Monday, July 24, 2017

What is wrong with American healthcare? Nothing, expect, greed.

No one makes the argument for "Single Payer" healthcare, but, let me point to "Emcare" as the primary reason why there needs to be a massive change in the cost of healthcare insurance.

EmCare (click here)

Part of the problem with a political agenda that includes "Single Payer" is that the specifics are not discussed enough and there is too much wiggle room for lies and political rhetoric. 

Does anyone actually believe the cost of health care insurance is going to come down? Why should it? THE FREE MARKET SYSTEM is suppose to work to maintain costs. It will never work if there are companies, like EmCare, that simply don't care what they charge patients. They don't care. They want their money and they will get it.

Interesting though is the way EmCare is going about it.

July 24, 2017
By Julie Creswell, Reed Abelson and Margot Sanger-Katz

Early last year, (click here) executives at a small hospital an hour north of Spokane, Wash., started using a company called EmCare to staff and run their emergency room. The hospital had been struggling to find doctors to work in its E.R., and turning to EmCare was something hundreds of other hospitals across the country had done.

That’s when the trouble began.

Before EmCare, about 6 percent of patient visits in the hospital’s emergency room were billed for the most complex, expensive level of care. After EmCare arrived, nearly 28 percent got the highest-level billing code.

On top of that, the hospital, Newport Hospital and Health Services, was getting calls from confused patients who had received surprisingly large bills from the emergency room doctors. Although the hospital had negotiated rates for its fees with many major health insurers, the EmCare physicians were not part of those networks and were sending high bills directly to the patients. For a patient needing care with the highest-level billing code, the hospital’s previous physicians had been charging $467; EmCare’s charged $1,649...

EmCare is not an insurance company. It is not a hospital. It is a subcontractor for care that is given hospital privileges, in what appears to be, rural hospitals. They don't have to answer to insurance commissioners or any regulation, they simply decide if they want to purchase their next yacht and charge their patients accordingly.

That is clever. Very clever. EmCare is in emergency rooms. Not surgical suites, but, the most delicate place in a hospital where life and death are in the balance.

How do they do it? 

July 24, 2017
By  Mike Cummings

A new study by Yale researchers (click here) of more than 8.9 million visits to emergency departments (EDs) reveals that a small group of predominantly for-profit hospitals in the United States have the highest concentration of out-of-network ED billing rates: While 50% of hospitals have out-of-network billing rates below 5%, 15% of hospitals have out-of-network billing rates above 80%.

The researchers previously found that 22% of privately insured individuals who went to in-network hospitals were treated by out-of-network physicians and thereby potentially exposed to significant unexpected costs. In their new study, they also found that recent legislation in New York State has been effective at reducing the incidence of out-of-network-billing, but that policy makers could do more to better protect consumers....

The billing comes from EmCare as an OUT OF NETWORK provider. A healthcare insurance consumer may very well seek pre-approval even on the way to the ER, but, it doesn't matter because the physicians treating him are not in network.

In California, dialysis centers found they would be paid better if their patients were not on a government medical insurance program. They took it on themselves to see to it their patients had health care insurance from the exchanges. There was nothing illegal about it. It caused the cost of healthcare to increase.

If Senator Bernie Sanders is looking at the same paradigm shift I am, there is no answer to the corruption entering the healthcare industry spawned by greed.

Physican groups such as EmCare will drop out of insurance carrier after insurance carrier to bill independently as Non-Network providers.

Single Payer is not about ideology. Single Payer answers this level of corruption with a solution and that is what Senator Sanders is looking at. No matter how many provisions are built in to the Affordable Care Act to bend the cost of health care down, it won't happen because there is too much greed and corruption in the costs.

The Affordable Care Act didn't seek to change the infrastructure of health care delivery, it sought to support it while containing the costs and over time reduce the costs to consumers. Some of that belongs to Americans. If they take advantage of their free annual physical and take their physicians advice the cost of health care will come down because of a healthier America. That is still in play, but, emergency rooms are emergency rooms and EmCare chose the one place in the hospital that no matter how healthy Americans become they will still need emergency rooms.

Single Payer would insure all Americans. It would contain costs by the fees it pays for services including practicing physician SALARIES and not simply COSTS. A physician would receive a salary like any other professional in this country, except lawyers.

The fraud will stop because the billing and fee schedule will be simple and straight forward.

