PHOTO TRIVIA

Portofino is a beautiful resort town between Genoa and Monaco. Harbor side are many restaurants and little tri-legged tables and stools where one can enjoy a cappuccino while contemplating the world.


As the saying goes "HAVE A GREAT DAY"

LIGHT POTPOURRI

Friday night I had no serious subject to post. The House had passed the compromise "Stimulus bill" on purely party line voteing although a fewe Democrats had voted against it. The Semate had suspended voting for one absent membe rto return and vote "yes" asasuring passage of the controversal bill. My feeble analysis will have to wait for a little more published information.

About 30 years ago I suddenly found out that there was not an avaiable microphone I did not like. Similarly, the availability of the Internet and the "Blog" has created an opportunity to verbalize on anything and everything. The source of the material can come from anywheres, newesmedia, meetings, other blogs,old memories, what have you, as so forth. I do not consider posting old photos as anything more than a desirte to share some of our pleasant life experiences with my "friends".

I seldom forward email jokes, in fact the number people send me annoys me and most I do not open.. However this one cam from a "old patient" an Italian girl married to an Irishman whose first babies I delivered in the late 40s early 50s. She still represents the epitome of the personal relationships that made my 46 years of practice an avocation and not a job. We still keep in contact. I hope you also enjoy it.

I'M SURE THAT GOD ENJOYS A GOOD LAUGH, TOO!

There were 3 good arguments that Jesus was Black:

1. He called everyone brother

2. He liked Gospel

3. He didn't get a fair trial

But then there were 3 equally good arguments that Jesus was Jewish:

1. He went into His Father's business

2. He lived at home until he was 33

3. He was sure his Mother was a virgin and his Mother was sure He was God

But then there were 3 equally good arguments that Jesus was Italian:

1. He talked with His hands

2. He had wine with His meals

3. He used olive oil

But then there were 3 equally good arguments that Jesus was a Californian:

1. He never cut His hair

2. He walked around barefoot all the time

3. He started a new religion

But then there were 3 equally good arguments that Jesus was an American Indian:

1. He was at peace with nature

2. He ate a lot of fish

3. He talked about the Great Spirit

But then there were 3 equally good arguments that Jesus was Irish:

1. He never got married.

2. He was always telling stories.

3. He loved green pastures.

But the most compelling evidence of all - 3 proofs that Jesus was a woman:

1. He fed a crowd at a moment's notice when there was virtually no food

2. He kept trying to get a message across to a bunch of men who just didn't get it

3. And even when He was dead, He had to get up because there was still work to do

Can I get an

AMEN!!

Potpourri Ramblings

Responsibility, Accountability , Transparency not Translucency, and CAR (Citizen's Assistance Request, courtesy of Councilman Mapp) are catch phrases that for the past week or so are are appearing on the postings of Plaainfield's blogers and the responding commentaries of readers.

Obviously there is a core of individuals, both elected officials and citizens, who if given the opportunity and framework to act collectively would , no could, try to restore Plainfield once again as the Queen City.

There is a large core of talent and specific expertise living here that has remained hidden and uninvolved because of the psychological slum which Plainfield has become. The once magnet shopping center of Central New Jersey is now a mecca of 99 Cents stores and grocery. Boarded homes are in every ward as are the numerous for sale signs. I need not remark again about our vehicle destroying streets. Access to quality institutional health care is difficult. Confidence in the local government is low, to wit;

Administration has shunned accountability. The lack of a budget after 8 months into the fiscal year is unconscionable. How the state can permit a municipality to function under emergency appropriation resolutions is beyond understanding. "Hand to mouth" operations does not equate with good government.

This years Council professing a dedication to Transparency must also exercise Responsibility. The question remains, will the use of small committees at the expense of customary frequent Council meetings result instead in translucency? Meetings, especially if held electronically, do not generate minutes for public review.

The County union's reaction to planned job loss is understandable. However were there ever any discussions between Freeholders and workers about possible accommodations to arrive at large enough savings so that those jobs if necessary could be saved.

We should have time over this President's Day weekend to belatedly formalize our reachable community goals for the present year. Some financial proposals will be on the upcoming Council meeting's agenda. They will need careful not emotional consideration. It is not too early within the next two weeks to try to start the budget process for FY 2010. July 1 is only a little over four months away.
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FEB 12,2009

Five views of Dubrovnik 30 years ago . Three are from the city wall.
Five

THE INSURERS AND HEALTH CARE

FYI: I have reprinted this press release.

Although this is directed at the Insurers practices against the physicians, they have used similar tactics against the hospitals while trying to have the institutions accept money losing contracts. In the late 80s & 90s the Blues would not sign a contract with Muhlenberg because the hospital refused their onerous terms. At the same time JFK accepted that contract. Even after the merger Blues' patients could not go to MRMC only to JFK in the area. They treated each hospital although both were part of Solaris as separate individual institutions.

During the ten years plus that I served as medical director for the Central Jersey Individual Practitioners' Association, a group of several hundred physicians practicing in western Union County and eastern Middlesex County, I had dealings with CoMed, Cigna, Aetna,NewYork Life and a few smaller vendors in constructing a contract that reimbursed the physician equitably. Even when a contract was in effect those companies would attempt to deny payment or unilaterally reduce the service value. At the same time they would attempt to break the IPA by enlisting physicians under capitation. If they felt strong enough they would suddenly terminate the contract or negotiations which the IPA was conducting without any hidden agenda.

