VanGrossMD | A Bob Dylan Tribute

A Bob Dylan Tribute

Posted by vangrossadmin in Uncategorized 13 Dec 2016



 (Red interjections by Kenneth Van Gross, MD)

 June 7, 2009


Once upon a time you dressed so fine
You threw the bums a dime in your prime, didn’t you?  This was the 80’s Health Care System- rampant spending..extravagant testing thought to be a bottomless pit……and there was even some opportunity to do some expensive work-ups on the poor and eating the costs
People’d call, say, “Beware doll, you’re bound to fall”
You thought they were all kiddin’ you
You used to laugh about
Everybody that was hangin’ out  Although there were warning signs about over spending in the medical field, there was mostly guffawing by the medical profession and cynicism about the burgeoning impoverished class in the US
Now you don’t talk so loud
Now you don’t seem so proud
About having to be scrounging for your next meal.What a sequence of lyrics! “Suddenly” (and it seems that way) the health care system has crashed!

How does it feel
How does it feel
To be without a home
Like a complete unknown Pity for the Health Care System, now wandering aimlessly.
Like a rolling stone? This was my Rolling Stone reference in the proclamation title page.

You’ve gone to the finest school all right, Miss Lonely
But you know you only used to get juiced in it
And nobody has ever taught you how to live on the street
And now you find out you’re gonna have to get used to it “Getting juiced in it” is a good way of describing the no holds barred medical spending characterizing the run up to the HMO’s that got launched in the ’90’s. However, as is noted, the Health Care System, hatched in the great US academic medical institutions has been left to “live on the streets” crying poverty.
You said you’d never compromise
With the mystery tramp, but now you realize
He’s not selling any alibis Clearly, “The Mystery Tramp” is the HMO and larger Medical Insurance Industry. Rather than compromising quality spawned by the cutting edge technology, this tramp was supposed to make things better. Now, not only does the insurance industry offer no alibis for the health care debacle, it insists everything is pretty much fine and dandy!!!
As you stare into the vacuum of his eyes
And ask him do you want to make a deal? Riveting. Doctor: (Staring at Mr.HMO Owner): Can we work out a system of rationed Specialty Medicine evaluations? Mr HMO Owner: Sure son. And don’t call me a “Mystery Tramp” or “Compromiser of Quality”.

How does it feel
How does it feel
To be on your own
With no direction home
Like a complete unknown  How sad…the great American medical field reduced to anonymity ( unknown amongst success stories) through its own failed system of medical care.

Like a rolling stone?Add ignominity to anonymity (see my final comment)

You never turned around to see the frowns on the jugglers and the clowns
When they all come down and did tricks for you
You never understood that it ain’t no good
You shouldn’t let other people get your kicks for you Wow…who are the jugglers and the clowns doing tricks and getting kicks for the medical profession before the HMO takeover? Other than the HMO owners themselves, probably the pharmaceutical and medical device industries. The promises? “Quality care through “health maintenance”. “Breakthrough” though “slightly expensive” drugs galore. “Scientific proof” for unlimited testing including MRI’s from here to eternity.
You used to ride on the chrome horse with your diplomat
Who carried on his shoulder a Siamese cat All kinds of imagery here. You’ve got some MD’s riding in their Rolls Royces. Next to them are the raiders from overseas who invaded sectors of the medical profession with their instant million dollar medical practices built on the wealth they brought with them here.
Ain’t it hard when you discover that
He really wasn’t where it’s at
After he took from you everything he could steal.In this sense, “he” is “your diplomat” who represents all of the Health Care Industry raiders from big business tycoons from all over the world, HMO developers and owners, pharmaceutical and medical device kingpins, etc.

How does it feel
How does it feel
To be on your own
With no direction home
Like a complete unknown
Like a rolling stone? Justifiable ongoing lamentation……….

Princess on the steeple and all the pretty people
They’re drinkin’, thinkin’ that they got it made
Exchanging all kinds of precious gifts and things
But you’d better lift your diamond ring, you’d better pawn it babeGreat lines…a final metaphor for the ivory tower princess of profligate health care spending, fully engaged in the “health care business” of buying and selling exorbitantly priced health care commodities such as scans, medications, multispecialist co-owned testing centers dedicated to turning a profit but not necessarily improving anyone’s health……but now, no longer cash cows, medicine has to cut the wild testing and dial back care enormously
You used to be so amused
At Napoleon in rags and the language that he used
Go to him now, he calls you, you can’t refuse
When you got nothing, you got nothing to lose
You’re invisible now, you got no secrets to conceal.Napoleon in rags….the psychotic homeless, now the Health Care System twin…now this broken system can go to him and treat him, what it should have done when his numbers began to increase in the “go-go 80’s” Napoleon lay in the streets actively hallucinating (perhaps he was a permanently traumatized veteran), the medical industry decided it had more important things to do…like order millions of semi-worthless tests and procedures for healthy people “with good insurance”.

How does it feel
How does it feel
To be on your own
With no direction home
Like a complete unknown
Like a rolling stone? Mr. Dylan has nailed this fractal subconsciously or via a premonition he himself couldn’t articulate. No stone that I know of is good to have in the human body. It represents a coalescence of a process that has produced illness. A moving stone carries the specter of landing at a site that can induce a fatal blockage. But it can also pass out in the urine for example. We are now witnessing that movement. It is up to the American people to evacuate that stone.