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.

TODAY'S POTPOURRI

I have not ignored today's commentary on Health Care, it is 99% ready for posting but I may reserve it for tomorrow. The ramifications of the subject are expanding rapidly, and I wish to make my remarks useful but open to rebuttals.

Nor am I ignoring John A Clore's libelous letter. Suffice to say the Courier will remedy in a day or two its faux pas. I am sure the letter writer is also aware that he is in a ticklish legal position. I may post my commentary later today'

I do thank "indafield" for his on line defense comments to Mr. Clores letter. See Courier.

HEALTH CARE #2

My first post was a brief explanation of the physician’s portion of the health care cost pie. Today we shall explore albeit perhaps incomplete and too simple some other slices of the pie.

Much has been said about the excessive use of diagnostic studies such as X-rays, Ultrasounds, Cat scans (CT), MRIs, Bio-chemical laboratory studies, pulmonary function test etc: Almost all are relatively late comers to the physician’s armory. As an example; for studies of abdominal organs the best techniques were the use of contrast media, barium for all portions of the intestinal system and iodine based solutions for the Kidneys and Gall Bladder. Those injected intravenously carried a risk of a fatal allergic reaction. The radiologist made his diagnosis by noting defects in outlines.

Without risk and free from invasive procedures, first the CT scanner then the ultrasound and in the 80s the MRI gave a detail picture of these organs and all other portions of the body . All have undergone marked improvement since first appearing on the scene.

New and sometimes exotic biochemical laboratory exams had widened our ability to diagnose body malfunctions and often prevent body damage or make an early diagnosis such as an early stage of a heart attack enabling us to reduce fatalities. There are test to detect early curable stages of cancers.

Not only have we taken all the above for granted, but many a physician has been sued for malpractice for not requesting a test or examination which would have detected a serious condition even if there were no indications. Thus the practice of medicine has become defensive for the doctor. All of the above add up in the cost of medical care.

Hospitals have to be able to do all these examinations and some of the equipment costs up to more than a million dollars. They need skilled highly trained personnel to operate and staff the units. Specialized floors for different disorders make treatments more successful, staffed 24/7 surgical units are essential. Whether in a hospital or free standing facility there are daily thousands of patients who would have been dead if not treated in dialysis units.

These are only a few of the expensive modalities that have caused costs to rise, but have saved useful lives. To cover their debit even the non-profit hospitals must recoup all their expenses plus enough to be able to maintain and upgrade as needed. They are not hotels, and even without any special units or care the daily costs are high.

Unfortunately they are also multitier in their billing. Most have been forced to sign low ball contracts with the HMO and other insurance carriers as well as the Medicare agents. The hospitals have never received even their cost from Medicaid and must treat patients who cannot pay. They try to counter balance these low payments by inflating the stated charges to the uninsured individual.

Finally, the insurance companies and the HMO providers including the Blues are not in business for your benefit, but to make money. They do so by (a) premiums based on risk, (b) restricting use of facilities and modalities. In fact in many cases they are dictating how an individual receives care. Most often it is the least expensive and of poorer quality. This includes payments for medications where a most effective drug is not reimbursed but a cheaper an often not as efficacious medication must be substituted.

Returning to premiums it is obvious that the risk is highest in the very young and in the oldest. Therefore at both ends of the curve the premium reaches its peak especially in the elderly who can least afford the annually increasing costs.

This “Table Setting” just scratches the surface of the costs of medical care. We will next begin to study the pros and sons of the various solutions that have been offered or proposed to date.

HEALTH CARE #1

I promised to post one or more “articles” on health care reform. But, before I can make any sense out of the plans that may be on the table, I am providing some background in order that you can appreciate my comments with a “jaundiced eye”. That is a medical term meaning in the vernacular as skeptic.

Way back in the dark ages (1946) when I returned from service and assumed my father’s practice a physician was a healer not an entrepreneur. Oh yes there were a few who used various tricks to impress the public, like being paged daily during public visiting hours at the hospital or paying non patients to sit in the waiting room to give the appearance of being popular, or excessive use of mechanical devises. Most however genuinely desired to treat the ill with the best methods available.

There was an intimate physician/patient relationship without which care could, no would be ineffective. The doctor or his substitute was available 24/7, and many a home or ER visit was made in the middle of the night. Telephone contact was readily available either directly or through a human operator at “Answerphone”. The office visit was either $3.00 or $4.oo and house calls were commonly $5.00. Very few charged extra for after hour’s calls and most held evening office hours several days a week. This was your “Norm Rockwell” concept of the “family doctor”.

