Tuesday, June 30, 2009

PUB LIC INVOLVEMENT-POLITICAL SUPPORT

Councilor Burney and the Council has recommended the establishment of Citizen's Advisory Committees and requested Volunteers to submit their application to aid in
  • (1) the Budget Process,
  • (2) Planning and Economic Redevelopment and
  • (3) IT development
Those who believe that they can productively participate in the three committees should make themselves available.

In an email to me Councilor Burney wrote " The main issues facing this city are:
  1. budgetary - a priority of services needed
  2. a severe deficit in new revenues (to offset organic budgetary growth)
  3. crime - continues to exceed the national average in virtually all areas
  4. schools - continue to under perform by most standards
  5. organizational strategic focus
There are of course many others, but most of them can be covered by solving the above listed issues. Better Policing is putting a bigger band-aid on the crime issue, but in the long term, some very difficult political decisions will have to be made, if we truly want to reduce crime in the long run. "

I have been advocating a broad multi-sourced commission to review the City's Codes, and Ordinances which create the local laws under which we function(?) plus a review of Planifield's government organizational structure. This commission should have defined charges giving it authority to recommend, and ideally produce initial drafts of new ordinances and codes for presentation. It also should be charged with making a complete analysis of the present dysfunctional city administrative organization with a blueprint for a working model.

There will need not only interaction with the present "Citizen Advisory Committees", but an honest commitment from all factions of the city government..

Both Plainfield Today and "Plainfield Plaintalker" blogs have reported in detail some actions during the past 4 or 5 years that not only facilitated the Connolly disaster, but has open the way for illegal small residency violations.

Budgetary recommendations for the present year should show a shift in focus from any inefficient department to strengthening those that will improve the city. If any reductions and/or increased line items appear that will improve Plainfield There will be no serious grumbling about increases.

Revenue deficits can only be addressed by increased taxation on taxable properties. That also means that a complete review of all tax exempt and tax abatement properties should be done immediately to recover lost revenues. Income producing properties owned by not-for-profits or charitable entities should not be entitled for a free ride.

Institutional homes, for which the city has been the county dumping ground for decades,are an excessive burden on Fire and Police resources, and now will be more so on Rescue Squads with the loss of the hospital. There must be somewheres county, state, federal or foundation funds available to help defray some of these costs.

Above all transparency should be an actuality not a buzz word. The "I will get back to you" is unacceptable. Any and all answers must be made available to all. The City's Internet site should be used and could be for the benefit of the community.

Monday, June 29, 2009

COLD POTPOURRI

Too many irons in the fire for today's blog and none red hot so will post later today. There will be something that I hope will generate interest.

Sunday, June 28, 2009

MINIMAL POTPOURRI

I wrote it all yesterday. Unless something makes the news overnight this will be it for today.

In progress for posting is an examination of possible health care programs and an amateur's analysis.

10:30AM:Today's Courier expose of the Connolly slum landlord ship should rate at least a partial Pulitzer. It is symptomatic of Plainfield's deterioration that all the upscale apartments have been allowed to become slums. The table of accessed valuation and sales price is remarkable when compared to taxes. How much money could the city have received? Also why are certain facts including taxes N/A. All should be public documents.

I repeat that this abomination points out that not individuals but the entire code structure and organization of the city administration organization needs overhauling. Only then can we evaluate those filling the slots.

I predict that none of the above will be politically acceptable and at best we may have to settle for a band aide.

Saturday, June 27, 2009

CALL TO ARMS

Plainfield's governmental structure is broken!

This is not the fault of the present Administration although it has done little to try to remedy the problems. Rather it is a cumulative result of two or more decades of poor administration.

I am going to revise my suggestion of Friday June 26 regarding a study of the Codes and Ordinances by expanding it to a suggestion that a Commission of Citizens and Council Members be created to review the entire municipal governmental structure and operation.

The handling of the Connolly Management's violations has been unacceptable. Just as a State has the right to impose stricter standards than the Federal laws impose, so should a community in regards to State laws.

If as was inferred at the Council meeting, there are State laws prohibiting city inspection of high rise buildings, I hope the Administration will publicize them.

