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Thu 25 Mar, 2010 04:32 pm
http://www.marketoracle.co.uk/Article18136.html
This one is important. If pubbies fail to put an end to Obamacare, this affects all of us:
Quote:
....
....
Obamacare will lead to an expansion of these forms of medicine:
1. Concierge
2. Wal-Mart
3. ER
4. HMO
5. Mexican
CONCIERGE. The rich and very rich hire their own physicians. They pay top dollar. The physicians do not take third-party payments, either from the government or insurance companies. They are independent practitioners. They make house calls. The houses they call on are very large.
For the upper middle class, there are fee-for-service physicians. They take no third-party payments. They do not make house calls.
WAL-MART. These are the walk-in clinics. They are price competitive. They treat minor ailments. They sell services on a one-time basis. They take credit cards. They may or may not cater to the Medicare crowd. They are assembly-line clinics. There are no major surgeries or other high-cost, high-risk services.
ER. Large hospital emergency rooms are mandated by law. The poor get treated there. In a life-and-death emergency, they work. People who would otherwise die in a couple of hours are saved. For walk-in patients, the ERs ration by time. Patients demonstrate their patience.
HMO. This style of medicine is efficient. It cuts costs by cutting services and cutting time. You see the physician on duty. You may not have seen him before. His job is to get you in and out as fast as possible. Time is monitored by the company. Computers make this easy.
MEXICAN. This is off-shore medicine. In Canada, when you can't get treated for months or years, you come to the United States and pay. This will not be possible for Canadians much longer, except for rich ones. Mexico will serve upper middle-class Americans as the USA has served Canadians.....
....
CONCLUSION
You had better decide which kind of medical care you can live with. Then you had better locate a practitioner soon. This is especially true if you want a fee-for-service physician. People with money will go to them. They are already hard to find. They charge more. It's not easy to become a patient. They are booked up.
If you have an existing physician, do what you can to become an above-average patient.
You had better start getting into shape. You can no longer afford to be vulnerable to the diseases and afflictions of a flabby lifestyle. ObamaCare has changed the risk-reward ratio. Risk has just gone up. It will continue to go up.
There will be no roll-back of this law. It is going to be enforced for as long as the U.S. government has money.
That may not be as long as Obama thinks.
Long article. Note this part of it well:
Quote:ER. Large hospital emergency rooms are mandated by law. The poor get treated there. In a life-and-death emergency, they work. People who would otherwise die in a couple of hours are saved. For walk-in patients, the ERs ration by time. Patients demonstrate their patience.
This one favors the democrats' core constituencies, and probably not you. People who work for a living do not have time to sit in waiting rooms for ten or twelve hours.
Detroit is already dead.
It's America's first Zombie City.
There is no greater municipal cesspit in the US and it has been governed by Social Democrats for decades
BTW
Just because Concierge docs won't accept insurance payments, doesn't mean that if you use them your health insurance is worthless.
You'll pay a bigger share, and you'll have to do the paperwork, but you'll still have the benefit of health insurance, and you'll get the best health care.
@Finn dAbuzz,
Quote:There is no greater municipal cesspit in the US and it has been governed by Social Democrats for decades
Mot so fast Kemosabe. Here are the main reasons Detroit became a cesspool...they're hardly all the fault of Social Democrats
1. Poor corporate governance among US auto corporations --> unbalanced US government budget
2. Exorbitant corporate over-leveraging --> US government debt
3. High wages, benefits, and pensions among auto worker unions --> foreign outsourcing
4. Foreign penetration of market share --> US trade deficit
5. Self-delusion of winning while losing (Flint, Saginaw) --> Vietnam, Iraq
6. Pushing out brands that no one wants --> unwarranted US government-backed sector growth
7. Deep racial divide in the 60s --> bipartisanship (Republican vs. Democrat)
The racial divide caused the flood of exiters to the suburbs
8. Dwindling population size ("brain drain") --> loss of foreign interest in US Treasuries ("support drain")
@Finn dAbuzz,
Finn dAbuzz wrote:
Detroit is already dead.
It's America's first Zombie City.
There is no greater municipal cesspit in the US and it has been governed by Social Democrats for decades
ABC evening news did a piece on Detroit last night. It looked like a war zone.
@panzade,
Quote:Mot so fast Kemosabe. Here are the main reasons Detroit became a cesspool...
You left one out, and the one you left out is likely the biggest one...
The cars GM has been making over the last 15 years are startlingly good; that isn't the problem. The problem is nobody can afford them.
