10 September 2014
Oh, Suleiman, You Were So Right
18 August 2014
- First, using military garb and weaponry when confronting a demonstration by the citizens of Ferguson, the police created an “us vs. them” dynamic that inhibited any peaceful outcomes those first few nights. Even though 70+ percent of Ferguson residents are African-American, the police assumed they were wrong on site; because they were black. Some police referred to the crowd as “animals”.
- The appearance in the minds of the neighborhoods was that Mike Brown was murdered, yet as of eight days after his killing, local officials have yet to release the police report on the shooting nor the initial autopsy. Would the same process have been followed if Mike Brown were white? Perhaps the community’s reaction to the shooting would not have been a volatile and large, nevertheless would the police have been as aggressive against a gathering of white people asking for information about the circumstances of the killing of an unarmed man by a policeman? I doubt it, even if the victim had tried to assault the officer before being shot.
- This afternoon and tonight there will be another demonstration by Ferguson citizens demanding more information about the killing of Mike Brown. Last night there was some looting and the police responded with smoke and tear gas grenades. The police were outfitted like a military platoon. The police leaders chose to escalate the level of violence. One has to ask why the police do not approach demonstrators who are violating the curfew with demands to disburse or to receive citations on the spot—not arrest—for curfew violations. Given the overwhelming armaments and physical outfitting of the police, they could engage individuals calmly without threatening arrest or injury. If there is looting, then a squadron could be dispatched to prevent further property damage without trying to arrest everyone in sight first. Let the community punish the looters; let the community disenfranchise the outsiders who are trying to roil the situation into a race war. If the Missouri Highway Patrol cannot contain the actions of the local police, then I think President Obama should activate the National Guard to restore peace and to separate the community from an out-of-control police department at city and county levels. Local police units should be shut down until new leadership can retrain and redeploy police officers with the mission of “to protect and to serve, not corral and intimidate.” If not already in place, the City Council should require all city employees, including police, to live within the boundaries of Ferguson. Military gear, weaponry and vehicles should be decommissioned within the police department and given to the Missouri National Guard. Neighborhood policing on foot should become the norm within Ferguson so that residents can learn who their police protectors are and vice versa.
- If these reforms cannot occur, then the residents should demand the Council create a Citizens Review Board to oversee police department activities.
12 July 2014
Domestic or International Migrant Crisis?
02 July 2014
Capitalism 2014: Profit Versus Women's Health Policy Parity
The dissenting justices offered what should have been overwhelming evidence of the error being made by the majority. Precendent, legislation and plain reasoning could not budge the five men who ruled that if a for-profit corporation was closely held its owners could refuse to offer contraceptive medicine insurance coverage as mandated by the ACA. The majority opinion will make many graduate students delighted because they will be able to reveal the heuristic bias of the majority justices: teachings and socialization of the Roman Catholic Church. Every justice ruling in favor of the plaintiffs is Catholic and male. It would appear that capitalism's basic tenent of commerce, the purpose of business is to acquire capital or wealth for the owners, now has a caveat. Three of the four justices dissenting are women.
Even Adam Smith distinguished between an owner's profit purpose and that owner's public responsibility in using capital. The local religious bookstore seems covered by this exception to the purpose for which the owners' incorporated their assets.
One has to wonder whether another religious belief would rate equal worth in determining the health care insurance coverage for a corporation's women employees. What criteria beyond the number of shareholders will qualify an employer for a coverage-exemption to ACA? This ruling is a can of worms just waiting to complicate federal regulations. Look forward to another 600+ page set of regulations arriving from HHS.
04 April 2014
Corruption In the United States of America
11 February 2014
Insurers Get A Free Ride
Some Questions, Thoughts and Observations for Today
What a charge to watch the women's ice hockey games! No body checking allowed! The game emphasizes skill rather than brute strength, although I would not like to cross any of the players. Another rules difference from professional hockey is that a goal during a power play does not erase the remaining time on a penalty. Today, the Japanese team was robbed of a goal and yet came on so strong in the first of the third period with a brilliant goal.
