Plunder me again
Posted by redlinedoc in Commentary of the times on April 19, 2010
As I read Paul Krugman’s – “Looters in Loafers”.i felt a bit prescient having blogged Bonuses for Bettors before the current revelations. Perhaps that should be re-evaluations. Slippery as eels these folks, they fall back on ‘caveat emptor
” although the only non-blinded fellows in the room were they. It was the impending release of poor Jeffrey, once the smartest guy in the room, realizing there were more cats to be skinned, er I mean folks to be fleeced. Well Jeff felt he got a raw deal and he, unable to wallow in the spoils.
When first I read of the looting and larceny I thought ‘heads on pikes‘; but I’m not blood thirsty enough for that. Then I watched Lehman implode and the jackals gather at the corpse to pick the sweet meats. Not one of them felt there was any wrong doing. Indeed they were all self righteous. At that time how little we knew.
I’ve generally supported the aims of this administration (nationally), but find myself watching the the internal dealing and the Goldman-Sachs revolving door spinning so fast its really a fan. I once saw a special about how an engineering firm kept their government work on one side of the hall and their civilian contracts on the other, claiming a mehitza of sorts so that the engineers, who otherwise ate in the same mess facilities, used the same parking lots and other than sharing separate entryways, were really not at all co-mingled. Right. When the former chieftans of Goldman Sachs run not only the regulating agencies but are also judge and jury I wonder. Hmmm. Right.
There is not an ‘appearance of wrongdoing’. It is offal on the table, and it would appear to be us, the American public. Perhaps I should revisit my former thoughts. Heads on pikes seem not so bad
Health trek
Posted by redlinedoc in Commentary of the times, Universal HealthCare on April 6, 2010
They trek in. They trek out. They stop, rest, disgorge their fantastic stories and let us help them; then out they go into the real world again.
Alas were this some fantasmagoric game. Its not. Its a Community Health Center. We seem to collect them. Its partly our mission and partly our trial. The health system in the United States has some serious problems those in power have yet to appreciate the depth of the hole, as it were. If I were not at the center of the swirl, I would stand back and laugh at the machinations of those who worry that government will take over health care with disatrous results.
We are already at disastrous and the only thing that keeps us from total ruin are the government operated and funded programs. I watched as our health center insurance, after all we too participate in the miasma of private for profit, stockholders take all insurance plans. Ours zipped up a mere 15% and still we face deductibles in the 1000′s, expensive primary care deductibles and rules for use of additional services so arcane that even insurance people can’t figure it out. Kudos’s, however, to my boss. He split off the rise so that the lowest paid on our staff paid the least percentage increase (perhaps 1-2%) and the highest paid 14-16% increases. It makes an intolerable situation bearable.
Back to the ballyhoo. Government run programs including medicare and medicaid offer some of the best coverage for care, most uniform although occasionally tricky policies for patients and even on the reimbursement side. You know that if you provide services, sooner or later, within some guidelines you’ll get paid.
A few years ago one of my private practice insurers sent a note out that the POB had changed for remittences to an adjacent town and another mail box. For most of us it was still the days of paper forms and humans not in call centers who worked the system. The box, no surprise, was a fake. After 4-6 weeks of languishing claims, the company began to get calls about where might be the remittances. After much furfuring, badinage and general lying, it came to light that some miscreant within the company had created this false address. Naughty man! Would we please resubmit the claims, which now had a current zero day for timing – about two nearly three months out from their original date. Someone made a boatload on that one!
The chicanery doesn’t end with the practitioners. The myriad of plans to medicare recipients, forced into a drug plan which is neither plan nor planned but a ponzi schema with a donut hole. For those of you sleeping under a rock for the past few years, the donut hole is a 5-7000 dollar shortfall which the medicare recipient must make up once the generosity of part D, we can’t negotiate price, plans have run out, leaving the senior holding bag, or readied to make the next payment on the stockholder’s investments.
If I offer a solution, its to step back from rhetoric and revisit a public option plan. Its not necessary to prop up the multinational corporations. We are the only quasi-civilized nation to be so hogtied by the greed of our corporations. To be sure other countries have found themselves, recently, at a shortfall because of the ill behaviour of organizations to big to fail, or perhaps to big to continue.
Consider this: the health of our citizens, much like their education is an investment in the future of our democracy.
At the end of all things.
