Holiday Time

Four more oldies- The Gaspe and Cape Breton

Salmon fishing stream Cape Breton

St. Lawrence river Gaspe

Gaspe

Cape Breton

Maybe Monday, certainly Tuesday back to the grindstone

PAIRS OF OLDIES

Per earlier blogs this is a "gone fishing weekend". Well not for me but for others. Besides the College football season starts. Rather than burn our a few brain cells this is time to revisit some old photos.

Two bagpipers in Scotland,. The second is at Glamis Cstle.



Two islands from the sea; Sardinia many years ago (50), and Mull inthe Inner Hebrides.

SELF PRAISE AND OTHER POTPOURRI

The other day Dan mentioned that you should read the "me" in my blog's side bar. I noted that I had a "bio" published in Who's Who in the East and form the 80's there has been a 'me" bio entry in Who's Who in America as well as in 'The World" and in "Science". Who my admirer was at Marquise I don't know, but unlike many of the self laudatory printed honors** it has not cost me a cent. Nor has anyone thought enough about me to avail themselves of my expertise.

Of course I am hurt that no one has appreciated my eminence so I must blow my own horn by reproducing the yearly entry in these respected source books.:

AS inWho’sWho in America; 58^th Edition 2004 and unchanged in 2009 edition.
"YOOD, HAROLD STANLEY, retired internist; b. Plainfield, N.J., Feb. 23, 1920; s. Raphael and Netta (Newcorn) Y.; m. Helen H. Hull, Nov. 8, 1941; children: Pamela, Patricia Yood Herskovitz, Paula Yood Peterson, Andrew H. BA, U. Va., 1940, MD, 1943. Intern Syracuse (N.Y.) U. Med. Ctr., 1943; pvt. practice Plainfield, N.J., 1946-91; med. dir. Cen. Jersey Individual Physicians Assn., 1987-2000; ret. Staff dept. medicine Muhlenberg Hosp., 1946–, pres. staff, 1980-86, cons., 1991-95, emeritus, 1995–. Contbr. articles to Jour. Med. Soc. N.J., Communication for Ciba, others. Pres. vol. med. staff Raritan Valley Hosp., Greenbrook, N.J., 1969; bd. govs. Muhlenberg Regional Med. Ctr., 1980-86, exec. com.; trustee, v.p. United Way Plainfield/Fanwood,_ 1975-81; bd. dirs. United Way Union County, 1978-81; pres. Jewish Community Ctr., Plainfield, 1970-71; v.p. Jewish Fedn. Cen. N.J., 1971-73, Cen. N.J. Jewish Home for Aged, 1973-80. Capt. M.C. AUS, 1944-45, ETC. Decorated Purple Heart, Combat Med. badge, Combat Glider badge. Fellow Am. Coll. Gastroenterology (sr.), Am. Coll. Angiology (ret.), Internat. Coll. Angiology (ret.); mem. AMA, Med. Soc. N.J. (governing council hosp. med. staff sect. 1983-92, chairm. 1988-90; trustee MSNJ 1989-90), Union County Med. Soc.,Lions (Life).Enjoyment in my profession ,pleasure in relationship with patients, a belief in the necessity for civic and community volunteer involvement, a commitment to support causes that aid the unfortunate an d do no harm to individuals”t "

The italics is a descriptive quote that the publisher requested each "biographee" to write about him/her self. So if any one wants to know everything (almost) about me there it is.

Now, you know all about olddoc. Neither Maria, Bernice or myself feel that we must hide in a cloud of anonymity as if we were ashamed of our postings. Would only others who attack us in columns which are characteristic of some of the rhetoric of the early JG Page feel the same.

** There are many publications that for a price will place your name in their "reference work" and there are others that publish(?) magazines and solicite for a fee to publish your name in a list. There are others like the outfit that about 4 months ago sent me a letter requesting a small fee of $200.00 for a display plaque stating that I had been selected "Best Internist".

I knew that when I was practicing I had enough patients including some deluded fellow phyisicians and nurses (the best judges) that concurred. But I could not imagine what the criteria they needed to justify such a claim since I had not treated a patient in the past 19 years.

