The state and federal money spigot has pretty much been turned off to a trickle, if that, for uncompensated care. Read the papers. Reimbursement rates get adjusted every quarter. Medicare and Medicaid have to curb spending, under orders from a moron President who has to cut everywhere and anywhere he can to pay for his stupid war in Iraq...and he has an MBA even! Massachusetts went to universal health insurance (another idea from a Republican who won't even get a wiff of the White House)...which costs too much, doesn't reimburse providers so much as for costs even, and is forcing already tight health systems to face major budget deficits as the free care pool has dried up. Of this, I know. I see the balance sheets for my hospital every month. And no, I do not work for a university health system.
Come to Massachusetts, Bill. My doctor always treats me well, I'm healthy as a horse, he sometimes waves my co-pay and he has late hours and a walk-in clinic every Thursday until 9PM!
As for Wal-mart, I don't shop there at all. I was never a fan of their slash and burn tactics, they do not treat their employees well (read about all the lawsuits for forced uncompensated overtime) and in some cases have left communities barren when they pushed the competition out, end then they themselves left town. I don't blame them for seeking to maximize profitability, but that's not the way to build communities or customer loyalty.
Cheers,
Gene
Wal-mart really is evil.
Moderator: Available
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Gene DeMambro
- Posts: 1684
- Joined: Sat Dec 12, 1998 6:01 am
- Location: Weymouth, MA US of A
Yale admitted the former Taliban official as a non-degree student. He didn't take anyone's spot, or otherwise displace another qualified student.
And besides, got a problem with higher learning being available to all, or maybe you just want it available only to those who agree with you?
Cheers,
Gene
And besides, got a problem with higher learning being available to all, or maybe you just want it available only to those who agree with you?
Cheers,
Gene
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Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
I'm scratching my head on this critique, Gene.Gene DeMambro wrote:
Massachusetts went to universal health insurance (another idea from a Republican who won't even get a wiff of the White House)...which costs too much, doesn't reimburse providers so much as for costs even, and is forcing already tight health systems to face major budget deficits as the free care pool has dried up.
As I understand it, this is a universal and not single payer health care system, with private insurance companies paying the hospitals and health care providers. That being the case, what doctors get paid is a function (more or less) of the RBRVS conversion factor of the particular networks they've chosen to sign up for. And what hospitals are getting paid is a function of the case rate or per diem contracts they have with the health plans. That can't be the problem with your former Republican governor. That's the status of your own free market of health care. (FWIW, it's one of the higher quality ones in the country.)
I thought universal health care was supposed to be a good thing. Among other things, it should negate the need for free care. If everyone is covered, then every doctor treating a patient should get reimbursed, right? So what's the problem?
Part of the issue with Massachusettes health care is one of the three "dings" for poor care - over-use of medical services. Wennberg * has made a name for himself by publishing comparisons of care between Boston and New Haven which shows higher rates of procedures in Boston with no evidence of improved health in the population. And the cause? An issue called provider-induced demand - particularly for high-cost specialty care. Meanwhile, primary care is suffering from a want of good people.
I could think of worse problems...
But where financial resources are scarce, it makes no sense putting yourself in a position of wasting precious health care resources.
- Bill
* See Dartmouth Atlas of Healthcare
IJ
No reason to be sorry, you intially only listed one reason for people to join the military---I never belived that to be a fundamental postion for you....I was just suggesting that it might be better to include multiple motivations.
BTW, in context with the whole prison discussion-----I was trying to explore what could be done to protect inmates......you did in point of fact "indict them" for commting acts of violence...essentially after the fact.
I was trying to figure out what, if anything, we could do to keep people safer...to prevent such attacks in the first place.
No reason to be sorry, you intially only listed one reason for people to join the military---I never belived that to be a fundamental postion for you....I was just suggesting that it might be better to include multiple motivations.
BTW, in context with the whole prison discussion-----I was trying to explore what could be done to protect inmates......you did in point of fact "indict them" for commting acts of violence...essentially after the fact.
I was trying to figure out what, if anything, we could do to keep people safer...to prevent such attacks in the first place.
