Here is the introduction to my book-in-progress, “Open Wide And Say Moo! – The Good Citizen’s Guide to Right Thoughts And Right Actions Under Obamacare.” Comments are fervently sought; you can leave them here.

You can read my rationale for undertaking this project, and thus opening myself up to the possibility of public failure, humiliation, derision, disapprobation, and unwanted scrutiny, here.

And here is the up-to-date archive for all the chapters that have been posted so far.
Update – September 1, 2012

Open Wide and Say Moo! is now revised and published!


You can find it on Kindle here.


Now available in the audiobook version!





From the Front Matter

“It will be of little avail to the people, that the laws are made by men of their own choice, if the laws be so voluminous that they cannot be read, or so incoherent that they cannot be understood.”

- James Madison, The Federalist #62


“The human race divides politically into those who want people to be controlled and those who have no such desire.”

- Robert A. Heinlein

“Today, this isolated relationship [between doctor and patient] is no longer tenable or possible. . . Traditional medical ethics, based on the doctor-patient dyad, must be reformulated to fit the new mold of the delivery of health care. . . The primary function of regulation in health care. . .is to constrain decentralized individualized decision making.”

- From the ominously titled “New Rules,” Donald Berwick, MD and Troyen Brennan, MD


From a recently discovered fragment, attributed by some to Plato:

Meno: This DrRich (whoever he is) has badly mishandled the title of his book. It’s not possible for a person to open their mouth wide while saying moo.

Socrates: It would certainly seem so. But I’ve heard of this DrRich. He is playing with us.

Meno: There’s a message in the title then. That being the case, then obviously he is attempting to draw a comparison between patients and cattle.

Socrates: Yes, it seems to be true. In his earlier writings he has often said that in his land they are establishing a new healthcare system that will treat patients like the interchangeable members of a herd of beeves.

Meno: Well, he would have been better off comparing them to a herd of sheep. After all, one can open one’s mouth quite nicely while saying, “Baaa!”

Socrates: But the fellow is reputed as sly. He chose “Moo” for a reason.

Meno: It doesn’t make sense. No doctor who truly wanted to do a thorough examination of a patient’s oral cavity would ask the patient to purse their lips in such a manner. (Never mind while asking them to make such a demeaning sound!)

Socrates: Precisely. Does it not follow, then, that for some unfathomable reason the doctor does not actually intend to do a thorough examination? But that at the same time, apparently, he wants to pretend otherwise – possibly to himself as well as to his patient?

Meno: You’re proposing that the doctor, by saying “Open wide” as if a full examination is about to take place, is engaging in a purposeful fiction? A fiction which he reveals in the very next moment when he specifies exactly what he means by “wide?” It makes no sense.

Socrates: But doctors do something like this all the time. Has no doctor ever said, “This won’t hurt much,” just before he does something unspeakble to you?

Meno: Certainly. It’s how they earn their drachmas. But my doctor is simply trying to get me to hold still long enough for him to violate my person (only in the most professional way, of course). In contrast, the strange doctor imagined by this DrRich is telling his patient, “I’m going to do an extremely inadequate and cursory examination of your oral cavity, and we’re both going to pretend I gave you the full bore going-over you ought to expect from a competent physician.”

Socrates: Sad, but true. But there’s one more thing – one more particularly disturbing thing – implicit in the doctor’s command to open wide and say moo.

Meno: You mean that, for such a singular and inappropriate command, it is delivered very matter-of-factly?

Socrates: Yes, my young friend. The attitude of supreme confidence this command carries with it is remarkable. The doctor clearly expects that his patient will comply fully with the fiction he is proposing to perpetrate, without protest or complaint, even though compliance is to the patient’s own detriment, and furthermore that the patient will do so with the most submissive of utterances.

Meno: It’s absurd to postulate such a thing. You give DrRich too much credit. I think he is simply an ass, and botched the title of his book.

Socrates: Let us see.


The title of this book is not as ill-chosen as you may think at first glance. It is, in fact, a particularly apt illustration of my overall theme.

