Reflections on a Medical Career by Robert S. Dotson, M.D.
The Impending Collapse of American Medicine
Just as is every issue in the US, Obamacare and the wider question of
the state of American health care are obscured by propaganda and
disinformation. In the article below, Dr. Robert S. Dobson looks back on
a lifetime of medical practice and provides facts and insights that
might help us to understand our situation.
The US medical system is the most expensive on earth without being
the best and without providing full coverage. One-sixth of the American
population has no medical coverage.
There are two main reasons that US medicine is so expensive. One is
that profits are piled upon profits. In addition to wages and salaries
for doctors, nurses, and medical personnel, the American health care
system has to provide profits for private hospitals, diagnostic centers,
insurance companies, and for the accountants, attorneys and management
consultants made necessary by the enormous litigation and regulatory
compliance cost. American medicine is the most regulated in the world
and the most criminalized.
What “Obamacare” does is to divert Medicare and Medicaid monies to
the profits of private insurance companies. Instead of providing
medical care to those in need, the taxpayers’ money will provide bonuses
for insurance executives and profits for their shareholders. It is the
height of folly for Obama worshipers to defend a law written by the
private insurance companies that uses public revenues to provide
insurers with 50 million more customers and to add yet another layer of
profits to the cost of American medicine.
Reflections on a Medical Career
Robert S. Dotson, M.D.
Robert S. Dotson, M.D.
All lovely things will have an ending, All lovely things will
fade and die; And youth, that’s now so bravely spending, Will beg a
penny by and by.
-Conrad Aiken (“Disenchantment IV”- 1916)
Thirty years have passed since a much younger physician opened his
ophthalmology practice in East Tennessee. A lifetime of hopes and
expectations, intermingled with the usual collection of fears and
uncertainties, has sped past at blinding speed. Children came, grew up,
and moved on to their own lives. Parents and grandparents, aunts and
uncles, many friends and colleagues have returned to dust in advance of
their fading photos.
Patients and their parents and children and grandchildren have moved
in and out of this world, too, inextricably woven into the fabric of my
life. Sadly, a few may have been hurt by lapses in judgment or the
arrogance of youthful physician pride and overconfidence. But, at the
end of the day, most were helped. I was fortunate to be recognized as a
“doctor’s doctor” early on and, though there was no attendant reward
other than the respect of peers, that was a sufficiently gratifying
laurel to carry.
As in any human story, joy and pain, love and sorrow, have marked
these same years. The Millstone of Time has also worn away foolish
aspirations and vainglorious pretensions. There is no one left to
impress, no accolades to seek, no rank to which to aspire. Consequently,
I feel freed to offer some end-of-life reflections on my profession and
career.
Any thinking American knows that there is something terribly wrong
with the health care system in this country. Throughout my career, the
political ruling elite has been enacting piecemeal a version of
“universal” healthcare coverage to satisfy the demands of an
increasingly vocal, but also increasingly disenfranchised citizenry. Our
overlords, of course, have been more motivated by enhancing corporate
bottom lines and enriching themselves, than in genuinely helping the
peasantry.
Every U.S. President since Kennedy in 1962 has dealt with the issue
in one way or another – by policy statement or passage of legislation.
LBJ oversaw the creation of Medicare and Medicaid in 1965. Nixon oversaw
the passage of the HMO Act (Health Maintenance Organization) in 1973
and ERISA (Employee Retirement Income Security Act) in 1974. Amazingly,
he also introduced CHIA (Comprehensive Health Insurance Act) in 1974.
Even more incredible was the spectacle of Ted Kennedy working to ensure
its defeat. Doubtless, Kennedy regretted that in future years. Following
the untimely departure of the 37th President, Gerald Ford signed ERISA
into law in 1974 on his behalf, thereby introducing some minimal
regulations to ensure that separated employees could maintain benefits,
such as health insurance, for a limited time.
Carter campaigned in favor of National Health Insurance, but failed
to pass anything similar during his time in office. He cited Kennedy’s
opposition to CHIA and to his own proposals as the main reason for
failure. Reagan’s era witnessed the passage of EMTALA (Emergency Medical
Treatment and Active Labor Act) and COBRA (Consolidated Omnibus Budget
Reconciliation Act) in 1986 that, among other things, provided for
emergency medical treatment coverage for anyone who could drag
themselves into an emergency room (of course, such a visit might
bankrupt them unless they were lucky enough to be an illegal alien).