There is a magazine I think New Jersey Monthly that does annually publish such a list and provides the recipients with award plaque. On the whole I do not know anyone who displays such an honor that I would consider it unjustified. However, like the US & WORLD REPORT's list of best colleges or best hospitals one has to wonder about the data source used to determine the rankings or the justification.

One more piece of trivia; the Communication to Ciba was about good results in trials on about 8 patients in treatment of hypertension with Reserpine a purified form of an Indian plant which in the early 50s was the first true medication that lowered blood pressure. For a short while I was a phantom pioneer in medical advancement. I didn't realize it until an Upjohn "detail man" showed me a copy of their reference to my * cases in their application for FDA approval to market their product. And I didn't even get a Ball Point Pen.

OF MICE AND MEN AND PMUA

I had intended not to write anything serious or earthshaking this Labor Day weekend. Health Care Myths etc #8 redux could wait as could any political tinged observations. However "the best laid plans of mice and men" per Robert Burns:

But, Mousie, thou art no thy lane,
In proving foresight may be vain;
The best-laid schemes o' mice an 'men
Gang aft agley,
An'lea'e us nought but grief an' pain,
For promis'd joy!

does change best intentions.

Today's (Thursday) Courier third page story about the Connolly Properties' Plainfield Apartments (9 buildings) in bankruptcy owing the PMUA $449,581.00 for sewer and solid wastes services much for "well over a year" raise some questions that the City and the PMUA must answer.

There is no question that PMUA could have discontinued "Solid Waste" collections. However, some one would have to explain how PMUA could stop sewerage from entering the system. Impossible so it falls on the rest of the captive residents to make up the income loss by being charged increased rates.

At least once a year Plainfield publishes a list of properties that are in default for Taxes or PMUA service for lien sale. I do not remember seeing any Connolly property listed. They may have been I can not say if they were not.

However, if they were not, why not? Could it have been a relationship between PMUA Commissioners and executives with the Plainfield Democrat Committee- some are elected board members- that might have influenced the tax collector's office to omit these properties from the list? Is there any relation ship with the reluctance to enforce violations of City Ordinances?

Again. I hope the properties were listed and liens sold to help our cities finances. I am sure that someone will post an answer.

In the meantime, we citizens of Plainfield have again had to support a entrepreneur who has received preferential tax treatment at our own expense.

OZ AND OTHER POTPOURRI

Corzine in Plainfield!!! Surprise!!! Jerry. I look for your post daily and apparently missed any mention that your great friend would be here. Could it be that there was a communication mishap to your office or to Plainfield's Internet Site?

Or has the Governor decided that there has been too much bad publicity involving members of his Trenton Administration as well as local Democrat public officials. Is so I can not blame his handlers for trying to disassociate from local leaders who has had financial dealings with an agency whose head is under investigation.

The new facility is in my stamping grounds as a kid in the 30s. On both eastern corners of Grant and & 7th that were undeveloped empty lots usable for unsupervised "sandlot" pick up games of Baseball and Football. Thank goodness we all survived and no one was seriously hurt. There must be someone who watched over us.

That reminds me that I am 90% through reading "The Evolution of God". When I can sort out my impression which may be never I may make a commentary. I will say that it is a thought provoking read that may give insight into one's religious orientation.


Thank you Dan for this picture to remind us that the past four years in Plainfield's Administration has been an accomplishment DEAD END.


No that has not only been the maintenance of the Infrastructure. As the example what happened to the 6 year plan to repair the roads? How many were fixed or repaved. It seems to me that at this time last year with a great deal of fan fair work was to start on Kensington Ave. and be finished before the weather became bad. Only problem was the year to be finished was never stated.

Information Technology and Communication assets have been addressed in a hodgepodge wasteful manner. I could go on but today this is a non-political blog. I will not try to convince you who to voe for but rather why you should not vote for certain candidates. If we can present the negatives the maybe you will find reasons to vote for a more promising candidate.

I am and have been for four years an anti Corizine person . I never like wealth to buy a political position that paid little. There has to be something wrong. Blumberg is of course the exception, I believe that he is so wealthy that he can be truly interested in improving New York City and its schools But he is the rarity. An overpaid Wall Street Banker smacks of interest in power.

