Archive for category Commentary of the times
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.
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?
From My Window
Posted by redlinedoc in Commentary of the times on July 20, 2009
Its sometimes a sad view, a view of contrasts, a view of contradictions, a view of humanity. I look out into the swirl of mad colors, through the colors of people, through the colors of spring turned summer, through the bright signs to the monochrome lives of the poor on our block.
She must be 15, maybe. She swirls out the door of the rattrap that fucntions as home slamming the door, wearing nothing to deceive the immagination. She would be pretty but she has mean and hungry eyes. They aren’t child eyes of wonder, that luster long gone. The inquisitiveness of memory is locked away. Hunger. Money. Use me. Now.
She clambers to a car, her high heels a misery to satisfy yet another customer. Hunger. Money. Use me. Now. They are off but it is not long that she appears again, on the street, long legs up and down the block this child lost grown too fast. And yet again in but a few minutes she is gone from sight. Hunger. Money. Use me. Now.
And so this long afternoon progresses. From time to time, as we all do, I look out my window at some block familiars and some I haven’t and will probably never again see. They are all hungry. All waiting. And then she appears but in new colors and new shoes, striding out with her hard child-long-gone eyes.
I see her walk down the block. A throw away child. I doubt that there is a want ad which reads “Join the fun life, you too can be a street prostitute at 15″. Yet. There she is.
Hungry. Money. Use me. Now.
Moments of madness
Posted by redlinedoc in Commentary of the times on July 13, 2009
I was driving home this evening listening to the discussion about why the financial institutions are putting out the same hybrid products that brought us this wonderful recession, hearing the pundits explain that it brings capital into the markets and although its a bit (a bit?) risky, these instruments help to drive the market. Ok. I’m no financial whiz but didn’t we just loan billions and trillions of dollars to these self serving financial institutions to NOT have them bet the store? Wasn’t part of the project to make them more fiscally responsible? Somehow we the poor schmoes who pay taxes are subsidizing a very wealthy gambling habit. We’re bound to lose. We may be the house but in this case we hold none of the trump cards.
Trump cards? Isn’t this banking? Isn’t this where the banker sits across the table and says “Well Joe, opening a restaurant is a risky business and we’ll need some collateral” — or so it was in the past. Now we have bankers betting (your house) on 10:1 or 100:1 odds knowing that the worst will be that the government will for a time be paying into their bank. Where are their ethics.
Ahh ethics. It seems that capitalism trumps ethics. Do undo others before they do unto you. The Ivory Tower at Havard spoke several weeks ago about plans to include teaching ethics to the business school. Its the piper teaching the cobra. Once the cobra leaves the nest, well then its just a bunch of snakes isn’t it?
It wasn’t until the sentencing the other week that I got it. Bernie Madoff…. made off with our monies. Too sweet. such onomatopoeia. No one saw the deal too good to be true, 30:1 winnings? Get real folks. Its all about the casino, and we the taxpayer have been at the largest gaming table ever, Bernie and his friends (and there are more no doubt) are pikers compared to the banks and so called financial houses that take our monies and throw it on the international craps table. Oh lost a few billion in that scheme. Not to worry Uncle will back you. . . .and he has.
Its Monday — everybody works on Monday
Posted by redlinedoc in Commentary of the times on July 8, 2009
That line from the movie “Dave” would be poignant if it were not so sad here . Most of the people I see want to work — but there is no work. “Work was something that used to exist” — Jean Sheppard — and he was talking about the ‘Great Depression’. Alas it was neither great nor did we learn from it. But I digress.
Yesterday one of my patients arrived all smiles and cheery… yes.. he just got a job. A real job in a field (food service) he wanted to work in. There’s something radiant about someone who just got a job, a glow and an aura about them. He had been jobless for nearly 1 1/2 years, looking looking but not finding much of anything. A sniff a lead and he was overjoyed.
I hear much talk about how the poor make themselves that way. I see something quite different. I go to the stores in the neighborhood where change is made poorly and incorrectly. At first I thought this an oversight but it happens so frequently that I realized that this is a way of doing business to increase profits, since many don’t check the change. There is loansharking for food, an egregious plot on the poor where 30$ in groceries on Thursday becomes 60$ (or more) on Monday. It doesn’t need much enforcement since there really isn’t much alternative place to go. Additionally the stores carry such small cans of items (2 ravioli in a can), that the prices end up enormous for minimal nutritional value.
Work is hard to find in this poor urban area. Transportation is available but not always convenient. There are dangers, the indolent prey on the poor. There aren’t many but ripoffs and knockdowns occur regularly. Most people travel with one hand free.
My guy. All smiles. He’s looking forward to work. I think most are. Its depressing being marked ‘poor’ and then no places to work. Poor areas become poorer. Business shys away from the area. Poor areas become poorer yet. The spiral continues.
I wish that all the folks here could feel the joy … pleasure … of work, of a job.