Medical labs and imaging centers (and, the providers staffing them) were
given “special attention” under CLIA (1988).
The first President Bush had little time for national health care
issues, as he was primarily focused on launching the NWO. Poppy’s
“Thousand Points of Light” degenerated into in-coming tracers from the
illuminated Angel of Death – simply more “peace, freedom and liberty”
being delivered to millions of innocents across Battlefield Earth. It
seems so trivial now, but Bush was unseated after reneging on his pledge
of “no new taxes,” not for offshoring the US economy or taking the
first step toward turning US foreign policy into the pursuit of world
hegemony.
The Clinton administration tried to force through “Hillarycare” in
1993, but met with stiff opposition from their Republican opponents (of
course, the opposition was due to perceived threats to corporate profit
margins). Nonetheless, Team Clinton was able to push through HIPAA
(1996) (Health Insurance Portability and Accountability Act) and SCHIP
(1997) (State Children’s Health Insurance Program) which, contrary to
the titles of the acts, neither improved health insurance portability or
accountability nor improved the health of children.
The Clinton White House had more important fish to fry: war in the
Balkans; the liberal distribution of depleted uranium and cruise
missiles across the globe; test wars on Americans at places like Ruby
Ridge, Waco, and Oklahoma City (OKC); the appearance of numerous
“Arkan-cide” victims whose mortal remains seemed to be discovered at the
most inconvenient times; and, a semen-stained blue dress. The first
versions of the Patriot Act were trotted out in response to the false
flag event of OKC, but Congress and even the Imperial Senate balked at
moving so precipitously toward the New Amerikan Security State.
The ascension of son Bush and his neoconservative cabal turned the
government to the drive toward world hegemony. The serendipitous events
of 9/11 opened the door for passage of the neocon’s PATRIOT Act and for
the still on-going implementation of their Project for the New American
Century (PNAC). New alphabet agencies like DHS and TSA were created to
augment existing departments and agencies (FDA, DHHS, IRS, FTC, FCC,
EPA, FEMA, DEA, BATF, FBI, NSA, CIA, and DOD) charged with dominating
the nation and the planet beyond. Orwell’s dystopia, 1984, became
reality: “War is Peace. Freedom is Slavery, Ignorance is Strength.”
President Bush modeled Big Brother’s third slogan for an admiring
populace more concerned with Harry Potter and Janet Jackson’s nipple
than with the deadly machinations of the psychopath in charge.
It seems likely that steps toward the Third World War were taken
during Bush II’s reign with “war, war, WAR” being unconstitutionally
declared against the nebulous (some might say, non-existent) terrorists
lurking under every bed and in every closet, cave, and country on the
planet. In spite of a premature proclamation of “Mission Accomplished”
from a flag-festooned carrier in 2003 by the Decider-In-Chief, the
killings have continued with little pause up to this day. The Great
Decider used the opportunity of “victory” abroad, however, to turn his
attention to the healthcare needs of his subjects.
What could be a better bone to throw to the peasants than the
expansion of pharmaceutical coverage for those under Medicare? And, what
could be a better pay-off for corporate buddies than massive new
government wealth transfers of taxpayers’ dollars to Big Pharma via
such a plan? It was a perfect “win-win” for the oligarchs at the top of
the pyramid and a “lose-lose” for the peons at the bottom. To the great
joy of Big Pharma, the Medicare Prescription Drug, Improvement and
Modernization Act (Medicare, Part D) was launched in 2003 to insure
unimaginable profits for its corporate members and more expense for the
common people it was alleged to help. As in any casino, our healthcare
croupiers are well trained to leave no dollar on the table.
President Obama, a corporate stooge par excellence, was able to ram
through “universal healthcare” with the help of a Howdy Doody smile, his
corporate sponsors, and the slavish devotion of an ever-delusional,
pseudo-Left. It mattered not that the legislation was written by the
insurance companies who had been profiting from the misery of patients
for decades.