A very big part of that is government mandates. For instance I can see antilock brakes on a motorcycle like the BMWs, I mean if you ever lock up brakes on a bike you're going down anyhow... But I don't WANT antilock brakes on a car and would not willingly pay for them if there were a choice. I talk to a lot of people who make habits of pulling onto road shoulders any time they ever have to hit their brakes halfway hard, with the ABS systems they'd hit the car in front of them while with my ordinary 96 Accord there'd be no problem.
Likewise airbags; I wouldn't willingly pay for them if there were a choice. And on and on. One word I never see in discussions of cars any more is weight; the small cars of today are typically 600 - 1000 lbs heavier than the small cars of 1960; what the hell is that about and how many of those thousand pounds are mandated by the US govt??
I mean, India is now seeing a kind of a people's car which can be purchased very inexpensively and basically just gets around; why the hell can't we have anything like that?
A light car about the size of a Honda Civic using carbon fiber and modern materials and a new age simple engine like that Evinrude/Bombardier E-Tec or possibly even the AngelLabs engine:
http://www.angellabsllc.com/
and no bullshit, and Detroit or at least GM (Government Motors) might could come back.
@gungasnake,
gungasnake wrote:I talk to a lot of people who make habits of pulling onto road shoulders any time they ever have to hit their brakes halfway hard, with the ABS systems they'd hit the car in front of them while with my ordinary 96 Accord there'd be no problem.
1. I'd be interested to see any
data that indicates ABS increases the distance it takes a car to stop.
2. Perhaps the people you talk to would be better advised to a) slow down
and/or b) leave more distance between themselves and the car in front of them.
Edit: Found this:
http://www.abs-education.org/faqs/faqindex.htm
Quote:In what circumstances might conventional brakes have an advantage over ABS?
There are some conditions where stopping distance may be shorter without ABS. For example, in cases where the road is covered with loose gravel or freshly fallen snow, the locked wheels of a non-ABS car build up a wedge of gravel or snow, which can contribute to a shortening of the braking distance.
Seems unlikely to be helpful to most drivers, though.
@DrewDad,
gunga, wasn't part of the reason people started buying foreign cars was that they offered ABS and air bags and Detroit wouldn't?
@panzade,
You kinda left out the issue of being dependent on a single industry....
@DrewDad,
I wasn't sure about that. I know Detroit did a lot Army manufacturing during the Vietnam War. I don't know if they're still making armaments
@panzade,
Quote:gunga, wasn't part of the reason people started buying foreign cars was that they offered ABS and air bags and Detroit wouldn't?
No. At first it was Detroit's refusal to make smaller cars. Detroit was being run by bean counters after WW-II and they honestly believed they could never do more than break even selling a small car. Some sort of a turning point was reached around 1959 when Ford came out with a car it thought was the ultimate American car, the Edsel, which was gaudy and gargantuan to the point that it grossed people out and Volkswagen beetle sales redoubled. Also at that time under the aegis of Routes Group English cars prospered in America and a number of them were perfectly good, in fact the only English car which really struck me as bad at that time was the Triumph.
Detroit at that time started making what it viewed as smaller cars with six cylinder engines including the Corvair and Maverick and what not which ranged from mediocre to dreadful while VW perfected their type IV engine and high end European cars, still relatively small, took off.
The big changes came in the mid 70s and early 80s. Detroit I think deliberately built the two worst small cars seen since France left the US market i.e. the Pinto and Vega and I think the idea was that anybody who ever owned one of those would be cured of wanting to own small cars. It was one of those plans which worked too well. Anybody who ever owned a Pinto or Vega never wanted to own another Detroit-made small car again and changing laws finally forced big cars off the roads.
VW was forced out of America for a while by the new air quality laws which could not be met with air cooled engines. The beautiful type IV which they'd worked so hard to perfect was simply banned.
Another thing the new laws did was force a change from carburetors to fuel injection. That also made the game harder to play. For a number of years in the 70s, the EPA would hold meetings to discuss new regulations, and Detroit would show up with lawyers while Honda and Toyota showed up at those meetings with engineers.
What finally happened in the late 70s and early 80s was that California congressmen finally just invited Japan Inc. into the country to sell cars. It amounted to looking at Detroit and saying something like
Quote:"Hey, it's not really like you guys are providing our constituents with reasonable cars or anything like that and you've connived to destroy everybody who'e ever tried to compete with you here beginning with Preston Tucker and now this thing with DeLorean; we're just going to invite japan Inc. in here and let you try to compete with or destroy THEM..."
I assume you're reasonably familiar with the rest of the story.
I am so disappointed ! I expected that gunga was going to prove that Detroit was a thriving metropolis until this week when Romneycare aka Obamacare passed.