Last edited by cxt on Wed Apr 09, 2008 10:17 pm, edited 1 time in total.
Forget #6, you are now serving nonsense.
HH
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Gene
That is exactly my point---in this case "higher learning" was not "available to all"----just check the list of people that were denied admisson to the school in question in that year alone.
100's of applicantes with high test score, good grades, etc were refused admission.
While a guy with no such comparible test score or grades with a history of serving as the mouth-piece for a group that advocated lethal intolerence for gays, keeping women as chattel and the murder of people for what we see as free speech issues was allowed admission.
Personally I find such things reprehensible---and adding insult to injury---100's of people that performed better on admission tests and years of schools were denied admission for such a person.
How would such a conversation go:
"yeah, sorry Jane, I know you worked hard for many years, I know you tested high on all the admission tests, I know you helped run a homeless shelter and rasied money to fight AIDS, but your really not quite Ivy League material.......besides, we have to make room for a murderous relgious zealot that wants to hang homosexuals, put women in a burqua, cus the heads off those who blasphme, and justifes the killing of 1000's of innocent people on the basis of them being "infidels."
That is exactly my point---in this case "higher learning" was not "available to all"----just check the list of people that were denied admisson to the school in question in that year alone.
100's of applicantes with high test score, good grades, etc were refused admission.
While a guy with no such comparible test score or grades with a history of serving as the mouth-piece for a group that advocated lethal intolerence for gays, keeping women as chattel and the murder of people for what we see as free speech issues was allowed admission.
Personally I find such things reprehensible---and adding insult to injury---100's of people that performed better on admission tests and years of schools were denied admission for such a person.
How would such a conversation go:
"yeah, sorry Jane, I know you worked hard for many years, I know you tested high on all the admission tests, I know you helped run a homeless shelter and rasied money to fight AIDS, but your really not quite Ivy League material.......besides, we have to make room for a murderous relgious zealot that wants to hang homosexuals, put women in a burqua, cus the heads off those who blasphme, and justifes the killing of 1000's of innocent people on the basis of them being "infidels."
Forget #6, you are now serving nonsense.
HH
HH
Val
Also kinda the point--in context.
Wal Mart is cast as evil because they do what is best for "them."
Yet as you describe the motives for Yale---they also seem to be acting utterly for their personal benefit--regardless in that mission is supposed to be education....not good PR, not "high level contacts"--but education.
(In any case, not sure that this guy has "contacts" whatsoever.)
Why is Wal Mart "evil" because it makes unpopular descsions for the good of their stockholders but Yale is spun as...well at the very least not evil for given a highly valuable spot, at a top tier school to a murderous, homophobic relgious zealot?
(It should be noted that publically espouseing the viewpoints and opinions he made and supported as the public mouthpiece of the Taliban would cause for expulsion from Yale if he was a student or professior or Adminstrator.)
They both seem to operating for their personal benefit regardless of the specific situation and regardless of public feelings----it was quite a story at the time.
What Wal Mart did was essentially "good for their stockholders and Wal Mart" according to you what Yale did was esentially "good for their students and the school."
Why is one "evil" and the other "not?"
Both seem to me to be acting in their own self interest as they see it at the time.
Also kinda the point--in context.
Wal Mart is cast as evil because they do what is best for "them."
Yet as you describe the motives for Yale---they also seem to be acting utterly for their personal benefit--regardless in that mission is supposed to be education....not good PR, not "high level contacts"--but education.
(In any case, not sure that this guy has "contacts" whatsoever.)
Why is Wal Mart "evil" because it makes unpopular descsions for the good of their stockholders but Yale is spun as...well at the very least not evil for given a highly valuable spot, at a top tier school to a murderous, homophobic relgious zealot?
(It should be noted that publically espouseing the viewpoints and opinions he made and supported as the public mouthpiece of the Taliban would cause for expulsion from Yale if he was a student or professior or Adminstrator.)
They both seem to operating for their personal benefit regardless of the specific situation and regardless of public feelings----it was quite a story at the time.