US versus Canada tomorrow. Must watch game!
Yesterday the House voted to prevent the EPA from enforcing its rules and regulations on federal lands. What arrogance! If the EPA cannot keep federal lands (meaning those that belong to all the people) then what agency will? The history of the Bureau of Land Management (BLM) is not exactly pristine in the trade offs between commercial interests and the people's interests. This is just another Republican attempt to emasculate the EPA, one of Nixon's primary achievements. It is also a Christian premise to be the stewards of God's Creation and I cannot see how this legislation furthers that objective. Talk about your cafeteria Christianity.
This weekend's tributes to the Beatles brought back so many good memories of the 1960s. Good memories are not numerous on my memory list for those years, and much of my discontent was fostered by the disconnect between what the "greatest generation" was doing to the country politically and in Indo-China. I wish the musical tribute had included "Imagine," a humanist charter of peace and community for the world. It seems we cannot achieve the ideals of this song, so I hope God will listen to our intentions to achieve John Lennon's words.
Are there still wars in Afghanistan? Syria? Egypt? Ukraine? South Sudan? Ethiopia and Somalia? One has to chance upon any television news concerning any conflict in the world as long as the Olympics are going on.
Of course, MSNBC continues to keep the world informed about Christie's bully politics in New Jersey. Seems ordinary to me. Remember Teddy Roosevelt? If you do, you're very old. The historians and biographers have shown us how this Bull Moose was admired for his aggressive personal style in politics and war.
Has no one realized a valid reason for listening to Chancellor Merkel's phone calls? We want to know what trade negotiation tactics and strategies the Germans are going to use when they negotiate trade agreements with the US and with other countries. Trade! The two significant, opaque trade agreements being negotiated today are the TPP in the Pacific Rim and an unnamed one with Europe both along the lines of NAFTA. Remember the promises of NAFTA for US commerce? See how NAFTA has ruined self-sufficient agriculture in the Americas. How many US jobs went south--because they went South. Now the US Trade Representative wants to fast-track these two new trade agreements through the Congress. There is more transparency in our Afghanistan plans. Watch the NSA continue to monitor trade issues through its new, mega-databases. The original intent for NSA was valid during the Cold War, but is industrial espionage worth the money spent in secret and the amount of un-monitored activity?
It appears another American citizen was killed by a drone (not sure if it was a CIA or DOD weapon) this week. When asked about the process for permitting this kind of murder, the official responded with an equally alarming statement.
First, there are several sources of information brought forward to identify an enemy combatant who is an American citizen. CIA, other informers, self-identification, and NSA-obtained phone data are analysed within the National Security Administration with conclusions forwarded with recommendation as to the accuracy of identity to the National Security Council members. The NSC, which included the Defense Department and CIA input, makes a recommendation "up the line" ultimately to the President for a decision.There is for me a serious omission in this vetting process: the NSA's stated database content. To allay privacy opponents within the US, the NSA has repeatedly said that it only records the telephone numbers of all conversations and never the content. How can a life-and-execution decision use such data without knowing the content of the phone call(s)? Suppose suspect X phones Pasha Pizza in downtown Tripoli. NSA considers Pasha Pizza to be an Al Qaeda front. The NSA, according to its stated protocol, identifies suspect X as contacting Al Qaeda and sets up suspect X's call as a probably enemy combatant communication. All they need is a pattern for pizza-loving X's calls to Pasha Pizza for X to be labeled an enemy, who happens to be a Brooklyn-born freelance reporter living in Libya.
Ignorant of the phone call content, NSA can be a party to this reporter's execution by drone, justified as his being an enemy combatant in contact with Al Qaeda.
Think this could never happen? How reliable a system do we have? Is the President forever immune from sanction or prosecution for ordering the assassination of an American citizen through this type of "due process?" Before answering "yes?" remember the Lettres de Cachet under the French kings that put people in the Bastille for indefinite periods of time without trial or recourse to appeals. Also, recall that the idea of appeals following an execution is rather moot.