@gungasnake,
Actually, Mexican AMericans are returning to their native soil where health care is less expensive.
Your posts demonstrate that no one should ever trust a link from a right-winger because many Canadians are happy with their health care.
They're pretty pissed off in Detroit
@panzade,
Like I said, the one thing in the world which might save GM and possibly Detroit would be some sort of a decent little car which could be bought for 5K or 6K. If anybody reading this has any sort of a line into the Oinkbama admin, they might want to try to relay this idea.
A no-nonsense version of a little car with a 1000cc version of that E-Tec engine could probably be produced and sold for 5 or 6 Gs.
Rose Ann DeMoroExecutive Director, National Nurses United, AFL-CIO and California Nurses Association
Posted: March 23, 2010 08:07 PM
Diary of a Wimpy Health Care Bill
Passage of President Obama's healthcare bill proves that Congress can enact comprehensive social legislation in the face of virulent rightwing opposition. Now that we have an insurance bill, can we move on to healthcare reform?
As an organization of registered nurses, we have an obligation to provide an honest assessment, as nurses must do every hour of every day. The legislation fails to deliver on the promise of a single standard of excellence in care for all and instead makes piecemeal adjustments to the current privatized, for-profit healthcare behemoth.
When all the boasts fade, comparing the bill to Social Security and Medicare, probably intended to mollify liberal supporters following repeated concessions to the healthcare industry and conservative Democrats, a sobering reality will probably set in.
What the bill does provide
-Expansion of government-funded Medicaid to cover 16 million additional low income people, though the program remains significantly under funded. This limits access to its enrollees as its reimbursement rates are lower than either Medicare or private insurance, with the result some providers find it impossible to participate. Though the federal government will provide additional subsidies to states, those expire in 2016, leaving the program a top target to budget cutting governors and legislatures.
-Increased funding for community health centers, thanks to an amendment by Sen. Bernie Sanders, that will open their doors to nearly double their current patient volume.
-Reducing but not eliminating the infamous "donut hole" gap in prescription drug coverage for which Medicare enrollees have to pay the costs fully out of pocket.
-Insurance regulations covering members' dependent children until age 26, and new restrictions on limits on annual and lifetime on lifetime insurance coverage, and exclusion of policies for children with pre-existing conditions.
-Permission for individual states -- though weakened from the version sponsored by Rep. Dennis Kucinich -- to waive some federal regulations to adopt innovative state programs like an expanded Medicare.
All of these reforms could, and should, have been enacted on their own without the poison pills that accompanied them.
Where the bill falls short
-The mandate forcing people without coverage to buy insurance. Coupled with the subsidies for other moderate income working people not eligible for Medicare or Medicaid, the result is a gift worth hundreds of billions of dollars to reward the very insurance industry that created the present crisis through price gouging, care denials, and other abuses.
-Inadequate healthcare cost controls for individuals and families.
1. Insurance premiums will continue to climb. Proponents touted a "robust" public option to keep the insurers "honest," but that proposal was scuttled. After Anthem Blue Cross of California announced 39 percent premium hikes, the administration promised to crack down with a federal rate insurance authority, an idea also dropped from the bill.
2. There is no standard benefits package, only a circumspect reference that benefits should be "comparable to" current employer provided plans.
3. An illusory limit on out-of-pocket medical expenses. But even in the regulated state exchanges, insurers remain in control of what they offer and what will be a covered service. Insurers are likely to design plans to attract healthier customers, and many enrollees will likely find the federal guarantees do not protect them for medical treatments they actually need.
-No meaningful restrictions on claims denials insurers don't want to pay for. Proponents cite a review process on denials, but the "internal review process" remains in the hands of the insurers, and the "external" review will be up to the states, many of which have systems now in place that are dominated by the insurance industry with little enforcement mechanism.
-Significant loopholes in the much touted insurance reforms:
1. Provisions permitting insurers and companies to more than double charges to employees who fail "wellness" programs because they have diabetes, high blood pressure, high cholesterol readings, or other medical conditions.
2. Permitting insurers to sell policies "across state lines", exempting patient protections passed in other states. Insurers will likely set up in the least regulated states in a race to the bottom threatening public protections won by consumers in various states.
3. Allowing insurers to charge three times more based on age plus more for certain conditions, and continue to use marketing techniques to cherry-pick healthier, less costly enrollees.
4. Insurers may continue to rescind policies, drop coverage, for "fraud or intentional misrepresentation" -- the main pretext insurance companies now use.