What Wal Mart did was essentially "good for their stockholders and Wal Mart" according to you what Yale did was esentially "good for their students and the school."
Why is one "evil" and the other "not?"
Both seem to me to be acting in their own self interest as they see it at the time.
Forget #6, you are now serving nonsense.
HH
HH
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Gene DeMambro
- Posts: 1684
- Joined: Sat Dec 12, 1998 6:01 am
- Location: Weymouth, MA US of A
Read my post again. Yale admitted this man as a special student, who did not take the place of another qualified applicant. But I have no opinion on this issue, as I really don't care. But since he was issued a student visa by the US State Department, maybe we are placing blame in the wrong place.
Massachusetts now mandates health care coverage for all adult residents. If you get it through work or college, pay for your own plan (such as self-employed) or are on Medicaid or Medicare, then you need to fill out a form and file with your taxes. If you have no coverage by the end of last year, you loose your personal exemption on your state income taxes. If you cannot afford a private plan on your own, the state will help subsidize a plan for you, through participating carriers. Benefits vary, and some plans do not offer prescription drug coverage.
Now, almost a year into it, providers are loosing money treating such plan participants (reimbursement rates are too low - there's your problem right there) and the state is going to be way over budget with their subsidies. And there were complaints that the offered plans cost much too much anyway. If fact, the state asked plan providers to go back tot eh drawaing board when they were first announced - much too expensive and none offered prescription drug coverage. And then, of course, there are high co-pays for brand prescription drugs, and limits to certain mental health services. When Mitt Romney was governer, he pushed and pushed for this "free market" based universal health care coverage. There was a big signing ceremony at the State House and everything. Then when he was running for President, he backed away from this "success", saying he wasn't really involved. No wonder McCain ended up kicking his....
No need to lecture me, Bill, on the appropriate utilization of health care resources. If been saying all along (to you and Ian's dismay) that I simply want doctors to treat patients based on the evidence at hand. But when people come the world over to go to Boston hospitals and attend Boston medical schools, we must be doing something right.
Cheers,
Gene
Massachusetts now mandates health care coverage for all adult residents. If you get it through work or college, pay for your own plan (such as self-employed) or are on Medicaid or Medicare, then you need to fill out a form and file with your taxes. If you have no coverage by the end of last year, you loose your personal exemption on your state income taxes. If you cannot afford a private plan on your own, the state will help subsidize a plan for you, through participating carriers. Benefits vary, and some plans do not offer prescription drug coverage.
Now, almost a year into it, providers are loosing money treating such plan participants (reimbursement rates are too low - there's your problem right there) and the state is going to be way over budget with their subsidies. And there were complaints that the offered plans cost much too much anyway. If fact, the state asked plan providers to go back tot eh drawaing board when they were first announced - much too expensive and none offered prescription drug coverage. And then, of course, there are high co-pays for brand prescription drugs, and limits to certain mental health services. When Mitt Romney was governer, he pushed and pushed for this "free market" based universal health care coverage. There was a big signing ceremony at the State House and everything. Then when he was running for President, he backed away from this "success", saying he wasn't really involved. No wonder McCain ended up kicking his....
No need to lecture me, Bill, on the appropriate utilization of health care resources. If been saying all along (to you and Ian's dismay) that I simply want doctors to treat patients based on the evidence at hand. But when people come the world over to go to Boston hospitals and attend Boston medical schools, we must be doing something right.
Cheers,
Gene
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Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
You need to read more literature, Gene.Gene DeMambro wrote:
But when people come the world over to go to Boston hospitals and attend Boston medical schools, we must be doing something right.
I highly recommend publications in the last 2 decades by Wennberg and others (small area analysis).
Also read up on The Institute of Medicine's series on quality problems in medicine today. Too much care is poor quality care.
Also read up on provider-induced demand.
Your "must be doing something right" health care system is falling apart in the primary care setting. You might find it interesting to know that my company is involved in some NIH-funded research designed to test new paradigms in health care (the medical home concept). The goal is to limit some of this excessive specialist care, and put more control in the hands of better-reimbursed primary care physicians. Harvard's Alan Gorrel is the principle investigator.
