Archive for category Commentary
it couldn’t hurt .. or could it
Posted by redlinedoc in Commentary, Medicine, Sometimes it works, Universal HealthCare on October 12, 2010
I’ve been watching with interest the current Republican party dance around repeal of the Healthcare insurance legislation just passed. Its a sad bit of badly made political salad with very little for those who need health insurance, a guaranteed business for the insurance companies (universal sign up), guaranteed pharma profits (no pharma negotiation) and extension of the market for about 40% of those who are still uncovered or uninsured.
State legislatures, not to be overlooked are trying their best to carve themselves in our out of the new Heatlhcare bill by blocking advances or by shouting states rights. With hard economic times, its easy to get voters to hear the shouting but miss the salient points.
We’ve missed the boat, again. Smoke and mirrors and distraction reign supreme. The emperor, or his bill, have no clothes. This does not cover a majority of the uninsured. I’m waiting to see how those who are unemployed, now some approaching the 2 year mark, will pay for this bit of fluff. The state’s assistance systems were already at a foundering point and shoving the burden to physicians and hospitals for the under and uninsured will only exacerbate the problem.
There’s a bit of shuck and drag going on here. We’re told that we need to work to pass this. We’re told it will bankrupt us. We’re told this is socialism at its worst. Socialism?
Today one of the walking wounded comes to the clinic. She works 40-50 hours a week, full time she’s told, at one of the local hospitals. To expedite services the hospital contracts out its housekeeping. The firm, to keep profits ripe, they don’t pay insurance. Hmm. Ok. We took what was a paid in-house position, took away the benefits, hired the same folks to do the same job so that the profits would stay as high as maybe ….
I digress. Here’s a full time working person with no insurance. How is a public option for her, socialism? From where I sit, we pay into the medicare system. We pay it in wages and taxes and reap a long term benefit devoid of the need for stockholders to benefit. Although an inconstant fiduciary, generally governments have handled trust funds much better than banks or insurance companies, always looking to the next gaming table, ripening the profits.
If we allow the loud shouts to take back the minimal advances, and I agree its far from perfect, we’ll end up with still more uninsured. The hidden cost of the ‘uninsured’ long patched over by draining high end payments from private insurers into the unbalanced pot is at an end. The insurance blokes, have cut off that avenue. The uninsured now go to emergency rooms, expensive care, and not much of it.
Emphasis from the Healthcare Plan was on primary care, extending to patients the ability to see and to find competent expert medical care. If we persist at deconstructing the fragile imperfect house, we’ll have but a very expensive house of cards fallen loosely and very expensively apart. Threats of Medicare cuts are more thunder than substance. We do need government to help us. Watch carefully.
Shelley Runs Demi Marathon
Posted by redlinedoc in Commentary on September 26, 2010
I don´t have pictures yet but Shelley ran with John Sullivan in a (billed as 26 km) race through the streets of Xela.
The race began a bit late and Dr. Sullivan and I were watching on street corners for the racers. Its 2600 meteres up here so the air is thin. Things done Guatemaltecan style are often without much preparation. There were no crossing guards, no blockoff´s to run interference for the Chicken Bus population and the cars seemed relatively oblivous of the racers.
The hills were daunting. The traffic next to the runners spewed dark deisel fumes as the racers coughed and ran. Motorcycles, always taking the smaller parts of the road roared by .
We were able to watch the race from four vantage points – the last so close to the finish line that I didn´t get to photograph Shelley at the finish. She insists that the race was only a 15k but she finished and she and John were sore but happy.
Pictures I hope later and a short video as well.
Signing off for a bit until I can get to pictures and uploads. Do check out my Flickr page.
Hola
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.
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.
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.
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?
Sin service
Posted by redlinedoc in Commentary of the times on January 12, 2012
I’m astounded at what passes for service. I probably shouldn’t be.
Recently I went to a BestBuy. They employ college grads, young folk, with slicked hair and ‘tude. I’m usually in there, an older guy, tie, shirt looking about for what I need. At first I thought “bad clothing” or “bad BO” but that’s not it. You can be systematically ignored in the store. Asking a tech question may or may not get you a human to help, but for me it has worked to the extreme opposite, sent to some corner of the store so that when I get back, that person is gone and another in his/her place.
I have some news for BestBuy and their ilk. Of the monies we spent on tech this past year, and we spent a fair amount, we spent less than 5% at BestBuy, maybe less this year. These guys are circling to be the next CompUSA. The CompUSA dudes had it down though. Customer and service never made it on the same line with them.
As I watch the no-eye-contact cashiers, the smiles from the managers as they pull the goods through the turnstiles but neglect the customers paying for them, they fail to understand that it is not employers who pay the wages, they only handle the money. It is the customer who pays the wages (Henry Ford). They too are doomed, dinosaurs of a different age.
I wonder how in this economic race to the bottom, rather than increase the service, turn on the warmth, bring the people in the doors, the assumption that build-it-they-will-come still prevails. I am fortunate but have become much more picky about disbursing my funds, preferring service and knowledge over glitz and push.
Its a lesson the car industry has yet to learn as well. Chrysler, famed for its CEO statement of yore “well we don’t make that model anymore” as an apologia for lousy engineering and a corporate culture of not caring. Bellied up to the National Soup Kitchen they took the money to renew themselves but if “bring back the Dart” is any measure of what that means, we’re in for more of failed engineering (the PT Cruiser), harum-scarum tactics (most of the SUV’s), and less attention to the consumer.
Sure advertisement can push the consumer into believing that more pollution is better, that higher standards (be cautious of that word) would make the industry unprofitable and that what we need is a return to the over-sized, overpriced, under-engineered cars of the 90′s or 70′s.
Service at its worst is at the front lines of restaurants. Somehow, the ‘tip’ has become part of the expected payment, even for non-existent service. I mean, how much service or even humanity do you get at the local donut parlor? Mindless avatars push out coffee and what passes for food without ever making eye contact. And there it is, the tip mug. It doesn’t say ‘por service’ anymore, heaven forfend, just TIP MUG. I’d rather tip the machine at Horn and Hardart!
Out for breakfast recently we waited as other’s were menu’d, coffee’d then served then left! I thought wow, we much be invisible. I snagged one of the waitstaff who said, oh excuse me then disappeared, forever. Another came over with coffee offering to get out check. We almost left the restaurant. I demurred and said we’d had neither coffee nor menus nor food yet! Oh my gosh. And she too disappeared. The third came over without eye contact, without ‘gee I’m sorry’ and took the order. Coffee appeared similarly. The food was delivered but without a rehash or recall. Who knew we wanted a bit of a warm up. Customarily I’m a very good tipper but rose to this occasion to tell the person at the register, quietly, what had happened.
“We get a lot of that around here”, she said ruefully. Dinosaurs. I can hear them falling all over the place.
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