That meeting led me to attempt to review by using Rashid Burney's "city government site" the approximately over 400 pages composing the City's Codes. Two Chapters; Chapter 6, Building Codes and Chapter 8,Health contain articles that would address all of Connolly property problems. Mechanism for inspection and enforcement although vague are in place, including protocols giving the appropriate Department head rights for action under emergency situations.

Penalties where documented have not been updated in years and do not reflect the decreasing value of the dollar.

There are articles that define hours during which construction can take place, as well as addressing the late night party noise complaints citizens registered at the last Council meeting. The city has the power under its codes to act when holders of defaulted mortgages neglect the properties.

Plainfield's administrative structure is a problem. Health is under the responsibility of the Director of Administration and Finance , Health and Social Services. a position which has been vacant for months. The City Administrator has acted in a temporary role although there is a question about time limits on this solution.

Building codes are under the overall direction of the Director of Public Works and Urban Affairs. There is a Division head for "Inspections" who is responsible for code enforcements. I am sure that the size of the staff has been compromised annually in budget planning.

Although Health and Building Code matters may be coupled there seems to be no mechanism for cooperative action by the separate divisions..

This past week the question of Tax Abatement and Pilot programs was raised in the Council. There seems to be little knowledge of the number and terms of the many programs. Again there seems to be a lack of access to all material.

The Commission I suggest should be specifically charged as to its functions and time frame whether it be three months, six months or a year to deliver a report to the Council. It should have the right to interview anybody in the administrative part of the government.

Something must be done now. This is not the time for jawing or wind blowing but a recognition of the Council's fiduciary responsibility to the community. Otherwise, all talk of reviving Plainfield, is a waste of not only time but also money. Instead Plainfield will become Slumtown, USA.

SPELLING and other typos.

It is amazing how in this electronic world how a writer's thoughts can be altered without his knowledge. Spelling checkers are notorious, especially if they are the kind that automatically "correct" as one types or scans a document. I know the difference between a johnny cleaner -LAVATORY_ and a technician- LABORATORY. worker.

I write most long subjects such as the Health Care postings on Word before copying and pasting to the blog. This is the source of many the silly typos.

No matter how many times I proof read such errors appear after I have "put the document to bed".

HEALTH CARE #5

Health care #5

Providers:

In determining the costs of Health care the largest cost engine other than the consumer is a lumped together heterogeneous group. There are two main divisions; those that provide professional or pseudo-professional services, and a larger cost producing materialistic group.

The first grouping includes Physicians, Nurses, and Physician Assistants. Nurse Practitioners. Occupational Therapists, Physical Therapist, Social workers, Radiology –no longer limited to Xrays- and isotope technicians, highly trained clinical and pathological lavatory workers, EMTs, and others who have direct patient care contacts.

Although there often is only a tenuous relationship among some, most often specific patient’s care is accomplished under some type of team format. All are important in health care and none should be ignored. But there services must be paid for whether it is on a fee for service basis or a contracted or salaried format.

I am not going into detail about this group except for physicians.

I would have thought that I would have been an expert about the Physician’s impact. However, it has been 19 years since I last treated a patient and a decade since the Central New Jersey Independent Practitioner's Association collapsed under pressure from the commercial carriers.

During this past two decades the costs of operating a physician’s medical facility has increased exponentially, especially with the need of non professional support personnel. It has reached a point that it is financial impossible for an individually operated office to exist. I have no data but I would suggest that nowadays more than 50% of the patient charges in the office go towards the human overhead.

Every insurance carrier has different forms and/or rules and regulation that must be adhered to in order for the patient to receive specialist care or diagnostic studies. Any deviation will result in failure to pay. Telephone contact is often needed and we all know the frustrations of talking to the computer that intercepts the call. All this takes time and time is money.

The government is requiring many reports and applications to be file electronically which means the cost of capable updated equipment. While the use of mail is not forbidden, there are real and implied roadblocks interspaced. Pressure is being put on all offices to maintain records electronically rather than written. The theory being that it is legible (true) and can be available to other physicians and hospitals. Provisions for security and privacy are questionable. The cost for mandatory encryption and the determination of accessibility is high.