This project is bad for the country. First, why do we need to risk our central plains watershed and aquifer so that Canadian oil companies can send their dirty, shale oil to Texan refineries? How many permanent jobs will remain after the pipeline is built? 50? No one states or estimates an exact answer. With the Texan refineries already operating at full capacity processing American Sweet Crude, where will this Keystone petroleum go? Onto the world market, that's where. Since this is Canadian product, the only income the US will gain are transport fees, distributor commissions, and shipping fees for the international trade. I wonder if the State Department asked if there would be a net increase in the risk of environmental damage due to the increased ship traffic for this exported Canadian oil. "No problem, we've all the protections in place," or words to that effect.
Why do we need this project? We have our own supply and let Canada pollute the rest of the world with its dirty crude. Why should we be complicit when the western Canadian provinces refuse to allow a pipeline across to the Pacific?
That's enough for today. Be sure to send your comments and to forward these snippets to your friends. Comments should be addressed to <firstname.lastname@example.org> or as listed below.
22 October 2013
The House of Tea Still Promulgates Hate
You had better be poor if you purchase subsidized health care insurance, or, or...well, you'd just better be poor. Like any of the public assistance programs intended to help more Americans be able to participate in our consumerist society's basic enjoyments such as eating well, staying healthy and remaining in housing during hard financial times, there is a means test for Obamacare.Republicans gained one small concession in the final package, as the bill also requires the Department of Health and Human Services to ensure it is verifying the income of individuals purchasing subsidized health insurance on its marketplace exchanges established by the Affordable Care Act. Under the 2010 law, exchanges opened for business on Oct. 1. Eighteen of the Senate’s most conservative Republican members voted against the measure.
How dare anyone think that as an American, I might feel entitled to have the best health care resources in my community and to have access to timely, appropriate care. Those dummies in the House, those 144 Republicans who voted against the compromise would let 40 million of their fellow citizens forgo access to a doctor when ill, to vaccines to prevent epidemics of diseases that can wipe out a race and to the medicines their taxes enabled.
If a woman who has raised a family, working hard managing the home and hearth reaches 66 years old and is living on the surviving spouse Social Security, her fixed monthly income might be $950. Out of that income she pays for her food, her rent and not much else. She and her kids had to sell their family home to pay off their father's debts, the outstanding mortgage and all that was left was the car her husband had paid cash for a couple of years back. Now, because of her financial squeeze, the woman applies for Medicaid so she can receive health care. She cannot afford a Medicare Advantage Plan due to the co-payments required for doctor's office visits and prescription medicines. Medicaid is her only hope for health insurance. Her application is denied. Shock! The reason given is that her automobile, her only personal property considered in applying, is worth more than $2,000 which is the upper limit of personal property value allowed. This is the evil of means testing by federal agencies. The VA does the same for veterans to access its health care system and that to me is equally galling.
Without the Affordable Care Act of 2010, this widow's plight is what the 144 Republicans in the House and 18 senators think is okay. That is un-American; it violates our national standards of caring for those in need. We did not ask Haitians if they had insurance or their own money when we sent medical supplies, physicians and nurses there to combat disease and to treat those who were injured in the earthquake. But 162 Congressional delegates decided that it was bad for the country to provide health care for citizens like this imaginary widow.
Restoring our sense of America is no longer a partisan issue. Shaming these politicians is the duty of every voter, of all leaders in the community and nation. They must not go unchallenged for the damage to our economy and to our sense of altruism toward each other.
And I still do not understand why they hate so much.
13 October 2013
Drips and Dribbles: How Congress Spends Money
13 August 2013
- Require OMB approval of any contract exceeding $50 million that is being sole-sourced or otherwise not subject to a competitive RFP process including a minimum of three proposals; This requirement must include the DOD, DOS, DOI, DHS, DHHS, DOE and most federal agencies such as the FAA, NOAA, NSA, CIA and NASA (with exceptions that Congress oversees with security requirements). OMB should report to Congress at least sem-annually on contracts reviewed and actions taken.
