Posts Tagged business+ethics
Turfed too
Posted by redlinedoc in Medicine, Universal HealthCare on August 22nd, 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.
Again and again
Posted by redlinedoc in Universal HealthCare on August 13th, 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 13th, 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
Heads on pikes
Posted by redlinedoc in Commentary of the times on June 22nd, 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.”
Bonuses for bettors
Posted by redlinedoc in I never saw THAT coming on March 1st, 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.
bankrupt, banks, business+ethics, executive+compensation, fairness, fiduciary, other+peoples+money, poor+insurance, poverty, risk, vulnerable
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