- Bill
"No reason to be sorry, you intially only listed one reason for people to join the military."
Someone saying that economics contribute to decisions to sign up (and they most certainly do) does not equate to saying its the only reason. So.... issue covered.
Bill, sounds like you think nothing I said about Walmart is wacko, you just don't have a net negative opinion of em. Sounds fine to me. I don't spend much time worrying about them at all, unless there's an interesting thread online, you know?
The healthcare stuff is more interesting and you'd be pleased to know I was touting lean methods and pointing out the inverse quality-cost relationship for medicare expenditures to students just yesterday at attending rounds.
Also of note: an insurance company called me today and asked me to suggest to my patient that she go to hospice (ie, give up and die already) because she's been sick so long (and I'm sure, expensive). Such an interesting world.
Someone saying that economics contribute to decisions to sign up (and they most certainly do) does not equate to saying its the only reason. So.... issue covered.
Bill, sounds like you think nothing I said about Walmart is wacko, you just don't have a net negative opinion of em. Sounds fine to me. I don't spend much time worrying about them at all, unless there's an interesting thread online, you know?
The healthcare stuff is more interesting and you'd be pleased to know I was touting lean methods and pointing out the inverse quality-cost relationship for medicare expenditures to students just yesterday at attending rounds.
Also of note: an insurance company called me today and asked me to suggest to my patient that she go to hospice (ie, give up and die already) because she's been sick so long (and I'm sure, expensive). Such an interesting world.
--Ian
IJ
But you framed it a a single issue prior.
That is what you said...I'm sorry if I got the wrong idea....but I'm not a mind reader
You didn't say "economics contribute to the decscion made"---a resonable and accurate assumption, which had you actually said it at the time--we would not still be talking about it.
We can blame this on me if you like---I simply read what you actually said instead of "hearing" what you meant.
Lets just call it my mistake and move on OK?
But you framed it a a single issue prior.
That is what you said...I'm sorry if I got the wrong idea....but I'm not a mind reader
You didn't say "economics contribute to the decscion made"---a resonable and accurate assumption, which had you actually said it at the time--we would not still be talking about it.
We can blame this on me if you like---I simply read what you actually said instead of "hearing" what you meant.
Lets just call it my mistake and move on OK?
Last edited by cxt on Thu Apr 10, 2008 3:31 pm, edited 1 time in total.
Forget #6, you are now serving nonsense.
HH
HH
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Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
Wow... That's a strange and potentially ugly domain to get involved in.IJ wrote:
Also of note: an insurance company called me today and asked me to suggest to my patient that she go to hospice (ie, give up and die already) because she's been sick so long (and I'm sure, expensive). Such an interesting world.
I'm dealing now with a close one who has near-end-of-life issues. What I find so important - and a lot of people miss - is to get in the head of the patient and find out what they really want from their life ahead. When you can do this, then potentially tricky decisions aren't at all.
Otherwise...
There's also a fine line between telling the truth and being an A-hole with no bedside manner. Medical school doesn't teach that. Fortunately I have connections, and was able to match the right specialist up with the person involved.
- Bill
Gene
No, I read it, I just don't buy it........still makes little sense..plenty of people on the "wait list" that were not accepted even as a "special student."
I would guess that 100's of people turned down for admission each year would have liked to be a "special student."
In fact, if he was not taking up space and time, then that would indicate to me that Yale has more room for students than they claim.
If they have room for him then surely they must have room for a at least one other person that was otherwise turned away.
So 2 wrongs make a right? The State Dept issued him a student visa so Yale had to give him preferential treatment?
Yale is a corporate entity, just like Wal Mart--Yale acts in its own self interest as they understand it at the time, just like Wal Mart, they take "questionable" actions based upon their corporate culture and worldview, just like Wal Mart.
IMO they differ perhaps only in degree...and they have much better PR.
No, I read it, I just don't buy it........still makes little sense..plenty of people on the "wait list" that were not accepted even as a "special student."
I would guess that 100's of people turned down for admission each year would have liked to be a "special student."