Posted by redlinedoc in Commentary of the times on March 18, 2010
Sad faces. Sad days. We see the poorest of the poor at my health center. Its a magnet for those who have nowhere else. We will see them. We do see them. We patch them up. We send them back into the fray, the madness that has become our world in the north end of Hartford, Connecticut, only miles from the richest squares of land in the country. The disparity is at once engaging and maddening.
Some days ago a new face appeared in my care. Ragged on the edges, worn but still under the veneer of the street, a once proud person. She tells me she worked all her life, perhaps 40 years or more, receives Social Security, a pittance because she worked at one of the many downtown retail stores, making ends meet, and saving for retirement through a store plan. Prior to mall-ville, Hartford, as did many other cities, house a plethora of stores from upscale department to jewelry and electronic palaces. It was a mecca in its time. These folks and hundreds, nay thousands like them retired to small owned homes in the north end. Clean. Neat. A neighborhood in constant transition but with ties to religious and community organizations. Then came Mr Skilling and his ilk.
Not content to raid the coffers of the gamblers of Wall Street, these folks conspired to use as tokens at the gambling tables the funds-in-trust for retirements. Now gone. Bankrupted. Disappeared.
She tells me that she couldn’t afford the taxes on the house. Predators always scent prey in the winds of fortune. In her case it was a ‘remortgage’ that promised to ‘clear up the debt.’ She lives in her car, however long that will last. She has no relatives in the area but has her ‘church’ and her ‘friends’ who don’t know and she sent me a gimlet stare to let me know that I shouldn’t consider letting them know.
So here we are at the end of all things, accomplishing the American dream, living in our car.
Technology Advances. People stay the same.
Posted by redlinedoc in Medicine, Sometimes it works on March 18, 2010
We often take for granted that people really understand technology. We recently installed a new computerized (well somewhat) Medical Record System in our workplace. It makes you go …hmmm.
This past Friday a co-worker came to me waving a sheaf of papers. “I did what you wanted. I put the orders in the system. I’ve been waiting a month and nothing (emphasized with the sheaf of papers) shows up on the computer.”
Nonplussed I asked “What’s this about?”
(as if to a small child) “I take the sheets. I put the order in the computer and then I write “SCANNED” on the paper. Its not showing up! This system doesn’t work at all!”
I look at the desk and sure enough there’s a pile of papers, each with “SCANNED” written on the face. (I did manage a straight face). ” You really need to send them downstairs to BE scanned. Its a machine”
I thought this would be the end of it. Yesterday one of the other team members tells me she was button-holed on the stairs about why nothing is showing up yet in her orders when she did everything we’d asked.
Well…. almost everything. Technology advances. People Stay the same (with apologies to Leigh Rubin).
Bonuses for bettors
Posted by redlinedoc in I never saw THAT coming on March 1, 2010
I’ve been quiet again. Probably feeling a deep recession myself, much more moral than fiscal but none the less, staying away from vocalizing what should be said.
I awoke to a story this morning about Jeffrey Skilling. His lawyers want to revisit the case so poor Jeffrey, who ruined the lives not only of stockholders, but his fellow employees by lying and taking their monies would be set free. But I digress.
I work in Hartford, now ranked the third poorest city of its size in the nation. Once it had a thriving downtown and people worked at department stores, in the pre-mall days, with names like G Fox and Company or Brown-Thompson and more. They probably never made much more than minimum wage but worked hard, many of them for 30 years or more and retired with small social security benefits but with a retirement plan that allowed them some leeway to visit grandchildren, keep an apartment or house and generally live a decent retired lifestyle. No high rollers here, just decent hardworking folks.
I spoke to one the other day, now on the verge of losing her house because she can’t make the tax payments. How? Well Jeffrey Skilling’s friends at Morgan Stanley and Lehman Brothers (and many others) took her monies to the racetrack, bet the monies on derrivatives (a fancy name for casino in the stock world). So long as everyone was making 100% returns (you do see where this is going) everyone was happy. Then the day came when someone looked and (((GASP!!!))) the emperor was naked. The whole house of cards fell and with it the retirements and savings of the folks in the North End of Hartford and elsewhere. Oh well. Not to despair. We’re so good (the Skilling-ites replied) that we need bonuses to make sure that we retain all these fine young minds. And so they did. We the people bonused the bettors. If they’d done this at a OTB window they could not have done a better job.
What of my lady in the North End. She, who worked all her life gets to go on assistance. She spoke with me with tears in her eyes. She’d never taken anything from anyone and now she was forced to accept this.
