare was spending (nobody was, or is). They wanted to curb the expenses, so they went after doctor’s pay. As you know, I’m usually the first person to say that most doctors (particularly specialists) are paid far too much, but the problem with this bill is that physician pay is a very, very small component of total Medicare expenses, so cutting it would have a negligible effect on the overall expenses. But doctors are generally one of the more politically inept interest groups (silly us for focusing on our patients, and not politics), so we were an easy target. Congress is very, very weary of going after the insurance industry. 

But even that same Congress realized that this was a bad bill, so they passed a short-term “Pay fix” bill that pulls money from other pools of money to make up for the difference between what Medicare was supposed to pay doctors under Gingrich’s plan, and what it actually pays them (under the old formula).   The problem is that because of how Gingrich’s formula was written, the difference between real pay and “on the books” pay widens further every year, and it’s getting harder and harder to cook the books. In fact, last year, Congress couldn’t figure out how to pass the most recent pay fix, and the Gingrich rate kicked in. Overnight, doctors took a 30% cut in their Medicare pay, and it wasn’t resolved for two weeks.

Now, to balance out my Congress bashing, the Democrat Congress should have repealed the Gingrich pay rate as part of last year's healthcare reform law, but that would have obscured the benefits of that bill, since some of the cost savings would be negated by increasing the “on the books” pay rate for doctors.

What all physician groups are asking for (including the Academy of Family Physicians and the AMA) is that Congress pass a 5-year pay fix (instead of the current few months at a time), so that we can work with Medicare to come up with a more permanent solution.

But in my opinion, this isn’t one of medicine’s more pressing issues. We’re using a lot of political capital to keep the pay cut from kicking in, and the general public isn’t all that sympathetic to doctors’ pay. And asking for more money in this political climate is a complete non-starter. But the whole point of organized lobbying is that we’re far more effective as a group. So when the Academy holds a vote, and the majority of physicians are in favor of pursuing a pay fix, we all lobby for it, even if many of us aren’t convinced that it’s the most effective use of our resources.

The other two issues that we lobbied for are much more important to me, and I think that they will have a far greater impact on the overall healthcare system. We want to increase funding for primary care medical education. The trip that I took to the Hopi reservation last summer was funded by this pool of money, and the trip was probably the single most powerful event that convinced me to become a family physician. These programs are an extremely cost effective way to address the shortage of primary care physicians. However, this isn’t a great time to ask for more funding for anything, so we got some pushback from some of the more conservative members of Congress. It’s an investment that will save the system a lot of money over the long run, but many people don’t see past the initial cash expense.

The last issue was an interesting one, and one that has the added benefit of not costing the government any more money. It relates to how our country pays for residencies (the time between medical school and being a grown-up doc). Since residents are fully licensed physicians, they can see patients in the clinic and they can perform procedures. This brings in money for the program that is training them, but it is usually not enough money to offset residents’ salaries (which are usually in the ballpark of $40,000). So if this arrangment wasn’t subsidized, hospitals would have no financial incentive to train more physicians, and we’d have a serious, serious physician shortage in about 15 years.

Since we receive a collective benefit from having enough doctors, we all chip in to cover the costs. Part of our Medicare tax goes towards funding residency programs. You pay about $2.50 per year towards this, and we really do appreciate it. However, this money is paid to hospitals for them to use as they please. So it should come as no surprise that hospitals are going to funnel this money into the most profitable residency programs. So even though it saves us all an incredible about of money to have a primary care-focused healthcare system, it is far more profitable for a hospital to crank out more neurosurgeons (since neurosurgery residents perform procedures that bring in far more money than the procedures done by family medicine residents).  This is why "free market principles" work great when you’re making shoes or selling computers, but they are very counterproductive in most aspects of the healthcare system.

What we asked for is that Medicare distributes the residency money to a wider variety of players in the healthcare system. Hospitals will continue to (and should) receive the bulk of that money, but we want to see community health clinics, small physician groups, and rural hospitals also receive some of this money, since they are far more likely to train primary care physicians. And since this proposal has the added benefit of being budget neutral (we’re just moving money from one account to another), Congress was pretty receptive. The hospitals won’t be crazy about this proposal, but as long as they don’t fight it too hard, I’ll bet that Medicare will start diversifying its residency funds in a year or so.

Something about D.C. just keeps bringing out these political postings, but we’ll be back to poop jokes and travel photos in no time.

M

The District

After a mildly excruciating networking hour (I barely made it through fifteen minutes), the conference adjourned for the day. I went for a walk, and checked out the city. Here’s where the conference was held (the intersection, not the building).

That street name sounds familiar, doesn’t it?

Here is a road with a building at the end of it.

I kept walking towards the White House, but the back entrance was mysteriously blocked off. Security looked antsy, and they were telling everyone to step back. Then I started hearing a unique siren off in the distance. It wasn’t like a fire truck, police car, or ambulance, but it was definitely loud.

Then this pulled up.

OMG! OMG! OMG!

I was pretty confident that I had just seen the president’s motorcade. At least until I heard the same siren sound coming from the opposite direction.

Out of curiosity, I pulled up the president’s surprisingly public schedule. He was moving from a meeting with Janet Napolitano to one with the Chinese Ambassador.

And here we are!

And to put it in context…

You know what I love about D.C.? You’re walking down the street, minding your own business, and out pops the headquarters of the IMF. Just sitting there.

And the Mexican Embassy...

…right next to Metropolitan Optical. Only in D.C. 

Actually, the Mexican Embassy is a pretty cool structure. It looks like it was build right next to, and on top of, two houses that were already there.

I kept walking and walking, and happened to come across the GWU Med School.

I looked for an A to paint red, but no luck. 

And the headquarters of the World Health Organization, a personal favorite.

As the sun started to set, I made my way to the Lincoln memorial.

There is definitely a warm, reverent feeling in that building that doesn’t come across on postcards. Or on pennies.

Currently, the view from the Lincoln Memorial is less than spectacular.

I mean, I know that we’re broke, but do we really need be Canada’s trashy neighbor that doesn’t fill our pool? 

I’ll be here all week, folks.

And one more Lincoln photo to justify the cost my camera.

Now, you could say that this is group of D.C. staffers playing softball on the National Mall, while the Sun sets behind them over the Lincoln Memorial. Or you could just say, “America, fuck yeah.” 

But maybe you should save that for this photo.

I certainly am proud to be an American.