In fact, if he was not taking up space and time, then that would indicate to me that Yale has more room for students than they claim.
If they have room for him then surely they must have room for a at least one other person that was otherwise turned away.
So 2 wrongs make a right? The State Dept issued him a student visa so Yale had to give him preferential treatment?
Yale is a corporate entity, just like Wal Mart--Yale acts in its own self interest as they understand it at the time, just like Wal Mart, they take "questionable" actions based upon their corporate culture and worldview, just like Wal Mart.
IMO they differ perhaps only in degree...and they have much better PR.
Forget #6, you are now serving nonsense.
HH
HH
Folks
Looks like Wal Mart made a serious error...they seem to have had what amounts to a "handshake" deal with a video production firm to tape all of its meetings/parties etc.
When they fired the firm, the firm had about 20-30 years (or so) of tape---which they are now getting ready to sell copies to anyone that can pay....among them people sueing Wal Mart for gender discrimnation and hassasment etc.
Rumor has it that Wal Mart offerd them $500,000 for the footage--and they were turned down flat.
I think it will be interesting to see how this goes down.
Looks like Wal Mart made a serious error...they seem to have had what amounts to a "handshake" deal with a video production firm to tape all of its meetings/parties etc.
When they fired the firm, the firm had about 20-30 years (or so) of tape---which they are now getting ready to sell copies to anyone that can pay....among them people sueing Wal Mart for gender discrimnation and hassasment etc.
Rumor has it that Wal Mart offerd them $500,000 for the footage--and they were turned down flat.
I think it will be interesting to see how this goes down.
Forget #6, you are now serving nonsense.
HH
HH
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Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
Interesting...
I hope this video production company gets a lot of money from these tapes. Why? Because after they sell them, it'll be the last business they do.
It's not nice to screw your customers. It's also not nice to violate confidentiality.
I could get fired, jailed, and fined in 6 figures for releasing some of the data I work with. And that's the way it should be - IMO.
What these eyes have seen - and are taking to the grave... Oye! Real life is better than any soap opera.
- Bill
I hope this video production company gets a lot of money from these tapes. Why? Because after they sell them, it'll be the last business they do.
It's not nice to screw your customers. It's also not nice to violate confidentiality.
I could get fired, jailed, and fined in 6 figures for releasing some of the data I work with. And that's the way it should be - IMO.
What these eyes have seen - and are taking to the grave... Oye! Real life is better than any soap opera.
- Bill
Bill
I'm actually kinda torn...there seems to have been no confidentialy agreement in place.
On the one hand I have problems with business ethics that all boil down to what is simply "legal".....rather than what might "ethical."
On the other hand...Wal Mart is infamous for doing business with lead pipe sensibilties.........with pretty much everybody...their vendors (esp the smaller ones) employees etc.
Can't decide if I'm looking at a karma here...or just another business that is willing to bend over it customers (its by far best customer BTW) when they find a loophole that would allow them to cash in.
Can't decide if the other legal issues here balance it out---if they have footage that could effect other lawsuits....then maybe they should release it.....on the other hand...they had the footage all this time and decided to sit on it because Wal mart was their client...only letting people know about it when it looks like Wal Mart kinda fired them.
I'm going to look into this a bit closer on Monday.
I'm actually kinda torn...there seems to have been no confidentialy agreement in place.
On the one hand I have problems with business ethics that all boil down to what is simply "legal".....rather than what might "ethical."
On the other hand...Wal Mart is infamous for doing business with lead pipe sensibilties.........with pretty much everybody...their vendors (esp the smaller ones) employees etc.
Can't decide if I'm looking at a karma here...or just another business that is willing to bend over it customers (its by far best customer BTW) when they find a loophole that would allow them to cash in.
Can't decide if the other legal issues here balance it out---if they have footage that could effect other lawsuits....then maybe they should release it.....on the other hand...they had the footage all this time and decided to sit on it because Wal mart was their client...only letting people know about it when it looks like Wal Mart kinda fired them.
I'm going to look into this a bit closer on Monday.
Forget #6, you are now serving nonsense.
HH
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