I had planned only to post the following(in Black), However when I opened my Courier this morning the Front Page shouted that Mapp was being investigated. More later today. Only in OZ are the competent punished and the unqualified rewarded.
I hope everyone had a pleasant and uneventful 4th.
The heat wave continues and southern Jersey still has many areas without electricity. My nephew in Mays Landing as of late Wednesday still had no current. His two daughters that live nearby only received theirs within the previous 12 hours. We can count our blessings that the storm did not hit us.
For the summer months I plan to post on Mondays, Wednesday, and Friday. The other two week days only if something worthwhile takes place. The Tuesdays after Council meetings will be an exception. No matter what; I will post something. I will also post the Sunday before the Council meetings.
Thursday, July 5, 2012
Wednesday, July 4, 2012
Tuesday, July 3, 2012
COURT COMMENTS
I am using this posting as a "living document" by copying and adding any and all comments about the Court's action below so no one will miss any by not reopening the "comments" attached to each blog. I have selected some from the column on the legal aspects
- Anonymous said...Someone needs to explain to me how anyone can say affordable health insurance. Individuals get the highest rates. Why can they not get group rates. They are in a group with all the other individuals.
- Dottie Gutenkauf said..
- Another and perhaps better example of the Supreme Court usurping legislative powers was the Citizens United decision. That Court also invalidated a Montana statute (I believe it was a provision in the state's constitution) barring the kind of SuperPacs now emerging as the result of the Citizens United decision. We are already seeing the power of unlimited anonymous funds in swinging elections--think of Wisconsin, for example. June 30, 2012 11:55 AM
- like the democrats don't do this as well. please.
- Anonymous said...
- The idea that the government will tax someone because they don't have insurance just doesn't make sense to me.
- My insurance (I'm self-employed) is very expensive. I am considered "high-risk" from a medical perspective.
- What happens if the insurance jacks up the cost to say, $1500/month or something unaffordable for an individual?
- Then the government is going to TAX me because I can't afford health care coverage?
- What's next? Mandatory disclosure of your health issues to employers, so they can decide whether to hire you, because if you're a 'bad risk', you'll jack up their health insurance rates? Olive June 30, 2012 10:58 PM
Anonymous has left a new comment on your post "COURT COMMENTS":
Yeah, that's right, let someone else pay for your healthcare. I know you, I've seen you hundreds of times. You say I'm healthy, why should I pay for something I don't need. then something bad happens-you fall and get a head injury,you crash your car (and if you think you car insurance will cover all your healthcare costs you are sadly mistaken unless you get a million dollar policy)and have 3 broken extremities. you get taken care of in the hospital and want to go to rehab-but you have no resources to go, then you blame everyone else and expect to be taken care of.
Rob has left a new comment on your post "MORE ABOUT ROBERTS RULING":
No Anonymous... I most definitely would keep my health insurance. I am not stupid. But there are plenty of people who are stupid and will use this as a reason to not carry it.
I don't believe in using Emergency Rooms for my healthcare nor do I believe in living off the government or expecting the government to make my life better.
MORE ABOUT ROBERTS RULING
I have written enough in the last few days. Thus I was not intending to post today or on the 4th.
However in my insomnia I began to realize that while we are are focusing on the Health Care implications of the Court's decision; we have been blind to the most important and far reaching impact of Robert's ruling.
He has opened a new can of worms by giving the government a new line of taxation not provided in the Constitution: Employing "penalties" for non compliance to Congressional action. That is the ruling which justified the mandated insurance provision although Roberts wrote that it was by itself illegal.
This is a potential weapon that can destroy our personal liberties. Think about it.
The comments that I had posted are now a separate post.
However in my insomnia I began to realize that while we are are focusing on the Health Care implications of the Court's decision; we have been blind to the most important and far reaching impact of Robert's ruling.
He has opened a new can of worms by giving the government a new line of taxation not provided in the Constitution: Employing "penalties" for non compliance to Congressional action. That is the ruling which justified the mandated insurance provision although Roberts wrote that it was by itself illegal.
This is a potential weapon that can destroy our personal liberties. Think about it.