Its Monday. Everyone SHOULD work on Monday
Heads on pikes
Posted by redlinedoc in Commentary of the times on June 22, 2009
It seems its a day of good news bad news. The good news seems to be that the boys at Goldman Sachs are snuffling at the trough and ready to suck up those great well deserved bonuses for having put us in the worst recession since the 30′s perhaps worse than that. I fear that we missed an opportunity for heads on pikes. I’m not ordinarily a gory sort of fellow; however, if a few of those egregious folk had their heads up along the boulevard perhaps fewer of these guys would be snorting at the trough so soon. Its a sign that regularion has lost and that we as a nation have or will loose big time now that the game is a foot and the money is liberally flying around again.
It makes me wonder in some ways what the big call is for CEO’s. I hear one company after another looking for the most expensive CEO guy they can find. I have no problem paying for success. Its the paying for the failures. United Airlines, General Motors, Chrysler, Hewlett Packard — each of those men and women walked away handsomely endowed with bonus and super bonus and stock options. As each of these companies tanked and drew down the economy we threw MORE money at CEO’s. I’ve yet to see cat skeleton’s around full cat food bowls. I believe if we all went to reasonable executive pay and said NO MORE! that indeed CEO’s would be paid proprionately and reasonably. Perhaps we should make the CEO take some of the risk (not with fako securities from the board but with his own monies. Perhaps, as in days of yore, CEO’s should bear a percentage of risk and win-lose with the company.
Danny DeVito, ever a mirror for the times, did it well with ‘Other People’s Money’.
The Harvard business school recently announced that they might teach business ethics to their grads. What a concept! Such things as stealing from old ladies is wrong, wiping out the life savings of people and towns is poor for future business, and the future. My son said that if once in a while if the inchoate mob, those who lost nearly everything, had an opportunity to be in a closed area with the hedgies and mutualaholics who ground their savings from real to immaginary numbers that much of this would be object lesson.
But then, that’s pretty gory.
Heads on pikes. Not a lot. Just a few. Some in Wall Street. Some on K Street. Some along the mall. Sobers the crowd and makes us remember that there really are people who are responsible. Until then, its still “Buddy can you spare a (discounted) dime.”
You’ve been turfed!
Posted by redlinedoc in Commentary of the times, Medicine, Universal HealthCare on June 21, 2009
More of my patients are being turned away at the gates every day. Often they need advanced care which we at the primary care level can’t give them.
I have always felt that we were most lucky, we are a smallish state and have a training institution and hospital which are owned and operated by the state. This hospital should be seeing the those at the fringe, those in great need. For many years the hospital was located in the center of an immigrant community. In the 70′s it relocated to a suburban location, very upscale. At first there was a bus to take people from the community but that quickly was quashed. Now it takes two busses and a local jitney at the heath centet, about 2.5 hours, to get there. Not much of a barrier.
Patients going to his greater facility of learning often encouter trolls at the gates. Trolls? Admission to this center of ‘much higher learning’ requires the proper insurance, not some of the lower paying kinds that our patient’s possess. When they call, the answer is frequently, call back when you have better insurance.
A few weeks ago, after some harsh notes from our facility, several well dressed physicians show up to try to make arrangements to expedite the admission of our patients into the gleaming tertiary care facility, state owned and supported. To show magnanimity one of the docs takes out a card with driving directions and some special parking near his clinics. There is muffled laughter as we tell him that the majority of our patients don’t drive nor own cars. He’s a bit culturally disconnected.
Lest you think that this is peculiar to the country estate hospital, the in-city institutions answer similarly.
Recently a patient shows on a Friday afternoon, all hunched over, the Groucho Marx walk, right upper quadrant pain, rather classic gallbladder symptoms; a surgical problem. She is referred, complete with small note from the doc, and ambulance transported to the in citty emergeny room to prevent her from having to find transport. The attending physician there concurs but adds the diagnosis ‘shitty insurance’ and instead of wheeling Senora Patient to a holding area for surgical admission, gives her back a note with the names of two surgeons in the area saying she needs urgent and immediate care. She of course calls those offices only to find that neither surgeon participates with her insurance. Quel suprise! Monday morning, quite more hunched over she comes back to our primary care clinic, sicker, with the note and no scar. A nasty note and a phone call, she’s retransported and admitted for care. This is a good outcome?
With all the ballyhoo about insurance companies participating in health care, and contrary to their every present advertisements that ‘they take care of you’ we need remember that there’s a profit motive totally separated from any health provision. The recent squealing and wheezing from the health insurance companies and their paid compadres in government about the death of health care should we use single payor or government sponsored health care is quite self serving, serving only their investors.
The only investors in Medicare are we the users. Its far from perfect. It has a 5-8 percent overhead, unmatched anywhere in the insurance industry, even with draconian plans which provide and income source for the insurance companies not safety nor security for their policy holders.
We need to re-direct our efforts and energies toward providing a comprehensive Medicare type system. A single payor system will insure fairness. I see no reason why the private companies can’t compete for business as they do in every other country with single payors. Lets see them for what they are, trolls at the gates.
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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