Medicare and Medicaid have their own peculiarities and regulations or criteria’s that change periodically to become more demanding. Practice “norms’ are defined and any minor deviation, even if it is in the patient’s best interests, becomes a potential censure item and often a basis for a malpractice suit, which are actively sought after on the media by attorneys. Since few come to trial and most even those without any merit are settled out of court, this is almost 100% win-win situation for the legal; profession .

The required data entered into each record can often be fulfilled with a check mark and certainly can be altered at any time.

Since we live in a litigious society Physicians need to order more tests than necessary, because any omission can mean losing a suit. It is sad that the legal profession attacks ever unfortunate negative outcome as mal-practice even if everything was done properly

The fact that insurance carriers can recoup their losses by increasing premiums; there is most of the time no intent to fight the case.

Everything above and not taking into account the years spent and costs in a physician’s training enter into the intangibles in the cost of the doctor’s services. You must agree that time and expertise must be factored into physician’s costs.

The major materialistic group providers include the acute care Hospital and its various services, as well as specific service Hospitals such as Mental Disease Hospitals, or specialized care institutions like the DuPont Children’s Hospital in Delaware or Sloan Kettering in New York. Each of these have a significant impact on overall care costs.

Hospitals are not hotels; the staffs needed include the usual service and maintenance personnel plus professional workers including nurses, technicians some who are highly specialized plus assorted “clerical” and administrative individuals. Their equipment needs runs into millions of dollars, and obsolescence is rapid.

To assure quality care X-ray units, CT scans, MRI’s, Operating and Delivery rooms. Intensive care or critic al care units etc. must be available 24/7. Thus even when idle they are generating costs.

Do not forget the free standing outpatient facilities such as 24 hour “Jack in the Box” clinics, Surgical Centers, Laboratories. Although they do not have to make allowances for the standby services hospitals must be prepared to use, therefore can operate less expensively they add to the bill,.

Non acute hospital institutions for Rehabilitation, Convalescent, Long Term Custodial care, “Half way Houses” also are part of the provider cost engine. There are more that will fit into this category and as the light strikes me I will add them to the list.

Add to the list the Pharmacy, the Surgical Supply store, and all the manufacturing facilities that supply them are also significant providers. The replacement of the Pharmacist’s owned drug store by the big chains has resulted in greater efficiency in purchasing and stocking medications but has not greatly reduced costs.

One cannot exclude the Insurance Companies, Federal and State programs including Medicare and Medicaid, The Veteran’s Administration facilities

It will take pages to consider the considerable cost impact of all the above. At best I could try to be specific about some and try to provide a connection among all. This would prolong the time before I can discuss the options available today for the public to receive care reimbursement and/or delivery programs.

I hope this overview has shed some insight into the problem.


Friday, June 26, 2009

LET'S DO IT!

In response to my last posting about Thursday's night Council meeting and the ability for the city to act in public health and safety issues, Bernice wrote: "Rashid Burney's web site has the entire Municipal Code online, though possibly lacking some updates. It is quite useful if you know how to look things up.
The Code is also full of outdated stuff such as defunct boards and commissions and really needs an upgrade. "

I have tried to find various codes sometimes with extreme computer difficulty. The City code should be available on the City site, but we owe Rashid gratitude for all that he has tried to do in the name of transparency.


I agree with Bernice and have advocated for several years that there be a complete review of all codes and ordinances that are on the books and have never been repealed or revised. I am also sure that the IBM card files are full of ordinances that have been forgotten and never repealed but could be enforced.

Once that is completed they can be compartmentalised and a 21th Century city government organized. This will take time and some money but may save us millions in the long run fighting antiquated legal roadblocks.

If Administration and Council would provide the means and I am sure that there must be an appropriate foundation that would produce grant money, that this could be an excellent source of summer employment under supervision for willing college or high school students.

The completion of this one project might be the needed impetus for a functioning IT department. The availability of accessible codes and the ability to enforce them would benefit the city and help various departments and agencies work in synergy.