On the other hand, Christe has never impressed me. Perhaps that is because he did not seem interested during his misconduct crusades to locate Union County. Perhaps it was because he leaned too far towards the despicable Republican right. Perhaps it is because he does not present as a Matinee Idol. Or perhaps he like Corzine seems to have little respect for the law when it deals with automobiles. His greatest plus is that he is not Corzine.

Welcome to greater Oz (New Jersey & the USA); Did it pay to save for your old age? Of course but only our government and those non GWB Democrats could have figured this out. Take the Homestead rebate. What was that? I would like to know. You will get it if your income is below a certain level. Of course that level is constantly being lowered, because the State has no money. The level is on gross income not net after taxes and deductions.

In order to have enough money to meet expenses the elderly whose income is fixed and no longer employed have to sell resources and also redeem a prescribe percentage of their their IRA's annually. For tax purposes this becomes income to be taxed as such. Not only is the retirement reserve being depleted but ones income for tax purposes rises meaning greater taxes. Also no longer does the person qualify for Homesteader rebates. I should.have gone on a big fling when I could have enjoyed my earnings rather then on that rainy day have it cost me extra money.

Of course I will have to sell more savings since the government is not giving a COLA raise for 2010, at the same time the premium for Part B and the drug insurance will be going up because of COLA. Perhaps, by denying those over 60 the swine flue virus vaccine,enough will subcumb to that epidemic and reduce Social Security and Medicare costs. That will look good on paper.

Health Care #8 Surprise

I had written a long post about the Hospital ER and also material on the Neighbourhood Health Center but POOF in went into cyberspace and I have not been able to locate it so I will have to reconstruct it. Meanwhile a change of tempo and one that may last until after the Council Agenda Session next Tuesday. I think we have been too intense this August about the forthcoming failure of The Obama administration to deliver a radical new national health care scheme.

I am aware that unlike today's health care, the quality of these pictures is poor, but what can one expect from slides that are about 35 years old.

The place:Kona Village Resort on the "Big Island. When we were there this deluxe "hotel" at only been in operation for a few years and among the "guests" were Military Officers on R&R from Vietnam with their wives.

The theme of this resort was to mimic a Polynesian Village and each of the "Halles" or huts were individual rooms. There was nothing primitive about them. Don't let the thatch roofs fool you. Inside the floors were exotic woods, the large bathrooms had marble counter tops, large tubs and showers etc. Some were around an small inland lagoon, others like the one we had requested were on the Lava field facing the Pacific.

The first photo shows two round Halles on the Lava Field , the second was behind ours at sunset and the third also a peaceful sunset over the Pacific.



The four or five days we spent there were so delightful that several years later we again returned. However, the resort had changed ownership and had become more commercial in that it was holding Luaus for Tourist groups instead of just the guests. By that time we had discovered Hana on Maui on the other side of the island far from the large hotel developments.

I believe I have written about Hana before if not I will do so in the near future. But before that I will post more on Health Care.

MYTHS AND FACTS OF HIGH COSTS IN HEALTH CARE. #4

MEDICARE; This is the program that has been suggested as the model for the Public Insurance Option or even the single payer mandatory insurance. Opposition to his program has come from various sources mainly the Insurance industry. The focus has been the failure to maintain good costs controls.

But first, rather than a detail account of where the program costs have risen. one should have an understanding of the program.

The program is a tribute to President Lyndon Johnson's Great Society reforms. As presently constituted it consists of three separate programs;

• Part A - Hospital Insurance
• Part B - Medial Insurance
• Prescription Drug Coverage

Part A "Hospital Insurance" is available to Age 65 or older, people under age 65 with certain disabilities, and people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

Part A is part of the Social Security benefit, and although most do not pay a premium because they or a spouse have 40 or more quarters of Medicare-covered employment. there are exceptions; In 2009 The Part A premium is $244.00 per month for people having 30-39 quarters of Medicare-covered employment or the Part A premium is $443.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.

