stay or go?

For the Ragtag Daily Prompt: migration.

I took this on a beach walk with my aunt and uncle on Sunday. They were visiting from Virginia. They’ve flown back now.

This is taken with the zoom all the way out. I recognized the great blue heron, but in the first picture I can’t tell what the geese are. With a face in profile in this second photograph it’s clear that they are Canada geese.

The geese are migrating but the great blue heron stays and winters over. Most of our hummingbirds migrate, but the Anna’s can winter over. And I have been asked: stay or go? My landlord asks if I will renew my lease for my clinic in February.

I reply that I am waiting on the US Congress. My clinic is more than half medicare patients. 48% are over age 65. Congress is discussing paying a flat fee for medicare visits: about $43.00 dollars. At the moment I do not see how I could keep my small solo clinic open if that goes through. Stay or go? It is stressful. I want to stay. But I may have to migrate like the geese….

I think a frightening number of physicians would either migrate or stop taking medicare patients, opt out of medicare, if Congress passes this bill. The AAFP is fighting it. I contact Congress too, but I am tired of fighting for single payer, medicare for all. Patients spend more on their dogs’ health than their own. How can I do good care and feel valued for $43.00 per clinic visit?

I thought the thing most likely to close my clinic is the cost of my own health insurance. But Congress may close me down by dropping my payments from 48% of what I bill, to less than 25%. Yet they say they want good care for our country….

Message me if you contact Congress to say do not do this. And thank you so much if you do.

The proposal for medicare changes is 1472 pages. So I am supposed to find time to read that and comment on it in addition to taking care of my patients? What sort of insanity is this?

Melanin whales

For mindlovesmisery’s Wordle #85

“Shipwrighteous bastard,” she thinks, wrestling with the submersible. It is hard to avoid the really tangly patches of kelp, now that the submersible has lost the ability to rise. It is now an ungainly hunk of machinery at this depth in the water. Phase doesn’t dare go any deeper, because she knows she’ll have to let the submersible go eventually. She curses the shipwright again, who nonchalantly assured her that the submersible would hold up for the full migration distance. Phase thinks for a nickel she’d return and mutilate the bastard, but again, she knows that she can’t, not really.

Her suit beeps. “I know,” she snarls. The suit has noticed the change in her hormones and that her immune plexus is aroused and at risk. The suit would like her to find a quiet place and meditate. “Shut the fuck up,” she mouths to the suit. The screen of her mask changes color just a little, lightening to the color that she thinks of as injured silence. She doesn’t mouth it, but thinks that the suits are too damn sensitive now.

She is thinking about the submersible and calculating the amount of energy to keep her breathing at this depth versus taking the supplies that she can carry and rising to the surface. The latter would burn less energy but without the submersible sled, she will have to dump more than half her supplies and choose between food and weapons. She will need both to complete the migration and not be eaten by the melanin whales.

She and her suit alert at the same moment, to a current change in the water and a large dark form…..

 

the immune plexus in the brain: http://www.nature.com/neuro/journal/v15/n8/abs/nn.3161.html

the photo is from 2006 at Lake Matinenda