The question is, Do the powers that be want and efficient city?

An afterthought; Both Council and Administration have asked for citizen volunteers for various committees and commissions. While I may not be able to give enough time for any of those mentioned, I would freely offer my services as an 'idea man" harebrained or otherwise.

Topsy is here again! While we are at it lets us have an up to date listing of all properties that are tax exempt or have a form of tax abatement. Those not justified must b on the tax rolls

Council 6/25/09

Installments 5,and 6 of Health Care may be appear latter today or tomorrow . The delay is caused by needed revisions I could post both as follows;
"Providers"; Any person or facility that will cost the patient money. Not included are the legal and legislative professionals whose financial impact can not be calculated.

Best advocate for two sets of Council meetings a month was last night's special meeting. The agenda consisted of 6 items. One, regarding the selecting of a non-profit agency to operate the facility was withdrawn pending further information.

A second Resolution resolution granting the Cedar Brook Senior Housing Apartments a new"Pilot Study" authorization of payments in lieu of taxes was tabled to a Special Meeting on July 1, 2009.Councilor Mapp raised several interesting questions including why the property had not become tax accessible after the end of the original 2002 30 year Pilot exemption.
The building was built with Federal financial incentives including annual monetary payments in lieu of taxes. I am sure that the original investors and other partners who included members of a real estate consortion from Perth Amboy with connections to the Wilentz organization did not lose any money on the deal over these past 37 years. Mapp also questioned if the city knew the principles behind the present ownership and the new owners . He raised the possibility that the only true change in ownership was the name.

Also tabled for information was a resolution Authorizing the execution of a contract among PARSA/PMUA/The City of Plainfield for an easement at the transfer station site for a new joint pumping station.

What was passed was:
  • a renewal of a liquor license,

  • A transfedr of $159,000.00 of General funds appropriations for 2009 from-correct me if I am in error- a grant for the Dudley House operations to DPW for salaries and other maintenance work on the house.
After the business session matters were completed, Councilor Mapp brought up the possibility of reverting to a Calender Year instead of a Joly 1-June 30 Fiscal Year. Changes in State law now make it a possibility. It is my opinion that for sanity sake it should be investigated.

The public discussion period was focused on when legal action will permit the repaving of Netherwood Ave and Kensington Ave which have been stopped by the contractor's default. Thge holdup seems to lie with the bonding company.

The Connolly properties were also an item of spirited debate. Again the state of the city's codes and enforcement capabilities were mentioned. It was noted by Administrator Deshields that it is the State that has the responsibility of inspecting high rise apartment buildings. There is something wrong if the community can not enforce safety and health violations.

Dadhields noted that a task force was being organized to implement cooperative inspections by the various city agencies that have responsibility. Frequent periodic reports must be made public in order that the process is not pushed to the back burner.

A personal comment; I can not accept as a fact that a community is prevented by state and possibly federal law from actions that protect the health and safety of its citizens. All our local ordinances need to be recoded and outdated ones replaced with effective new ordinances as part of the city code. The impact of state laws must also be "codified". Plainfield can never return to the Queen City if we are helpless to prevent violations or punish violations of all health standards by allowing pumping raw sewerage into the streets.

Would not the city's Internet site be a wonderful helpful place to post all the safety, health, quality of life ordinances , and penalties for violations.

I urge that any question askewd at a public meeting which was to be answered after investigation be also posted pdq o this site.

Thursday, June 25, 2009

HEALTH CARE iNTERIM

I had not prepared my next segment regarding providers for posting today. I wished to listen to ABC's question and answer program with President Obama hoping that something new and constructive might happen.

Unfortunately I felt that the program was too scripted to be anything more than a PR effort. Once again I will have to read a transcript in the Times, I hope, before I might be able to write an intelligent analysis.

Additionally ABC this AM is making hay with the Republicans. Too much rhetoric, much out of context is coming out of the tube. Once again I want to see permanent printed hard copy before making any comments. I may from time to time add something to my potpourri. (Added 7:30am)

Instead I will next clarify the group I term providers and superficially try to explain where they fit into the cost engine. I may be able to digress with some suggestion of savings.