It is no accident – and would be comical, if it were not so serious –
that there will be no true, equitable national health care system under
the Patient Protection and Affordable Care Act of 2010 (aka,
“Romneycare II” or “Obamacare” or, lately, “Robertscare” in homage to a
Supreme Court judge) and its accompanying legislation, the Health Care
and Education Reconciliation Act. No Single Payer. No mutual insurance
system that provides a basic level of healthcare for the proles of this
collapsing Security State. Instead, we are witnessing the imposition of a
system that will further enslave and impoverish the peasants here in
Gulag Amerika. How poetic that a self-identifying “black man” is the
front for resurrecting a 21st century version of chattel slavery in the
twilight years of Empire.
Obama was positively beaming in his many photo-ops with the
sponsoring corporatist representatives of Corporate Medicine, Big
Insurance, Big Pharma, and Big Government who enabled the Prince of
Change to achieve this milestone deception of America. The very fact
that this “wonderful” new system – lauded by supporters as
“revolutionary” – is to be enforced by a projected army of 16,500 new
IRS agents should give us pause.
Notwithstanding passage of the legislation, decades of bad healthcare
policy and corporatist plunder are finally taking their toll. The
collapse of the ill-conceived US health care system might be near.
Ever more intrusive regulations are driving up the cost of medical
care, and the practice of medicine is being criminalized. Even with all
of their flaws, Medicare and Medicaid have provided a safety net for the
elderly and disadvantaged since their inception. Those systems’ days
are numbered, however, as they are being gutted to turn health care into
profits not for doctors and hospitals but for insurance companies and
Big Pharma. For starters, large sums have been ear-marked to be taken
from Medicare and Medicaid to help fund PPACA (Patient Protection and
Affordable Care Act). Is looting Social Security and Medicare “change
one can believe in”?
If this system is bad for patients, what does it mean for doctors? It
means falling reimbursement rates and rising overhead costs for
providers, onerous government mandates and regulations, and
institutionalized, legalized larceny by Big Pharma, Big Insurance and
Corporate Medicine. As an example of how time and circumstance have
affected my own profession of ophthalmology, one need only look at
Medicare approved reimbursement rates for cataract surgery.
In reflecting back over my many years in the field of ophthalmology
(as of this writing, I am 63 years old and feeling pretty shop-worn), I
am staggered by the changes that have occurred. When I opened my
practice in 1982, Medicare approved surgical fees for cataract and
implant surgery were near $1200. By 2012, that approved charge had
dropped to about $570 in Tennessee. (There is some variance within
states based on rural versus metro areas and between states where some
are declared to have higher costs of doing business.)
Additionally, the US dollar has declined in value an average of
almost 2.5% per year over the past 30 year period. Needless to say,
overhead operating costs – salary, rent, insurance, personnel costs,
taxes, and normal business expenses – have exploded during this same 30
year period. My office rent was raised 20% in the Fall of 2011, for
instance.
To further illustrate the absurdity of the situation, it is worth
recounting an anecdote. Several years ago, a patient excitedly told me
of the vision restoring cataract surgery that her poodle had received at
the local veterinary college. It “only cost $2600 for both eyes!” At
the time, Medicare was paying about $1400 for two eyes in a human –
including work up, surgical fee, post-op care for 90 days, and the very
real liability associated with being a physician in a litigious society.
I do not begrudge my animal doctor friends their success, but surely
the worth of human care should at least approximate that for a poodle.
Although I know veterinarians who are struggling in their own practices
due to the economic recession, at least they do not have to deal with
government fee-setting and the liability and costs associated with
treating humans. They are able to price their services sufficiently to
keep their practices open and to provide for their own health care and
retirement.
In my own practice, the amount of “write off” on charges for
legitimate services rendered began to climb as we entered the 21st
Century. For years, the “disallowed” charges by Medicare and private
insurers resulted in “discounts” of 20-25%. As the economic upheaval of
2008 rolled around, those fee adjustments (actually theft of labor from
providers) began to climb – 30%, 32%, 35%, and in my last year of
practice over 60%! For years, I had been able to subsidize my Medicare
(cataract) side of the practice by offering elective refractive surgery
procedures (LASIK, PRK, etc.) to my patients. As these were private pay
cases, they offset the draconian cuts in Medicare and insurance fee
“adjustments.” The economic collapse of 2008, however, reduced that
income stream for many ophthalmologists and, subsequently, led to the
closing of many practices throughout the country.