Under Obamacare, or under any Progressive healthcare system, the Good Citizen must learn to develop the proper mode of thought. When a doctor or some other agent of the healthcare authority informs you with all apparent sincerity that something is true, while their every action indicates that something quite different is true, and you choose to believe what you are told, instead of what your own senses are saying to you, this is called right thinking. Then when you act on what you are told, again in contrast to all the evidence to the contrary, it is called right action.

“Open wide and say moo” is therefore a metaphor that suggests how we as patients are likely to be treated under Obamacare, and it implies how we are expected to respond.

To such an absurd command a skeptic would reply, “What in the hell are you talking about? Do you want me to open wide or not? And what the hell is this ‘moo’ business?”

This is neither right thinking nor right action.

In contrast, right thinking will allow you to process such a request from your doctor in the proper way. You will recognize that the vague command to “open wide” is a mere courtesy. It is a way for you (and your doctor) to pretend that a thorough oral examination is about to take place, and thus to feel better about the kind of healthcare you are about to receive (or give). The real command, you will recognize, is the more specific one, the one that, in essence, defines what is actually meant by “wide.”

And so: Being a Good Citizen (and thus a perfect Obamacare patient), you will purse your lips, just barely wide enough to allow your ObamaDoc (a doctor whose primary interest is in keeping the Central Authority happy) a quick, cursory look at your oral cavity, the kind of look that will certainly preclude discovering anything amiss, and you will simultaneously utter that most placid noise of bovine compliance.

For Obamacare to work, you will need to accept that the quality of healthcare you are receiving is precisely the high quality the Central Authority insists you are receiving, which is to say, the highest quality that can possibly exist – despite the obvious evidence you may notice (if you are of a mind to notice) that it is not.

The people who will run Obamacare, we must realize, will not be lying to us. They actually will believe what they are saying. They fully expect us to believe it, too, and they will become quite exercised if they begin to perceive we do not. Here, an analogy to religion (which will be a recurring theme in this book) is apropos.

When something horrible has happened to you or a loved one, your pastor is likely to tell you that we must all trust that God has a plan, and that in God’s plan what seems very bad to us today must always serve God’s higher (if hidden) purpose. And we must have faith that some day, when it is all done, we will understand that higher purpose, and we will rejoice.

Similarly, when we think we see something terribly awry with the healthcare we or our loved ones are receiving (or not receiving, as the case may be), we will be exhorted to trust that the Central Authority also has a plan that serves a higher purpose. And just as true believers will be rewarded with God’s higher purpose in the end, so will the Good Citizen, by and by, be rewarded by the fruits of the Central Authority’s own supreme plan (as long as he or she does not become too disabled or too dead to appreciate it).

It is critical to understand that Obamacare, or for that matter, any Progressive program for societal improvement, simply will not work without your full buy-in and full cooperation – without your right thinking and right action. For this reason the Central Authority is very, very, very interested in making sure you develop these proper ways of thinking and acting.

Right thinking, in essence, is faith that the enlightened expertise embodied within the Central Authority knows what is best, for us and for all. And right action is complying, without complaint, with that central judgment. (For practical purposes, of course, right action will suffice all by itself, as long as you refrain from expressing too publicly your not-right thinking.)

The utter inability of most people to comply with these simple (but non-negotiable) requirements is precisely why no Progressive program for societal improvement, anywhere, has ever worked well for a very long time.

The closest that Progressive policies have ever come to realizing the universally beneficial ends which Progressives always promise has likely been in the Scandinavian countries. Here, the trauma of the World War II experience, combined with a homogenous population sharing a deeply-felt common goal, resulted in a generation of citizens who were truly dedicated to the attitudes, thoughts, and actions (specifically, working hard and tirelessly for the good of the whole), which were needed to make their collective society a success. Their children’s generation was slightly less dedicated to selfless action for the sake of the collective. Their grand-children’s generation seems far less so. Today, even Scandinavian socialism is fraying, at least around the edges.

Perhaps three generations of Good Citizens is the most Progressivism can hope for, even under the most favorable conditions.

In any case, we in the United States, through our duly elected representatives, are now committed to Obamacare. And if the Supreme Court later this year throws out the individual mandate and drives a stake through the heart of Obamacare, odds are high (as I will explain later) that shortly thereafter we will just end up with Obamacare II (or, more accurately, Hillarycare III).