Following that segment I will try to present my knowledge of the various health care delivery choices that are or may be available.

In the meantime I intend to attend the Council meeting this evening.

Wednesday, June 24, 2009

BRIEF POTPOURRIE 6/24/09

One must read both the print and on-line editions of the paper (Courier) to become somewhat knowledgeable about the community since they are often different.Of course the hard copy. unlike me. goes to bed early and thus late breaking stories like gang shootouts may be missing in the morning paper.

The Spivey report on the 27 Conolly properties is extremely disturbing.

At the last Council meeting I questioned if the present building codes had teeth, and if they were being enforced. I recommended that ordinances revising all property codes with string penalties for repeated violators be on the agenda in July. To procrastinate is criminal.

There is a caveat, the enforcement of the codes must be for legitimate repeated violations not as a harassment vehicle as has been the case in the past.

A new thought, Is there any provision for a "Public Advocate" in our city TO. If not there should be legislation creating one. I hope Administration and Council will consider. The only hope for this community is not who rules the roost be they New or Party Democrats, but in dividuals whose short and long term agendas are to make Plainfield the New Queen City, not New Jersey's South Bronx.

Update on my "Cause celebre(accents missing):I have stated that the CN's printed apology 6/23/09 was adequate and I do not feel that there was any initial intent by the paper to defame me. I would like assurances that no one else will be subject to such a malicious letter. And while I have accepted with reservations, J. Ckore's apology, his explanation given the unalterable printed original letter seems more fictional than factual. That is why I maintain reservations.

HEALTH CARE #4


How do the “cost engines” determine the funds expended for Health Care? I had arbitrarily defined four and I will expand on each, but not in order.

The most important is the “Consumer”. That includes every individual in the target area whether or not they have seen a physician or used any of the other resources.

Consumers can be classified as:

1. Those who use health resources only when needed.

2. Those who never use any health resource.

3. Those who use health resources both when needed and for routine prophylactic purposes.

4. Those who abuse the system.

Perhaps the vast majority are those who use the resources only when needed. By interpolating an estimate addition use for recommended periodic preventive checkups, this groups cost to the system can easily be determined.

The costs for those who have regularly scheduled preventive usage as well as when needed obviously can easily determined on an annual basis.

The cost that would be attributed to those who never use health resources is an unknown but statistically handled factor”. That can only be determined by “guesstimate” based on numbers and actual costs per individual in the second grouping. Variables such as location, age group, and cultural uniqueness will enter into the equation.

The X factor is in the group of abusers. It is human nature to take advantage of “something for nothing”. This group will need education and probably use of some punitive measures to keep in line.

I am going to skip the diverse group of providers at this time. This engine is perhaps the biggest cost producer.

That leaves Creators and Overseers; Among the Creators are researchers in various sites who develop new products and/or treatments. New diagnostic tools such as MRI heart scans, use of tagged biological for diagnostic purposes when available to the public add to demand for state of the art and making these modalities available impacts on cost.

Also included in his group are new and sometimes exotic treatment modalities such as the gamma knife for brain and other non invasive surgery, as well as organ transplants.

Creators would include the pharmaceutical companies whose research produce new drugs, as well as academies that do studies to determine effectiveness and outcomes of treatments.

The Overseers include state licensing boards, state and federal legislators, professional organizations, insurance carriers, the media, and of course the ever presence ambulance chasers (lawyers advertising on all medias for clients with real or imagined injuries).

I cannot speak with authority about the impact of the regulating bodies for hospitals, free standing surgical centers, laboratories, radiological and isotope facilities but they are numerous and all do periodic on site inspections. They also set standards that must be achieved and maintained. All of this requires additional personnel and equipment.

Every physician, hospital, laboratory, etc has to have one or more Federal and/or State license to operate. The fees are a source of government income. thus increase on a increasingly more frequent rate. Moreover, the method of communication from provider to regulatory agency is turning from mail to electronic methods.