- Require full budget funding allocations for federal inspectors, auditors and other regulatory compliance functions; Enforcement of laws and regulations is pathetic. Congress passes a law to address a public need, yet the first victims of tight budget allocations usually eliminate the function whose job is to see whether the law is being followed.
- Require full funding of our Judicial System and the DOJ; For our system of justice to function as designed, to minimize lengthy trials, arbitrations or torts, we need more judges, more public defenders, more local prosecutors and better information systems to support them.
- Require public member appointments be filled for all Executive and Congressional Commissions before they are chartered. The absence of a public member enables the lobbyist-indebted Congressional or Executive department members to function irrespective of the opinions that a non-political appointee might offer.
Undermining a President-The Republican Party Agenda #1
See what the House is dealing with while the Senate is struggling with 554 amendments to to the Senate Bill on health care reform. According to Republicans and news media stars (who talk without breathing) President Obama should be held accountable for the following:
- ACORN irregularities that are alleged to involve importing young girls to be prostitutes, abusing its 501(c) 3 tax status to commit gross election violations such as same-day registrations;
- Irresponsibility with spending that have us with such a huge deficit, with such wasteful spending to bail out the economy that the dollar is in danger of losing its status as the world currency.
- Creating a health care system that will create generate such tax burdens that we will bankrupt the country.
- Anything else that people feel that is bad about our country since January 21, 2009.
Suddenly, the past eight years of the Bush/Cheney administration never existed. George Bush paid for the Iraq and Afghanistan wars with money the Congress approved as supplemental funds outside of the official government budgets. Who gave Wall Street a trillion dollars to prevent a world-wide economic collapse, but did not have any accountability for how those federal funds should be used?President Obama brought those extra-budgetal items into the formal budget process. There is no mention of the huge budget surplus left to President Bush by President Clinton, especially with the Republicans having controlled Congress throughout the Clinton years and the White House for 12 of the prior two decades.
John Boehner in a CNN interview referred all questions about a Republican health care plan to the party's web site: gop.org. I looked at it and I am embarrassed for Republicans seeking a cogent, coherent health care plan alternative to the Democratic Party's plan moving through Congress. The web site makes me sad while reading comments in their Forums. Comments therein are dominated by some people who believe in a literal Constitution as the only legitimate way to evaluate the federal government's actions since 1787. Most predominant in the health care forum is the argument that the 10th amendment prohibits the federal government from regulating insurance providers. The prohibition derives from their view that the insurance industry is by governed and controlled by State law so therefore the insurance industry is by definition not interstate commerce. The majority of comments refer to most federal government programs as unconstitutional.
In response to one post asking whether we should leave people to die in the streets, another post said that "if you don't have health insurance- get a job." Nothing of substance was evident in any of the Forums I read, except for one written by a marine in Afghanistan. Most of his comments were ignored or dismissed as unrealistic, too much government and not worth doing. George W. Bush did not get much mention except that he was a liberal and undisciplined in his spending.
I could not find anything like the information Republican House leader Boehner asserted was there to read nor was there anything else worth reading. I did find remarkable that they had a list of Republican Accomplishments and a list of Republican Heros. Most of the accomplishments occurred during Reconstruction after the Civil War or prior to World War I. Most predominant were those Republicans who were African-Americans, mostly during Reconstruction in the South, sponsors of anti-KKK legislation, Voting Rights Act and Civil Rights legislation. Weirdly slanted commentaries of these hallmark achievements as due to Republicans and were accompanied by biographical material about an African-American legislator elected during Reconstruction while Grant was President. One would conclude, according to this line of thinking, that the entire Civil Rights Movement following World War II was unnecessary. Who can swallow that?
Their propaganda is pathetic.