I’m not the blood thirsty sort; however, I have visions of letting Jeffrey or his ilk, loose in a field with some of the folks they fleeced. Heads on pikes. It might slow the cascade of betting other peoples monies. It might bring some cold comfort to those without heat or shelter because they lent trust and were returned fiduciary irresponsibility.
I spoke with a 401K counselor recently about all this stealing. He of course in his snow-cones-salesman’s way assured me that this could never happen to mutual funds? Huh?
Somewhere out there I recall that fiduciary meant fiscally responsible. If we bonus these people perhaps they should pay (directly) some of those millions to those they fleeced. An idea but hardly likely to fly. Nope. Heads on pikes I think.
Turfed too
Posted by redlinedoc in Medicine, Universal HealthCare on August 22, 2009
It amazes me that in the land of the best healthcare we’re more in the business of denying care than providing it.
I get a call the other day that a kid has stepped on a piece of glass. Its off hours but I say “sure, bring him in, I’ll take a look”.
A pale frightened 13y/o arrives at the clinic with parents. Apparently yesterday he jumped up off a picnic table (in the way that 13 year old males do) and sprang directly onto a wine glass lying on the ground. The glass shattered into the bottom of his foot. The parents, correctly, take him to the nearest emergency room. He waits approximately 3 1/2 hours since its “only a bleeding foot”. Xrays show glass in the wound and the physician diagnoses tendon injuries to the tendons of the toes. Ahh, you say, a case for the surgeons.
Not so fast. He has a state option child health insurance. They sew up the foot (with the glass inside) and direct him to a private practice clinic the following day. He continues to bleed, slowly, through the night. Mom and dad pack him off to the local recommended doctor only to find that he (nor most others) do not accept this insurance. They are tempted to return to the emergency room but call me.
He cannot be treated here. He needs advanced care which we cannot offer to him. I make some calls with the assistance of our pediatrician. He’s transferred to a tertiary care facility. By 4PM he’s in an operating room and being cared for.
What went wrong? Why didn’t the emergency room transfer him inter-hospital when they realized they had a severe injury they couldn’t handle? Why did they refer him through out patient when clearly there was no real outpatient option?
Insurance. When the insurance pays so poorly that even the most basic of services are covered but lose money, then the hospitals, left to chose to bleed monies or to restrict services chose the latter. In the land of ‘the best healthcare” we are forced into rationing that healthcare based not on need, not on priorities but on the needs of the stockholders of insurance companies.
We the torturers . . .
Posted by redlinedoc in Commentary of the times on August 14, 2009
My mind and my body shout “No, no its NEVER right never correct”. I was listening to NPR the other day regarding our coming to terms with torture. OUR coming to terms? That ‘our’ is ‘us’, We the People…
I have this open ended discussion with my family about this. How is this ‘us’. How did We the People. .. become Us the torturers….. How is this ever right.
I think it comes from trimming a bit off the Constitution, that rather dusty rag of a document which our Founding Fathers found so important. So we don’t really have free speech anymore since big brother listens in on our cellphone, phone and regular conversations with impunity and without warrant. Its that old bothersome ‘search and seizure stuff’ those good old boys found so awful from their British masters. Needing a warrant, probable cause and that rather outdated stuff. We need this to be free from terrorists. I’m becoming a bit terrified myself lately.
A young priest named Torquemada started a campaign of ‘information gathering’, a tongue torn out here and there, in the name of state safety. What information did he get. None. Nothing. What information did he in fact want. None. It was a campaign of terror. Torture. Terror. —hmmmm.
Throughout our long human history there are records of those who tortured in the name of state safety, abnegating the safeguards in their particular times, accruing power piece by piece. So, I ask my brood, how did we come from “preservers of democracy” to “torturers”. How do we see ourselves? What are the checks and balances, the ironsights of our democratic process?
Again and again
Posted by redlinedoc in Universal HealthCare on August 13, 2009
Why can’t we pay for health care for everyone? Why is it that is this country we have such a divide? Is it our puritanical upbringing which says work hard and you’ll get your rewards?
Sadly folks, the Puritan’s didn’t have it all that wonderfully. Life was hard but it was short. There were no antibiotics, no x-rays, no casts, no real surgery (with anesthesia). Hospitals were to be avoided as pest houses and physicians themselves at the time knew they did little for their patients. Some cures were probably worse than the diseases.