Next episode will be devoted to Providers. After that we can investigate the various proposed plans available to consumers.

Tuesday, June 23, 2009

WORLD OF MIRACLES part 2

The Courier's apology printed today in "letters" is adequate. Unanswered of course is why a letter that obviously would have been recognized as libelous if proper vetting had been done was ever permitted to be printed. The paper's cupability can not be ignored.

Regarding the change in the letter in the on-line edition. The plus is that all libelous reference to me has been expunged from the Internet. The negative is that the original damage existed and can not be erased from the minds of his fellow travellers. On the other hand the change compromises the integrity of the paper.

There exists a major problem in the on-line papers' open comments relating to published letters. While I am against censorship, there is often an abuse of free speech by the commentators that make this feature a cesspool for anonymous egotistic recreants.

WORLD OF MIRACLES

This morning I chanced to review the online letters in the Courier, Specifically J. Clore's letter of June 19th. To my amazement not only was Dr. Rosenberg's name substituted for mine as published in the original letter, but the entire body of the letter was changed. This letter as published today is a perfect legitimate opinion without any mention of personalities

That the Courier would print the original is disturbing, That on June 23 the substance of the letter has been changed electronically is even more disturbing. The term is cover up.

AS of 7 AM I have not read today's printed or on line Courier to see its apology. I would not have been disturbed if the Courier had deleted Clore's letter but to present something new is the pits.

JG I need you. I have reproduced today's electronic version.

Rabbi Dr. Bernhard Rosenberg's letter in the June 16 edition of the Courier News certainly exposes his true agenda. Is his hatred for President Barack Obama so pathological that it allows him to blame the President for the murder of the security guard at the National Holocaust Museum? How can he sanely draw a connection between the President's opposition to the illegal Israeli settlements, and this tragic murder?

Dr. Rosenberg then writes that President Obama "perpetuates the myth" of blaming all of the Palestinian problems on Israel. He also makes a thinly veiled attempt to compare the President to white supremacists. Both statements are beyond absurd.

It is not criticizing the Israeli settlements that increases "hatred for Jews in Israel." The blind, knee-jerk support for every Israeli policy and action, and the slanderous attacks against anyone who criticizes Israel, is what leads to the anger.

You can't compare President Obama's constructive criticism of Israel, to the homicidal actions of a raving anti-Semite. To do so casts real doubt on the sincerity of Dr. Rosenberg's position.

JOSEPH A. CLORE

Plainfield



And yesterday's comment in the online edition
JClore1950 wrote:
I humbly apologize for mistakenly naming Dr. Harold Yood in my letter instead of Rabbi Bernhard Rosenberg of Edison. A regretable typo on my part.

To be continued, The matter is no longer "balderdash".

JUST POTPOURRI

Today I intend to take another break from "Health Care" as a subject, although I have a few brief remarks about recent experiences and also Iran's election and other world affairs.

Before any comments I am reprinting a comment from J.Clore to my Sunday's post, "Reflections".
I apologized after 48 hours because I did not realize my mistake until a friend pointed it out. I mistakenly addressed my letter to you instead of Rabbi Rosenberg. I did not mean to address you at all. None of my comments were actually directed at you. I apologized to you today on the Courier News website, and I apologize to you again now. Joseph A. Clore June 22, 2009 2:50 PM

Mr.Clore also added a comment to his on line edition of the letter in which he referred to my name as being a typo.

Although I had thought that references to my agenda in the letter had no relativity to Rabbi Rosenberg's letter, rather than asking JG for the name of one of his lawyers I am accepting Mr. Clore's apology with reservations. Except for the fact that his letter is on the Internet I consider the matter to be balderdash*.

Similarly, The Iranian leadership has acknowledged some slight non significant irregularities in the voting. It seems that in some 50 or 71 (it is irrelevant) towns there were more votes casted than registered voters. Shades of the Hague years in Jersey City.

More seriously is North Korea's boasting of its new nuclear capabilities and threatening us and the world. Perhaps the Chinese and Russians should have asked Israel to neutralize that nation before it became a threat on their borders.