One reason for 'doctor bashing' is the process by which patients get access to a physician, however caring the physician may be. A patient has to establish his or her financial ability to pay for access, so financial stress can produce a negative reaction in the caller or at the registration desk. Second, the patient's financial resources, i.e. insurance coverage, must meet the requirements policed at the check-in window. Third, an empathetic, dedicated physician often cannot limit patient personal access to the time slot established by the practice or HMO, so patients may have to wait over 30 minutes-often more- for a 10-15 minute appointment. Patient waiting areas are not healthy places because no one knows what reasons for appointments the other occupants have. The lack of infectious disease controls in private practices and in most HMO registration, waiting and pharmacy facilities is appalling and unregulated by the UBC (Uniform Building Code) or accrediting agencies. Is it little wonder that the patient may not feel nurtured in the physician's office?
Dr. Rotering's supportive opinion piece most likely describes the best intentions of practicing physicians today. Of that I have no doubt. Patient-centered care, however, is less about the physician's expertise, attitude and empathy than it is about the environment within which the physician must practice. The members of the LinkedIn.com group are mostly health care professionals, not patients. Their perspective tends to focus on what to do for patients rather than to start from the patient's perspective of the patient expectations of them.
Patient-centered care is about nursing, about office staff and about financing of health care more than it is about the physician per se. Such a care model must include an awareness of the patient's time constraints, too. Working, single parents with an ill infant or child, a worker seeking access for a non-work related illness or injury, patients seeking psychological and other behavior/mood professionals and any patient without a working knowledge of English or with any cognitive impairment (such as with age) have not been the starting points for designing a patient-oriented care practice today.
The physician is the last person to encounter such patients and I believe that is a 180-degrees wrong design for health care. Imagine how differently our system might be if patients met first with the physician. The physician's ability to diagnose and to establish treatment modalities would determine the steps taken by the clinic or office staff on behalf of the patient as prescribed by the physician. Perhaps certain tests would be needed or medications prescribed for follow-up with the patient. If so, the tests might be chosen more specifically to the patient's state of health and initial medications might address symptoms while an underlying illness is being diagnosed. As I see it, the only reason physicians require testing results before seeing a patient is so that the physician can see more patients per shift. That is not patient-centered care. That is practice-centered care.
Physicians are bashed these days because the public sees the profession as having become greedy (remember, these are perceptions not reality); in charge of the entire health care system-other than the insurers-and, therefore, as able to make any changes physicians want in the delivery of health care. Yes, bashing for these reasons is not only unfair to individual physicians, it is also unfair to other patients' perceptions of their health care options. Patients requiring particularly expensive interventions often find themselves waiting for an insurance review of their physician's request for covering the procedure and patients may find themselves calling their insurer to speed up the approval process.
Certainly, insurers want to minimize patient care costs and insurers occasionally may prevent an unnecessary procedure. The role of private health care insurance providers, however, is to support the patient's ability to pay for services, not to function as a professional practice review board. Further, private insurers establish their reimbursement rules according to those promulgated by the public insurers. Public insurers like Medicare and Medicaid, though, seem to limit a physician's professional discretion through enforcement of the DCM-10 coding mechanism of reimbursement for services rendered. I think this effort to control health care costs by the Centers for Medicare and Medicaid Services (CMS) inhibits innovation in diagnosis and treatments and, rather, encourage physicians to find the best ways to help their patients get well and remain well.
And, part of this issue lies with each and every physician who tolerates sub-standard professional care by other physicians, who will not police their own ranks of bad actors, who subsume their medical ethics below financial support from third parties like pharmaceutical suppliers, and who refuse to criticize the judgment or actions of other physicians in formal arbitration and courts. If local and state medical boards were more pro-active in correcting unprofessional or inadequate performance by those they have licensed and granted membership to their medical societies, then I believe the public image of physicians would improve by a great amount. Physicians also need to know how their staff treat the patients.
The final part of patient-based health care models is the heretofore unrecognized fact that in health care, the primary stakeholder is the patient. Using a football analogy, the patient hires the team, the primary physician can be the general manager, head coach or quarterback. Consulting physicians or temporarily-designated attending physicians are the coaches. Nurses are the teams, often the special teams needed to make the quarterback successful and to make up for an embattled quarterback. I hope this concept is clearer using the analogy. The patient is the owner is patient centered care. QED