The bottom line has always dominated these carriers actions at the expense of patient care. This also applied to hospitals and free standing surgical facilities. Often they would no permit (pay for) care at the best facility or by the best specialist.

Since I have retired there have been several judgements and fines against the Insurance companies for violating agreed procedures. They have risked them and payed them because they have gained dollars in the meantime. They continue to use financial blackmail against those who provide care. At the same time they will make rulings on treatments which are against the patients best interests.

Could these companies be violating anti-trust laws since they may be acting in collusion using an in house procedure developed by a third large commercial insurer.

MSNJ and the AMA File Complaints Against Aetna and Cigna Over Fees Based on the Ingenix Database

Yesterday, the Medical Society of New Jersey (MSNJ) and the American Medical Association (AMA) filed complaints in the US District Court District of New Jersey against Aetna Health, Inc. and the Cigna Corporation for systematically underpaying physicians who do not participate in their networks. The complaints are based on each company using unreliable data to determine payments of usual and customary fees for physician services. The physicians are seeking to prevent Aetna and Cigna from using their unreliable payment processes going forward and to recover reimbursements for physicians who have been underpaid.

In addition to MSNJ and the AMA, the legal action was joined by the Connecticut State Medical Society, the Medical Society of the State of New York, the North Carolina Medical Society, and the Texas Medical Association.

At the center of these complaints is the widespread use of the Ingenix database, owned by United Health Group (United), a large national health insurance company. The Ingenix databases and United were recently investigated by New York Attorney General Andrew Cuomo, resulting in a $50 million settlement. A separate class-action lawsuit subsequently settled for $350 million. United sold access to the Ingenix data to both Cigna and Aetna who in turn used the data to set fees for out-of network physician services. Aetna and Cigna process millions of transactions each year in New Jersey.

“These billing practices have proven unacceptable in the state of New York and they are unacceptable in the state of New Jersey, said Michael T. Kornett, chief executive officer of the Medical Society of New Jersey. This legal action seeks to prevent insurance companies from shifting the cost of out-of-network care to physicians and their patients,” Kornett added.

“We can no longer ignore the improper business practices of health insurers who decide to play by their own rules without regard to patients, or the legitimate costs required to care for them,” said AMA President Nancy H. Nielsen, M.D. “Through our lawsuits, the AMA and our partner medical societies seek to reform the payment systems used by Aetna and CIGNA by ending their dependence on the Ingenix database,” said Dr. Nielsen. “The lawsuits also seek relief for physicians who were seriously harmed by Aetna and CIGNA through the insurers’ long-term use of the flawed Ingenix database.”

Comment on Roads

This comment from Michael T was received today in response to my post of Jan.29 see .( http://dpotpourri.blogspot.com/2009/01/state-of-city.html). I am re-posting it today since it explains why preventive taring cracks is a must.

Wayne raises a good point. Seam failures are prevalent throughout this area. Asphalt machines cannot lay asphalt in one pass from curb to curb. Roadways are simply too wide. As a result, the material is laid in passes.

One cause of seam failure is laying asphalt in one long pass, and then returning to make the second pass after the first has cooled. This method saves time (money) for the contractor because the setup and staging is easier.

The result, however, is often a poor joint at the seam between the passes. The cooler asphalt doesn't properly knit together with the hotter material from the new pass.

Proper engineering oversight would assure that the length of each pass is limited, strengthening the bond between the passes.

Seam failure occurs on many of the Union County roads. The County bids their paving projects and usually pushes them through to completion in a short time period. The County wants the road to re-open as quickly as possible, so the contractor paves in extremely long passes, with seam failure occurring within a few years

WHOA

Square wheels give a rough ride. That seems to be Plainfield's fiscal policy, bump bump..

Today's Courier's article claims that the city is planning to defer pension plan deposits in order to decrease the citizen's tax burden. Any plan that will limit taxes is fine but not one which according to a quote attributed to City Administrater Deshields will add a minimum of $600,000.00 for the next 30 years or 18 million dollars weighing down future tax payers.

My math is probably wrong, but if the city liability for pension deposits every year is 5.5 million dollars and to get under the mandatory cap raise limit we need to cut $3.2 to avoid "major layoffs" the proposed plan would only save 2.75 million this year. This would still leave almost a half million shortfall this year alone at the expense of the future. This would mean that salary economies are still required.

The statutory limited 4+% tax raise-city portion of the tax bill only-would still take place. No one is accounting for or taking responsibility for the boo-boo in the proposed tax that is costing the tax payers $1.6 million this year. The finance director became the whipping boy, and probably rightly so. However there are two administrative levels above his position that must share responsibility.

It would seem to me that even though this is a mayor and assembly election year a concentrated drive must be made to restructure wages/salaries and work loads in order to prevent "major layoffs" by bringing the budget into a workable level.

I am also so naive that I can't believe that the reason we do not have a budget after 8 months into this fiscal year is that we must wait for the State to announce how much "extraordinary aid" we will receive. That is like counting on winning the lottery for living expenses.

The 2009 FY budget should have been adopted, perhaps including a provisional item although that is bad practice. When exact numbers become available the actuality is accomplished by amending the working budget.

No innovative number crunching or depleting mandatory paper surplus can substitute for sound fiscal management. Unrealistic staffing, employee contracts, hiring of Consultants, with or without Council approval, who fail to deliver and a rubber stamp Council are not signs of a quality administration.

There are signs that this Council will seek fiscal responsibility. Let us hope so.