-Taxing health benefits for the first time. Though modified, the tax on benefits remains, a 40 percent tax on plans whose value exceeds $10,200 for individuals or $27,500 for families. With no real checks on premium hikes, many plans will reach that amount by the start date, 2018, rapidly. The result will be more cost shifting from employers to workers and more people switching to skeletal plans that leave them vulnerable to financial ruin.
-Erosion of women's reproductive rights, with a new executive order from the President enshrining a deal to get the votes of anti-abortion Democrats and a burdensome segregation of funds, that in practice will likely mean few insurers will cover abortion and perhaps other reproductive medical services.
-A windfall for pharmaceutical giants. Through a deal with the White House, the administration blocked provisions to give the government more power to negotiate drug prices and gave the name brand drug makers 12 years of marketing monopoly against competition from generic competition on biologic drugs, including cancer treatments.
Most critically, the bill strengthens the economic and political power of a private insurance-based system based on profit rather than patient need.
As former Labor Secretary Robert Reich wrote after the vote "don't believe anyone who says Obama's healthcare legislation marks a swing of the pendulum back toward the Great Society and the New Deal. Obama's health bill is a very conservative piece of legislation, building on a Republican (a private market approach) rather than a New Deal foundation. The New Deal foundation would have offered Medicare to all Americans or, at the very least, featured a public insurance option."
Unlike Social Security and Medicare which expanded a public safety net, this bill requires people -- in the midst of the mass unemployment and the worse economic downturn since the Great Depression -- to pay thousands of dollars out of pocket to big private companies for a product that may or may not provide health coverage in return.
Too many people will remain uninsured, individual and family healthcare costs will continue to rise largely unabated and private insurers will still be able to deny claims with little recourse for patients.
If, as the President and his supporters insist, the bill is just a start, let's hold them to that promise. Let's see the same resolve and mobilization from legislators and constituency groups who pushed through this bill to go farther, and achieve a permanent, lasting solution to our healthcare crisis with universal, guaranteed healthcare by expanding and improving Medicare to cover everyone.
Leaders of the National Nurses United have raised many of these concerns about the legislation for months. But, sadly, as the healthcare bill moved closer to final passage, the space for genuine debate and critique of the bill's very real limitations was largely squeezed out.
Much of the fault lies with the far right, from the streets to the airwaves to some legislators that steadily escalated from deliberate misrepresentations to fear mongering to racial epithets to hints of threatened violence against bill supporters.
For its part, the administration and its major supporters shut out advocates of more far reaching reform, while vilifying critics on the left.
Both trends are troubling for democracy, as is the pervasive corruption of corporate lobbying that so clearly influenced the language of the bill. Insurers, drug companies, and other corporate lobbyists shattered all records for federal influence peddling and were rewarded with a bill that largely protected their interests, along with a Supreme Court ruling that will allow corporations, including the health care industry, to spend unlimited sums in federal elections.
Rightwing opponents fought as hard to block this legislation as they would have against a Medicare for all plan. As more Americans recognize the bill does not resemble the distortions peddled by the right, and become disappointed by their rising medical bills and ongoing fights with insurers for needed care, there will be new opportunity to press the case for real reform. Next time, let's get it done right.
Rose Ann DeMoro is executive director of the 150,000-member National Nurses United
This happened on a flight ready to depart for Detroit .
Jack was sitting when a guy took the seat beside him. The guy was an
emotional wreck, pale, hands shaking, moaning in fear. "What's the matter?"
Jack asked.
"I've been transferred to Detroit , there's crazy people there. They have a
lot of shootings, gangs, race riots, drugs, poor public schools, and the
highest crime rate."
Jack replied, "I've lived in Detroit all my life. It's not as bad as the
media says. Find a nice home, go to work, mind your own business and enroll
your kids in a nice private school. It's as safe a place as anywhere in the
world."
The guy finally relaxed and said, "Thank you. I've been worried to death,
but if you live there and say it's OK, I'll take your word for it. By the
way, what do you do for a living?"
"Me?" said Jack. "I'm a tail gunner on a Budweiser truck."
detroit was in trouble long before obama or healthcare, areas of the city have looked like a war zone ever since the '67 riots, the auto industry as the main employer has not helped, a relative is married to a guy who works as an engineer for one of the big three, through the 70's & 80's they overproduced, and counted every car produced as a car sold on the books, yet they had vacant lots full of cars (lots that required security to police)* and when the bust came this seeming pot of gold they, presumably had was just a can of loose change
*the same problem occurred in the city of windsor near me, the auto makers rented land near the airport and used it as excess car storage, friends of mine worked for security firms that policed the lots, one of them was 50+ acres
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