If we have modernized medicine, why can’t we modernize the way we provide care for our citizens. Why do we in the land of the brave, home of the free, live with a 3rd world medical care system. Sure people come here. The Sultan of Brunei came here and got wonderful care. M. D., a fictional name, in the north end of Hartford got turfed. Hmmm. Would the divide and provision of care have to do with money?
Indeed it does. The wheels grind exceeding slowly for those with limited funding.
All the Michaels are dead…
Posted by redlinedoc in Universal HealthCare on August 13, 2009
How did we allow the discussion to move away from health to how we should save the health insurance industry? How did that conversation move from a public healthy option to saving the profits of some of the most profitable companies in the world?
As there is increasing talk in Washington about the AMA time clicks by. And to whom are the insurance companies responsible? Ahhh shareholders, the same folks who brought us the current bank debacle, to whom we the people pay extravagant sums so that they can support CEO’s in a style to which they’d like to become accustomed. As there is continued agglomeration of insurers, they flock together, eat each other, thereby decreasing real market competition, in the guise of bringing lower cost to the consumer.
In medicine we speak for the patient. In insurance they speak for the money. There’s an inherent split here. When it comes down to it, shall we authorize care OR shall we make 0.02 for the stockholder, the stockholder and CEO options always win out. Duplicity is the name of the game. When Hurricane Andrew roared across the South Florida Pennisula devastating the area. Aetna group was the major insurer holding more than 4 billiion dollars in losses. That past year they golden parachuted their worthy CEO for 987 MILLION dollars (or there abouts) and then cried the blues that they didn’t have monies for claims. Hmmmm
I personally have run into the dealings of insurers. Serveral years ago one of the Connecticut health insurers sent out a note that all billing should henceforth be sent to a POB in Enfield. We all did send claims there and as weeks went by and no claims information was forthcoming, we were told that the claims were lost or that they should be re-submitted. Whoops. Someone bad in the company made an error and there is no POB in Enfield for our claims. We’re really sorry but you’ll have to re-submit them all over again. Hmmmm
I’ve had several friends who’ve suffered death at the hands of insurers, not in any direct sort of way but the usual games playing with existing conditions and difficult to access portals.
Working in a safety net group we see patients bounced from one provider to another, mostly based on non paying insurances. I think most of us are insulted when the insurers talk about the Medicare program, and how it fails to work. It succeeds with a 5% overhead, a draconian fraud unit, and coverage that most of us envy. Are there faults? Are there fixes to be made? Of course. We can in one swoop, make our system succeed. It needs a government backed program, devoid of usurious profits, not socialism, just good medicine.
We need to recenter the discussion, not about death notes but about how to prevent the needless deaths from an unwieldy bloated system which spends much of its monies not on patient well being but on corporate well being. Straight speak or soon, all the Michaels will be dead
Let them eat cruisers …
Posted by redlinedoc in I never saw THAT coming on April 21, 2010
The big boys at Chrysler appear to have taken the pipe, 4 BILLION (with a ‘B’ folks) in losses since exiting bankrupty! I doubt that will stop the executive piggies from snorting at the money trough in the name of needing to pay the best and brightest.
We need to remind ourselves that the Mouth of Sauron himself, the Chrysler damage control guy, at meetings this past year said “Oh .. we put a bad engine in that car — but — (pregnant pause and I presume a wolfish smile), we don’t make them anymore.” Not making one of the mechanically lousiest cars on the road is scarcely a strategy designed to win hearts and minds of Americans.
The car had a sluggish start. It was very retro, very cute, very flawed. The power train with an automatic could scarcely get the car out of its own way. Add a turbo and stickshift and it did go. Fixing the cars, it was my mechanic’s nightmare, was another thing. It would appear that the engine had been dropped into the car without regard for access. After all what fool would want to fix this? Access to the engine required removing the right side of the car and all the steering gear there. The engine mounts blocked access to such non critical parts as the timing belt adjustment.
I attended school at UCONN (University of Connecticut) which at the time had one of the finest civil and mechanical engineering departments in the country. I have friends from MIT, CALTECH, CASE to name but a few. They seem pretty competent. Is it possible there’s a large vacuum at Chrysler which sucks the smarts out of the engineering staff, followed closely by the moral vacuum which removes all traces of morality. I have long thought that American ingenuity can solve most problems. The difficulty is that American greed removes the problem solving substituting marketing glitz, full of sound and fury, signifying, nothing.
business+ethics, CEO, Chrysler, ethics, executive+compensation, other+peoples+money, Sauron
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