The comments that I had posted are now a separate post.
Monday, July 2, 2012
RELATED-HEALTH CARE
This survey by "Medscape" supp0rts my conclusion about the future of health care. Irt will be impersonal and assembly line.
July 2, 2012 (Washington, DC) — One third of physicians in small group practices who responded to a recent survey expect their 2012 income to fall below what they earned last year.
Financial pressures could have a devastating effect on physicians in practices of 10 or fewer participants: 26% surveyed said they might have to close their practice within the next 12 months.
"The survey was emailed in April to a random selection of 15,000 of the 200,000 physicians who are registered members of MDLinx, a medical news website, and 673 responded," a spokesman told Medscape Medical News.
A total of 49% of small practice physicians reported cutting staff and services to reduce operating expenses. Despite such measures, 23% said they have used personal savings, and 20% have had to borrow money to cover expenses.
By comparison, only 13% of physicians at larger practices or hospitals expected their income to drop this year.
"This poll is quite startling in the revelations about small practices, the healthcare lifelines to many communities," said Stephen Smith, chief marketing officer for MDLinx. "Physicians have had missiles raining in on their practices at an increasing pace—the economy, regulations, paperwork, insurance, lawsuits, etc."
Although the survey did not ask physicians to name reasons for the financial squeeze, 56% reported that Medicare and Medicare payments provided 75% of their income, according to a review of survey responses conducted by Medscape Medical News.
If the scheduled 27% reduction in Medicare payments takes effect next year, 61% of respondents said they would be forced to make additional cuts in services, and nearly 7% said they would have to close their practices.
"The coming retraction this survey hints at," said Smith, "would mean longer drives to less-personal, higher-cost medical care for millions of Americans."
FOR THE RECORD
So wrote the "Auditor" in his Star Ledger column. It is noteworthy that the press release on the Plainfield site was gone the next day!!
"Reading the fine print
The embattled mayor of Plainfield, Sharon Robinson-Briggs, claimed a legal victory of sorts last week, though not everyone agrees.
Robinson-Briggs said a state Superior Court judge in Elizabeth ruled that the city council violated her rights to due process when it fined her $200 for staging an anti-violence rally that cost the town $20,000.
“I am pleased that the Hon. Judge (Karen) Cassidy recognized the fact that the city council violated my rights,” she said.
The Auditor was worried that it had missed the trial. But as it turns out, the answer is no. A lawyer for the city council, which the mayor is suing over the fine, had made a routine motion to dismiss, but Cassidy denied it.
“It says it was ‘up for question,’ ” Sandra Thaler-Gerber, a spokeswoman for Superior Court in Union County, said of the judge’s denial.
But city spokesman Terry West sent an e-mail noting the council rescinded the fine based on Cassidy’s comments. West wrote: “It is clear that the city council had no legal basis to impose the fine based on Judge Cassidy’s ruling. In coming to her decision, Judge Cassidy made rulings of law.”
Council members say Robinson-Briggs simply drew the wrong conclusion. Rebecca Williams said: “The mayor has consistently referred to the lawsuit she instituted against the city council as an ‘appeal,’ which demonstrates a basic lack of legal understanding — especially since she states that she has been previously employed as a paralegal.”
THE COURT'S IMPACT
I have always like many of my peers believed that it was Society’s obligation and responsibility to see that no one for any reason should be denied access to treatment. The question being how that should best be accomplished.
The eliminating the broader Medicaid eligibility will of course defeat one of the goals of increasing the overall population coverage. Moreover none of the law deals with the “illegals” who are morally entitled to the same care afforded others.
One of the most difficult problems I have today is to analyze the American 21st Century version of health care as it is related to a combination of availability, quality, and effectiveness.
My perceptions are clouded by my own experiences in what I considered the golden era of American Medicine. This was a time when it was far superior to that of any other country. The only negative was availability to all living within the county’s borders.
Throughout the years up to the 60s charitable donations helped maintain free hospital clinics which were staffed by attending physicians as part of their hospital responsibility along with “ward” services in exchange for their right of privileges to treat their private patient. At least in the North East where the tradition started it worked well.