Most general ophthalmologists are, by definition, primarily cataract
surgeons. Many people – including Medicare recipients – do not realize
that the fees paid to their physician are fixed by the U.S. Government
after consultation with its many corporate sponsors within Big
Insurance, Big Pharma, and Corporate Medicine. Patients also do not
realize that those reimbursement levels are set by central planners at
below-cost levels.
Medicare issues cut across all specialties, and ophthalmology has not
been alone in experiencing cutbacks. Primary care physicians have
increasingly become “piece good workers” – managed by corporate pencil
pushers to see a patient every 6-8 minutes while being forced to carry
all the liability and manage all the data and coding previously done by
insurers. Who can diagnose, much less treat a patient in 6-8 minutes?
My own solo cardiologist was forced to close his practice last Fall
and seek employment with an area hospital, due to declining
reimbursement levels. More than 51% of cardiologists in the U.S. are now
hospital employees. One of my medical school classmates, a successful
internal medicine specialist, has recently given up the fight and has
plans to enter some other line of work. Several friends in Radiology
have seen their incomes decline as more and more work is “outsourced” to
tele-docs in Asia. Still other long-time friends who are general
surgeons are struggling to survive (a surgical fee for incisional
cholecystectomy, for instance, is now under $400). Several have retired
prematurely and others are looking for other work to do. As a final
example, another of my friends is one of five physicians in a busy
urology practice (2 offices and 26 employees) and they are now borrowing
from the bank to make payroll. A recent article from CNN, “Doctors
Going Broke,” confirms the growing problem. http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm
As income reductions are being imposed on private practice, costs are
being driven up by exploding regulations. In addition, the plethora of
new mandates and laws have increasingly criminalized every aspect of the
practice of medicine and created vast new armies of armed bureaucrats
whose sole aim is to impose civil and criminal penalties on any provider
unlucky enough to be singled out for attention. The old Soviet dictum
attributed to Lavrenti Beria (Stalin’s NKVD chief), “Show me the man and
I’ll find you the crime,” is in full force in Amerika.
The present puppet in the White House has completed the work begun by
his predecessors in moving the nation into a police state. The NDAA
passed in the Fall of 2011 was the final nail in the coffin of personal
freedoms guaranteed by the US Constitution. By suspending habeas corpus
and even trial by judge or jury, the Act has made certain that no person
is safe from being violated by a power-mad Security State. At the mere
movement of the Unitary Executive’s pen, it is now permissible to
“disappear” or even execute anyone on the planet – all on the whim of
the unaccountable psychopath in charge. Judge Andrew P. Napolitano, has
reported that our present Unitary Exec spends every Tuesday morning
reviewing and signing off on a kill list supplied by his loyal minions.
Nobel Peace Prize worthy stuff, indeed!
One is presumed guilty now in Amerika until proven otherwise and
nowhere has this been more demonstrated than in the policing of
medicine. Heaven help the poor provider who is targeted by the Medicare
Police – or now, one supposes, by the new IRS Medical Special Branch. If
targeted, his or her practice will be shut down without due process.
His or her assets will be seized without due process (assuring the
inability to even defend oneself). Finally, the unlucky
guilty-until-proved-innocent physician will be permanently discredited
(libeled) in his or her community with the ready help of the
Government’s countless propaganda organs – press, radio, and TV – all
before any day in court is seen.
New restrictions, rules, and regulations on healthcare – on providers
and patients alike – have imposed legal constraints with which full
compliance is impossible. Medicare rules and regs alone fill tens of
thousands of pages, and ignorance of any of them is no defense for the
unlucky. The original HIPAA legislation has been amplified with many
additions since its inception in 1996: FERPA, HITECH, ARRA (2009). Each
additional act or regulation has further criminalized the practice of
medicine.
Finally, the entire health care system is being forced to switch to
electronic health records (EHRs) and, soon, to a completely new coding
system (from ICD-9 to ICD-10). Failure to comply with these mandates
will result in further reductions in provider payments with every year
that they remain unimplemented. For a solo physician practice, it is
estimated that each mandate will cost as much as $80,000 to implement
initially and, then, $10-15,000 annually to maintain. For
multi-physician practices, costs run as high as three times (or more)
that of a single provider practice. Of course, the purpose behind all of
this is to make each person’s most private and personal information
available to government bureaucrats and regulators while also ensuring
its accessibility to the Security State’s many law enforcement tentacles
and to all the corporate members of the Medical-Industrial complex.