A more pleasant subject was my brief "Shuffle off to Buffalo" recent weekend. 50 years ago on a family vacation with all three daughters, my son was too young, we stopped at Niagara Falls before visiting Montreal and Quebec City. This time I had a brief trip on "The Maid of the Mists" which was as much fun as two generations ago. I have some pictures of both visits although 1959 was from the Canadian side. In those days the border was non existent.

The first quartet were taken in 1959; the quintet is this years, some from the Observation Platform others from the "Maid".


The "Spanish Cable Car" over the whirlpool. I am told it is still there!



And 50years later:




The biggest change was how commercial the area has become. The other notable fact was the great ethnic diversity among the visitors especially with the large numbers of family's of Indian ancestry. How many of us who are second or more generation Americans have taken advantage of our heritage?

To end this extra long blog; Today two new facts about today's practice of medicine hit me. I went to my doctor and although I had been to that office over 20 years the receptionist ask for some identification such as a drivers license to copy for their files. It seems that the Federal Government is requiring that to be on file for Medicare claims since providers, I mean physicians, bill Medicare therefore they are "creditors".

If that was not enough, although I have maintained my practice and Federal and State drug licenses so that I can write my prescriptions without bothering my doctor's offices for renewals , the pharmacist asked for my NPI (National Provider Index) number which I never had obtained since I CAN NOT legally treat patients. The process of getting one took about 10 minutes but as of the past year must be on prescription blanks.

Factor both in and understand why your doctor is no longer the friendly family friend.

*"Balderdash" is spelt with a "c".

Monday, June 22, 2009

HEALTH CARE #3

When I started this project I anticipated at the most two to three days writing. However there are no simple answers and it seems to be growing like Topsy. I don’t think that I have scratched the surface so please bear with me. There may be some interruptions in continuity for other matters but I hope to express my concepts. I know many will disagree with me and your comments on this subject will be welcomed and posted many with my own exposition. .

As a started to write this “episode” on 6/20/09 the headline in the Times read “House Unveils Health Bill, Minus Key Details” (boldface mine).

The article states that the bill is 825 pages. Obviously that will take some time to read and understand. We the ignorant will be dependent for analysis by media writers in the same manner that the congressmen rely on their staff.

This Bill seems to have major differences from the Senate proposals. There will undoubtedly be a long period talks, revisions, compromises and adjustments before a realistic program emerges.

We will await President Obama’s interview on Wednesday 10PM CHANNEL 7 to have a better idea about the direction he hopes to go. Above all we must remember the failure of the ill conceived Clinton proposals.

In the meantime there are certain basics that we can accept and understand; a study by the Deloitte Institute repeats what has already been ascertained that out of a total population of approximately 307 million, 45 million Americans lack basic health insurance, and 25 million more are uninsured. That is a little less than 25% of the population are health care paupers. Additionally adults receive recommended care only 55% of the time.

The much publicized Kennedy plan will only affect about 16 million of those listed above. It is more talk than show.

We should also accept the premise that Health Care is not a RIGHT but should be the responsibility of the community for the benefit of the community. The term community meaning the country.

There are indisputable facts of life such as that one can pay too much for a commodity, and one is never sure of receiving value for what one pays. Also one will never receive more value than one is willing to spend. These three axioms are the engines that will run any comprehensive health care program.

The costs of any health care program are dependent on four categorizes; Consumers, Providers, Creators, Overseers. All can impact on resources and I will try to address anon.

There is the element of financing. The estimated 1.6 trillion dollars over 10 years or average 160 billion per year has already proven by the bean counters to be too low. The obtaining the funds are questionable. A recent study showed that 43% of tax payers were opposed and only 25% in favor of increased taxes for health care. The remainder 32% were on the fence and it can be assumed that when their pocket book is involved they too will take a negative position.

The taxes suggested included increased income tax, taxes on health care benefits, employer taxation graduated by company size with some exemption for small employers. Any of the above or other innovative ideas will mean increase cost to the individual with a lowering of dispensable income.

Unless there will be an unlimited influx of capital there will be a finite amount of resources available which can result in rationing delivery of quality health care. That may take the form of delays or denials in more than the basic needs.