The breakdown of this system began with the advent of Medicaid. Once again a well intentioned concept initiated a reaction that led to unforeseen results.
Money is the root of all evil. The hospitals found out that they could be reimbursed for treating the economic poor who were Medicaid legible. Not only the facility use but the professional services were also compensated. Someone would get the money.
With the advent of the HMOs; compensation was extended to the insured. However, the HMOs negotiated contracts directly with the hospitals often with payments below the going rate. Here too often included in the hospital contracts were fees for physician’s care.
However instead of compensating the physicians that were providing the services, hospitals pocketed that portion of the bundled reimbursement sums received. This led to doctors refusing to staff the so called charitable services. Hospitals began employing physicians to provide care in the clinics and in house. They were now providing professional services and making a profit.
Medicare created another level of Government input into the delivery of health care. One no longer dealt with doctors, nurses and therapists; instead they had become “Providers” who were paid for their services on a scale determined by the government or insurance company?
The delivery of care had become a business attracting entrepreneurs. Protocols were being developed by financial wizards to determine payment scales for various services and "appropriate" hospital stays. The bottom line not the patient’s welfare or the value of the“provider’s” care was the driving factor.
Increased regulations and/or insurance carriers’ requirements to be met for reimbursement plus the pressures of our litigious society has drastically increased the costs of operating a practice; forcing doctors to combine in groups and delegating much of the patient care to PAs and Nurse Practitioners.
We now have a population who has accepted the concept of a structured medical office in lieu of a personal physician’s practice. Their contact with the doctor is probably the least time consuming in the visit.
What changes will the mandated insurance laws bring? That all depends on the dollars that are available. If funds are insufficient for the increased numbers absorbed into the system there will have to be reductions in either or both professional reimbursement and allocation of services; diagnostic and therapeutic.
With decreased professional reimbursement there will be an exodus of highly trained individuals from the field. This is a trend that is already in progress and may be exacerbated.
At the same time health care will not be attractive to the highest level college graduates. This will result in an increase reliance on lesser trained individuals who may be adequate in the routine aspects but will also be more dependent perhaps by regulations of cookbook medicine.
There are two old adages “You get what you pay for” and “You get nothing for nothing” which will be applicable to the quantity and quality of health care the individual will receive.
Under any circumstances there will be only a finite amount of dollars available. The net results will include an allocation of tests and procedure. The latter may result in either delays or denials.
There may also be limitations in choice of physicians to either a panel member or one willing to accept a low fee. The expertise of the doctor will not be a consideration.
At the same time the provider be it a physician, chiropractor, or therapist will be impacted by the limited funds by having the reimbursement for services lowered from present levels.
Over the past few years Medicare and Medicaid payments which are lower than usual and customary fees did `not increased in line with the “Cost of Living” ratio. This of course means that in buying dollars these individuals are receiving less each year for their work. `Of course the third party payers have taken advantage of government fixed rates.
This trend will continue if money is tight. It will impact on patient care with further modification of the production line less on hands business practices to a point that as a result of increased volume many will not see a doctor at any point in the office visit.
There is another aspect that is being ignored but may result in a complete change in our way of life and personal liberty.
There is an ongoing tendency by legislatures to mandate that doctors either accept or treat all patients under the government pay scales which can be cut at any time or be fined. If that becomes a law they may even be prosecuted as criminals if they fail to do so.
Physicians do not have the right of unionization except where they are employees. The AMA is not a union and when any cohesive action has been attempted in the past the Society and its individuals have been threatened with restriction of trade suites by the government.
One professional segment of society is being threatened to be treated as if we lived in a totalitarian state. Once the principle of restricting civil liberty rights is applied to one group the logical step will be to gradually extend it to all society. The distinction between Socialism and Fascism is nebulous.
I know that I am presenting a disturbing dark picture but I believe that it is within the realm of probability.
I started out by saying that “it was Society’s obligation and responsibility to see that no one for any reason should be denied access to treatment”. I will modify it by adding that it is not society’s obligation to make everyone accept that access.
Let us hope that our continued venture into socialism does not end in disaster. ``
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