Part B Medical Insurance is elective and not mandatory. Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. However the premium is tied to income as follows for 2009:

You Pay	If Your Yearly Income is
	Single	Married Couple
$96.40	$85,000 or less	$170,000 or less
$134.90	$85,001-$107,000	$170,001-$214,000
$192.70	$107,001-$160,000	$214,001-$320,000
$250.50	$160,001-$213,000	$320,001-$426,000
$308.30	Above $213,000	Above $426,000

A benefit of Part B is the capability to rent certain types of Durable Medical Equipment (DME). Under Medicare, rented equipment is classified under one of the following DME payment categories: capped rental; inexpensive or other routinely purchased DME; items requiring frequent and substantial servicing; and oxygen and oxygen equipment.

Capped rental items, except for motorized wheelchairs, are items that, when covered, are rented for a period of continuous use not to exceed 13 months. After 13 months, Medicare requires that ownership of the capped rental item transfer from the supplier to the beneficiary. Items classified under the capped rental payment category include hospital beds, infusion pumps, nebulizers, continuous airway pressure (CPAP) devices and wheelchairs. Please note that if your doctor prescribes a capped rental item (like a nebulizer or a manual wheelchair) and you decide to buy it rather than renting for 13 months, Medicare will not pay for any portion of the item.(boldface mine) The only exception to this capped rental rule is power or motorized wheelchairs, which you can buy as soon as you start using the equipment. Suppliers must give beneficiaries the option of purchasing a power or motorized wheelchair at the time the supplier first furnishes the item. If the beneficiary chooses to purchase, payment will be made on a lump sum purchase basis. If the beneficiary declines the purchase in the first month, payment will be made for the power or motorized wheelchair on a rental basis through the 13th month.

Inexpensive or other routinely purchased DME are items that can be purchased or rented. If rented, the total rental payments for the inexpensive or other routinely purchased item cannot exceed the purchase price for the item. Items that are classified under the inexpensive and other routinely purchased DME payment category include crutches, walkers and accessories for wheelchairs and hospital beds.

Items requiring frequent and substantial servicing, if covered under Medicare, can be rented as long as they are medically necessary. Examples of items that are classified under the frequent and substantial servicing DME payment category are ventilators and IPPB machines. Please note that if your doctor prescribes a frequent and substantial servicing item and you elect to purchase the item rather than rent, Medicare will not pay for any portion of the item.

Medicare also makes payment for oxygen and oxygen equipment on a monthly rental basis. One bundled monthly payment amount is made for all covered stationary oxygen equipment, stationary and portable contents, and all accessories used in conjunction with the oxygen equipment. These monthly rental payments continue for up to 36 continuous months and then the supplier must continue to furnish the equipment, supplies and accessories for the remainder of the reasonable useful lifetime of the equipment (5 years currently for all oxygen equipment and DME). An additional monthly rental payment may be made for those beneficiaries who require portable oxygen. Medicare will not pay for the purchase of oxygen or oxygen equipment.

Prescription Drug Coverage - Most people will pay a monthly premium for this coverage. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.

Why did I include Medicare as a problem in the rising costs of health care? For Parts A & B the country is divided into 15 Medicare Administrative Areas . For profit corporations receive contracts for each area supposedly as a result of bidding. I do not know the duration of the contracts. New Jersey , Pennsylvania, Delaware, and Maryland form district 12. The per capita costs of the contracts vary from one region to the next. If there are no competitive bidders in a district the cost to the government can be high. Thus there can be poor control over the administrative costs in any district since this will be passed on in the bidding This does not include the costs for services which the Feds sets.

A significant leakage of funds occurs with the DME program. There has been little control over the sale or rental of such items as motorized wheel chairs,or lift chairs. The result is fraud by some suppliers with the help of cooperating physicians to get these items into the hands of patients that may not need them. Unfortunately even when these abusers have been reported to Medicare no investigation has resulted.

There is also a number of unscrupulous providers who will upgrade the code for services provided, thus receiving a bigger payment. They can be hard to weed out except by periodic audit.

With the country divided into 15 administrative districts and many different carriers in the fold of administrating the programs it is difficult to place the blame for excessive operating costs on failure of the local carriers to prevent fraud or on the number of government employees needed to operate it. Perhaps it is too big for its own good.