There are many models that must be considered; Universal Federal System with or without op out provisions, Private Panel Plans, Private Insurance Programs, and a mixture of any or all. Everyone has its pros and cons which I propose to give my input in following posts.

The financing is crucial because that will determine what can be delivered. In a purely Universal Federal Plan the money will come from some form of taxation. It could be an added income tax, which would mean large increases at the upper end over the lower. To be effective all loopholes will have to be closed and that has never been done.

Or a VAT –not sales tax- could be the source. This would probably place the load on the middle class. Another source of taxation would be on the employer’s payroll. This could have a disproportionate negative effect on the small 10 or less employee business. And some accommodation would have to be met.
From Wikipedia: (Value added tax (VAT), or goods and services tax (GST) is a consumption tax levied on value added. In contrast to sales tax, VAT is neutral with respect to the number of passages that there are between the producer and the final consumer; where sales tax is levied on total value at each stage, the result is a cascade (downstream taxes levied on upstream taxes). A VAT is an indirect tax, in that the tax is collected from someone who does not bear the entire cost of the tax.) The VAT is a popular tax n mechanism in Europe and Canada.

The risk based actuarial format which private insurers use creates an excessive burden on individuals as they age and on those with known medical conditions. The fairest alternative would be to do the actuarial studies yearly to determine the total amount needed then create a tax or premium rate based on for example a minimum three population segments; the largest and that with the highest premium would be the 20-65 age work group. The second would be the over 65 age group at a decreased premium. The third would be the under 20 age group. again at a slightly decreased rate. I have not included other groups such as those unemployable by illness or other disability, and therefore are not income producers.

This financing problem will most likely need a combination of financial resources, and I am sure there will be a lot of opposition to whatever plan(s) is adopted.

If you have been able to follow my convoluted rambling discourse you will understand that you have just begun to appreciate the enormity of the financial program as to obtaining funds. I know I have just touched the surface but will next go back to the cost engines.

Sunday, June 21, 2009

REACTION

The first amendment gives each and every one of us the right to speak or write freely and express our thoughts even if they be anti-social or inflammatory. It does not give us the right to incite violence nor is it to be a vehicle to preach religious based hatred. It certainly does not give license for libel. Libel is defined as”(1) a statement or representation published without just cause and tending to expose another to public contempt,(2)defamation of a person by written or representational means.

Mr. Joseph A. Clore’s letter printed 6/19/2009 in the Courier News in which he accuses me twice by name of expressing hatred for the President and calling Obama a racists for being the author of another’s letter ,certainly meets all the criteria expressed above for libel.

Granted the unlikely possibility that Mr. Clore ,a self acknowledge anti- Vietnam War activist at Syracuse and now working for the government in the Environmental Protection Agency. May have made an honest mistake about the author of the letter that pushed his buttons he has had 48 hours to attempt to ameliorate the injury he has caused.

I for one wonder that since Mr. Clore wrote “Harold Yood’s letter in the June 16 edition of the Courier News certainly exposes his true agenda.” That it was not the contents of Rabbi Rosenberg’s letter that initiated Clore’s diatribe but since he accuses me of having an agenda that this was motivated by my public criticism of the local political leadership.

If that be the case, he is so far out in left field that he may never see the ball. I am too old to have a self-serving agenda. The only “agenda” I could possibly entertain is to make Plainfield a desirable community for present and future residents.

Religious, ethnic, racial, orientation bigotry is reprehensible no matter where the source and should be actively suppressed. I would quote from the end of President Obama’s Cairo Speech’

“There is also one rule that lies at the heart of every religion-that we must do unto others as we would have them do unto us” This truth transcends nations and peoples-a belief that isn’t new, that isn‘t black or white or brown; that isn’t Christian, or Muslim, or Jew. It’s a belief that pulsed the cradle of civilization, and still beats in the hearts of billions. It’s a faith in other people”

All the Clores and Rosenbergs of this world and their ilk should read all of Obama.s Cairo Speech. It is a masterpiece. Try to read it with hope not bias.