Unfettered access to this information will ensure that the Corporate
State can maximize its profits, largely avoid all risk and liability,
and eliminate any potential competition (such as, often cheaper and more
effective alternative medicine providers and therapies, non-GMO whole
foods, and nutritional supplements). It will also ensure that medicine
is practiced/delivered within strict cookbook guidelines that are
carefully written by non-physician bureaucrats to maintain corporate
profits and government power. All of this is well along in
implementation.
A recent article, “Efforts to implement Obamacare law raise concerns
of massive government expansion” from Fox News, 5 July 2012, (http://www.foxnews.com/politics/2012/07/03/efforts-to-implement-obamacare-law-raise-concerns-massive-government-expansion/#ixzz1ziuZDCSV)
informs us that lawyers have already “drafted more than 13,000 pages of
Obamacare regulations and that this number will increase further over
coming months. In addition, we are told that DHHS (Department of Health
and Human Services) has been given more than one billion dollars to date
in order to begin oversight of this mess and that more than 180
“commissions, boards, and bureaus” within the Agency are already hard at
work implementing the final destruction of American medicine.
Widespread vaccination of the population with untested “stabs” will
be mandated and enforced. As long predicted by Tin Hatters around the
planet, this will permit biometric “nano-chipping” of the citizenry
without the unpleasant need to ask their permission.
Vast sums will be committed to “preventive” medicine which will
prevent nothing and will only expand the reach of the Medical-Industrial
complex into every nook and cranny of a person’s life – and, into every
wallet. Certain corporate profit-driven diets and treatment regimens
will be mandated and enforced; access to nutritional supplements and
alternative medicine practices will be limited or banned altogether;
behavior patterns of all types will be monitored and carefully scripted
and controlled (what we see, hear, read, do, eat, drink, and breathe –
where and how we work, play, and live) under the guise of State Security
concerns and its new companion, Public Health or Public Good; and,
finally, the Corporate State will deploy “death panels” to decide when a
person has outlived his or her economic usefulness to the State. In
spite of Obama’s denials that such bodies exist and Palin’s
diversionary, hysterical rantings at Tea Party rallies, there is clear
provision in the Act for bureaucratic decision-making bodies which will
make end-of-life decisions for us all. These entities are already being
formed and deployed across the land. Our Anglo cousins in the UK are
showing us the way by withholding food and fluids from as many as 29% of
their hospital patients now who are judged to be living beyond their
government-dictated “use-by” dates (pragmatically justified “to free up
beds” – oh, those Brits and their refined sense of humor).
What can be done about the failing American health care system and
the wider collapse of the economy and civil liberty? Frankly, very
little. The system is rigged against the people as it has always been,
only now one can be “black-bagged” and disappeared at any time. Protest
too loudly and one is liable to literally see a grim Reaper overhead
with one’s personal biometrics programmed into its fire control system.
Like every other institution within the United States, the medical
system is totally and completely broken. It can no longer be fixed by
“voting” for the lesser of evils, by printing bales of fiat currency, or
even by deploying fleets of obsolete aircraft carriers across the
planet.
If as it seems we are arriving at the end of an age, if we can
survive the end, something better might arise from the ashes. The
prospect of collapse turns one’s thoughts to escape and survival. Can
you do either? Volumes have been written about preparedness in a time of
chaos, so I will spare readers a rehash. But, a few comments about
healthcare, in particular, might be in order.
In a perfect world, it is my opinion that we should have some form of
single payer healthcare system and divorce ourselves from corporate
medicine. In my opinion, this will not happen without the complete
collapse of the present system. Since that is unlikely to occur before
more seasons of national election fraud are imposed on us, a few
“in-the-meantime” suggestions follow:
Avoid contact with the existing health care system as far as
possible. Yes, emergencies arise that require the help of physicians,
but by and large one can learn to care for one’s own minor issues.