And given the strong likelihood that we will all be enjoying our healthcare very soon under either Obamacare or its equally Progressive successor, it behooves us to understand what, exactly, our new healthcare system will require from each of us in order to function as it is intended. These requirements, whether we choose to understand them or not, will turn out to have a major influence over all of our lives (and limbs). But by understanding the requirements which are being placed upon us, then we can each decide whether we will be a Good Citizen – or something else. (While it may not always be easy or pleasant – or perhaps legal – there is always a something else.) So, a main goal of this book is to explore the requirements placed upon all Good Citizens by a Progressive healthcare system – what those requirements are, why they are non-negotiable, and what our options may be, as individuals, relative to them.

If Obamacare is a terrible mistake, as I believe it is, when we allowed our leaders to choose it we at least made an explicit recognition that the status-quo is no longer feasible. It is infeasible because our present out-of-control healthcare spending promises to trigger societal destruction within a few decades.

But the cure we have chosen – moving to a Progressive healthcare system – is likely as bad as the disease. I hope to show why this is so, and perhaps to convince a few people that, before it is too late, we ought to explore a different option for bringing fiscal sanity to our healthcare system.

Unfortunately, our window of opportunity to change paths is narrowing quickly. Once Obamacare (or any Progressive healthcare system) moves beyond a certain point, entropy will dictate that it cannot be undone, short of the traditional method for un-doing the various massive, elaborate, Byzantine constructions mankind is perpetually inventing, which is to say, via total societal collapse. So time is of the essence, which is why I have decided to publish this book in real-time, on-line, as I write it.

This book is divided into three parts.

In Part 1, we will discuss how and why it looks (so far, at least) like we are going to end up with a Progressive healthcare system. We will consider the fiscal black hole our healthcare system has become, and show why some fundamental change in American healthcare has been inevitable for years (whether we take purposeful action to effect such change or not). We will have a look at the four ways it is possible to get healthcare costs under control. (Yes, there are four.) (And yes, there are only four.) Of the four, we as a nation have chosen the Progressive solution, since its proponents can always make it sound the least painful. For this reason we will end Part 1 by considering the general Progressive program for societal perfection, a program which will determine the chief characteristics of our new healthcare system.

In Part 2, we will survey what Obamacare will look like once it is fully rolled out. We will examine its basic tenets, and the implications and mechanics of the herd medicine it will impose. We will consider the kinds of things you will experience personally when you seek healthcare (or are ordered to get some) under Obamacare. Finally, we will survey some of the bigger-picture aspects of Obamacare, such as “life-cycle” medicine (i.e., aged-based priorities for healthcare), and how and why Progressives will stifle medical progress.

Part 3 can be entirely skipped by anyone who likes what they’ve read about Obamacare in Parts 1 and 2. (Your right action, in placing this book aside, should go a long way toward paying your penance for picking this book up in the first place.) Part 3 will examine what we can do, as individuals and as groups, to protect ourselves from some of the hazards of Obamacare, to reverse its most odious parts, and even to begin to construct a replacement healthcare system that might avoid the fatal flaws not only of Obamacare itself, but also of the Pre-Obamacare system of healthcare which has led us to it.

None of this, I understand, constitutes a particularly happy message. So I will try to keep it relatively light, employing along the way a bit of irony, sarcasm, wry humor, perhaps some puns (though very few if I have anything to say about it), and in general my sunny disposition. Just keep in mind, amidst all the merriment, that we are still pretty much screwed, unless we decide to do something about it.

I will end this Introduction by inserting a statement that many may consider out of place, and which others may feign not to understand, and which still others may find insulting, but which may come in handy for me, personally, at a later date. To wit: I hereby fully acknowledge that good people can be led astray by Wrong Thinking, and I believe that sometimes, even having passionately expressed such wrong thoughts in word and deed (say, in book form), many of these good people can be brought back into the light, if they are shown sufficient mercy and understanding. I therefore deeply pray, and fervently hope, that when such strayers are brought to judgment, the Central Authority will give strong consideration to attempting their reeducation and rehabilitation, rather than immediately submitting them to the more final penance of auto-da-fe.