In the interest of fairness, I have to give credit to the Governor's staff for answering my letter of about 2 months ago. There were a bunch of reasons to justify the status quo and explain why the problem I saw had solutions in the existing system. It was polite, late and unhelpful. So much for the appeal to reason in a polite and constructive fashion. Another windmill, but recognized as such and accepted until Marvel Comics comes up with a hero that can overcome the bureaucracy.
The response from CalOptima was even less helpful and and it came as no surprise that an offer to attend a presentation and dinner on the subject of phosphorus binders went unanswered, though the notice was very short. I console myself with the knowledge that I tried, and that I was doing what I thought was best for my patients, and I was acting out of a sense of professionalism.
I hope that the status quo continues to bother me, though I will need to live with it, divert my energies, and get on with life.