Though it is flawed, the internet has been an information leveler for
the masses and permits each person to be his or her own physician to a
large degree. Take advantage of it! Educate yourself about your own body
and learn to fuel and maintain it as you would an expensive auto or a
pet poodle. One does not need a medical degree to:
1. avoid excessive use of tobacco or alcohol or, for that matter, caffeine;
2. avoid poisons like fluoride, aspartame, high fructose corn syrup, and addictive drugs (legal or illicit);
3. avoid unnecessary and potentially lethal imaging studies (TSA’s radiation pornbooths, excessive mammography, repetitive CT scans – exposure to all significantly increases cancer risk);
4. avoid excessive cell phone use and exposure to other forms of EMR pollution where possible (the NSA is recording everything you say and text anyway);
5. avoid daily fast food use and abuse (remember: pink slime and silicone) ;
6. avoid untested GM foods (do you really want to become “Roundup Ready?”):
7. avoid most vaccinations and pharmaceutical agents promoted by the establishment;
8. avoid risky behaviors (and, we do not need a bunch of Nanny State bureaucrats to define and police these);
9. exercise moderately;
10. get plenty of sleep;
11. drink plenty of good quality water (buy a decent water filter to remove fluoride, chloride, and heavy metals);
12. wear protective gear at work and play where appropriate (helmets, eye-shields, knee and elbow pads, etc.):
13. seek out locally-grown, whole, organic foods and support your local food producers;
14. take appropriate nutritional supplements (multi-vitamins, Vitamin C, Vitamin D3);
15. switch off the TV and the mainstream media it represents;
16. educate yourself while you can;
And, lastly…
17. QUESTION AUTHORITY!
Doing these simple, common-sense things will add healthy years to a
person’s life and help one avoid most medical encounters during his or
her allotted time on earth.
Finally, we have a responsibility to our neighbors and our families.
We need to reach out to those around us – talk to them, listen to them –
sympathize and empathize. Take time especially to listen to those who
are in pain and are suffering and to help them by being humane. If you
do this, you will discover that we have more in common with each other
than the ruling elite wants us to believe. Governments obtain power and
control by taking advantage of divisions along religious, ethnic, class,
economic, ideological, and nationalistic lines. We must awaken to this
fact if the 99% are to prevail against the 1%.
As for me, I was finally forced to close my practice earlier this
year. Nearly two years of consulting with multiple attorneys,
accountants, practice management consultants, and bankers, and expending
most of my resources in a vain effort to keep operating, were simply
not enough. It seemed only poetic that April Fool’s Day 2012 should be
chosen for turning out the lights and ringing down the curtain. Patients
and employees and suppliers were notified of the end. Many had been
with me for my entire career and leaving them was and remains painful.
More than nine thousand active charts were transferred to the care of a
younger ophthalmologist still trying to stay afloat.
I share the heartache of many physicians forced out of medicine by
the high cost of practicing it. As the health system is stripped of
medical care in behalf of corporate profits, its exploitative character
will become clear to all. In the meantime, don’t give in or give up.
Plan for something better on the other side of chaos.
I wanted a perfect ending. Now I’ve learned, the hard way, that
some poems don’t rhyme, and some stories don’t have a clear beginning,
middle and end. -Gilda Radner
Glossary of Terms:
ARRA American Recovery and Reinvestment Act of 2009CHIA Comprehensive Health Insurance ActCIA Central Intelligence AgencyCLIA Clinical Laboratory Improvement Amendments of 1988 – administered by CMSCMS Centers for Medicare and Medicaid ServicesCOBRA Consolidated Omnibus Budget Reconciliation Act of 1985DHHS Department of Health and Human ServicesDHS Department of Homeland SecurityDOD Department of DefenseEMR Electromagnetic radiationEMTALA Emergency Medical Treatment and Active Labor Act – part of COBRA1986EPA Environmental Protection AgencyERISA Employee Retirement Income Security ActFEMA Federal Emergency Management AgencyFBI Federal Bureau of InvestigationFDA Food and Drug AdministrationFERPA Family Educational Rights and Privacy Act (1974 original legislation)GM Genetically modifiedHCERA Health Care and Education Reconciliation Act of 2010 – supplement to PPACAHIPAA Health Insurance Portability and Accountability ActHITECH Health Information Technology for Economic and Clinical Health Act (2009)HMO Health Maintenance OrganizationICD-10 International Statistical Classification of Diseases and Related Health Problems 10th RevisionIRS Internal Revenue ServiceNDAA National Defense Authorization ActNSA National Security AgencyNWO New World OrderPPACA Patient Protection and Affordable Care ActSCHIP State Children’s Health Insurance ProgramTSA Transportation Security AdministrationUSAPA Unifying and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism – aka, The Patriot Act