I will not go in to the changes in diagnostic aids and therapeutic modalities at this time since I have already done so in the past. I will discuss the impact in the next section.

When did things undergo a change? It was not the great advances in diagnostic tools or the explosion in curative medication. Instead it began with two Federal sponsored plans, Medicaid and Medicare and exploded with the advent of the HMOs.

Significantly, the physician was no longer referred to as a MD or doctor, but as a PROVIDER. I for one consider a provider as one who supplies a commodity. Health care had become a commodity similar to gasoline for the car.

To further accelerate the change the government programs began cutting reimbursement to hospital and doctor alike and the HMO’s not only reduced reimbursement but restricted the patient’s access to a limited number of “providers” many who were under contract and no longer fee for service but based on the number of individuals in their panel.

The change in medical practice was also influenced on the great number of malpractice suits which increased not only the physician’s overhead with rapidly escalating insurance premiums but also change the focus of care from the patients needs but to avoid any possible misadventure by over using external diagnostic tools. Many of the later like the MRI were unknown even as late as the late 60s, even unto the 80s.

Another problem was the overwhelming amount of paper work that resulted in the need for extra office personnel. All this, briefly, necessitated an increase in the doctor’s office staff, and resulting to a need for rapid turnover of patients in the office accomplished by a very brief Physician/Patient encounter.

All of this encourages a change from healer orientation to “bean counter” to make a living and ultimately to game the system at the patient’s expense.

All this is really perfunctory in addressing the physician component in the cost of medical care. The $4.00 office visit in 1946 or the $40.00 routine visit of 1980 compared to today’s $80.00 visit reflects the declining purchasing value of the dollar, not gouging as some would suggest. A gallon of gasoline cost 17 cents in the postwar 40s, a car less than $1000.00. In the 80s gasoline was far below $2.00/gallon. We have a running inflation.

In the next segment I will continue to address other “table setting factors” in the cost of health c are before we can analyze any of the proposed plans.

TAUGHANNOCK FALLS

How many are aware that between Lakes Cayuga and Seneca there is a state park with a waterfall, one of the highest east of the Rockies and even higher than the American Falls at Niagara. This is the Taughannock Falls 215 feet high. The name is derived from the Indians meaning "great falls in the woods".

If you are ever in the Finger Lakes region this is worth a visit. There are trails down to the cataract and into the glen.

PINGRY ARMS IS PLAINFIELD

Today's Courier's editorial focuses on Plainfield's problems with code enforcement and the Pingry Arms situation.

Monday night during the "Public Comment" session of the Council meeting , I asked whether Plainfield's building codes had teeth enough to force multiple dwelling property owners (specifically 4 units or more per building) to maintain the properties. I added that if there was not the appropriate code ordinances was the city preparing to remedy the codes.I further expressed my concern that with the new multiple apartment redevelopment planned for the center city that there was a danger of Palinfield becoming a haven for "Slum Landlords"

According to Wednesday's Courier, City Administrator Dashield stated that a task force was being organized to study the issue.

I have three basic questions; What are state laws? How do they restrict the city from enacting punitive codes? How quickly can the new appropriate ordinances be enacted.

It would seem to me that we have the administrative and legal mechanism to produce the desired results without the delay to form and then wait for a report from a task force before taking action.

Along similar lines, I believe that it was Councilor Storch who at the June Agenda meeting suggested that ordinances including sufficient financial penalties be enacted to force banks and other holders of foreclosed properties to maintain the buildings and grounds. I would expect that both items will be on the agenda for the July meetings.

The Connolly organization owns about 20 multiple apartment buildings in Plainfield. How many have tax abatements? What are the conditions in these buildings? Are code violations being enforced? Let the public know.

It is about time that Administration and Council take action to turn Plainfield from a slum landlord's haven into a community we can all be proud to live in. Viva "Queen City"

HEALTH CARE

While I am trying to assimilate some information about the proposed Health Care Reforms I am substituting a few pictures of Niagara. There would be more from 1959 but all of a sudden my computer is not reading the disc they are on. Therefor I present: Horseshoe Falls 1959 and four from 2009






I will state that my opinion on "managed care" plans is biased by years of trying to be a healer and patient advocate not a "Bean Counter" so when I start bear that in mind.