Why don't Republicans want this? The obvious answer is that Wall Street would be hurt by such a system. But, it is more than that. Physicians are among the largest political donors in state elections. Not federal, but, state. If all the physicians in a given state are receiving basically the same salary (specialists would be paid more) who is going to pay for political favors? What would the political favors be? Raise in salary? Nope, that is not a concern. Whenever a salaried person is working directly for any government there are unions to guarantee outcomes the members are looking for. Physicians would have unions to protect them no different than workers on production lines. 

Single Payer will end the abuse of the USA health care system and begin to address the needs of all Americans. For those running for office in support of Single Payer, they will need graphs and charts to explain how it works and where care will be better with lack of corruption and of course the US dollars involved. There are aspect of Single Payer that is not a hard sell.

The other company mentioned in the Yale study is "TeamHealth." (click here)

Two companies. ONLY two companies that specialize in Out of Network physicians. ONLY TWO, causing all this grief to Americans. This MUST be addressed before the entire system is out of sync with reality and the TRUE cost of healthcare.


Love what you do, plus where and how you do it 

TeamHealth recruits everyone from residents to Advance Practice Physicians. They do not specialize in one department of the hospital to place their Out of Network Clinicians; they place them in the ER, OR, Anesthesiology, Hospital Medicine and its sub-specialties, behavior health, ambulatory care and Post acute care. Oh, is that all? Why not just staff an entire hospital and bill patients directly for OUT OF NETWORK costs.

Hippocratic Oath, Modern Medicine (click here)

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

For the first time in the thirteen year history, its founder Michael Moore will not be attending.

Mr. Moore is beginning his limited engagement of "The Terms of My Surrender" on July 28th. The film festival is from July 25th through the 30th. He will be missed. People could always find him at screenings, panel discussions and the awards ceremony at the end of the festival. This year TCFF is flying on it's own and so far so good.

Everyone is wishing Michael Moore a successful run of his show and congratulations on the addition of Michael Mayer. It should be a good show. I hope his security is intact as it always has to be considering the fact he tends to be a lightning rod of one sort or the other. The novelty is that he was the one person who predicted Donald Trump would win the primary and the election. Hence. "Terms of My Surrender." 

I think the dedication to his show is obvious. He is not at the festival and that is simply unheard of. He is carrying out his own priorities and worrying less about the passions of the past. Good luck, Mr. Moore.

May 1, 2017

Academy Award-winning filmmaker and bestselling author Michael Moore (click here) is set to make his theatrical debut with The Terms of My Surrender, a subversive new solo play and cross-examination of America’s political climate, that will take aim at the current administrationThe show will open on Broadway this summer with direction by Tony winner Michael Mayer.

The Terms of My Surrender is set to begin a limited 12-week engagement July 28 at the Belasco Theatre, ahead of an August 10 opening.

“I think what the world needs right now is Michael Moore standing on a Broadway stage sharing his hilarious stories and incendiary political perspective, creating the kind of dialogue that can only happen in the theatre,” says Mayer in a press statement.

The Terms of My Surrender will be performed by Moore live each night, and will feature his signature wry, satirical humor. The show will pose the question: “Can a Broadway show take down a sitting President?”

Flip through the photos below of his announcement at Sardi’s:

The design team includes a set by Tony winner David Rockwell (Falsettos, She Loves Me), lighting design by four-time Tony winner Kevin Adams(Hedwig..., American Idiot), sound design by two-time Tony winner Brian Ronan (Book of Mormon, Beautiful: The Carole King Musical), costumes by Tony nominee Jeff Mahshie (She Loves Me, Next to Normal), video and projection designs by Andrew Lazarow, and movement direction by Noah Racey. IMG Original Content and Carole Shorenstein Hays are the producers, with 101 Productions serving as executive producer.

Tickets for The Terms of My Surrender are $29–$149 and are now available at or by calling (212) 239-6200. For more information, visit                      

What are you doing this week? This is just one film at the Traverse City Film Festival 2017. Join us.

Revenge and retribution is a strong driver of violence in the Middle East. The films Asghar Farhadi is involved in are nothing short of poignant.

I remember the first Iranian film I ever saw and it was at the TCFF years ago. It was not a Farhadi film. It was about 90 minute film of a father and son that fashioned satellite dishes for media reception. They found a way to hammer sheets of metal into satellite dishes, would deliver them to residents in tenement buildings by bicycle. The roof tops were full of satellite dishes. 

Eventually, the Iranian government (under Ahmadinejad) would show up and remove all the satellite dishes. That was good news for the father and son team, because, the residents would order more satellite dishes.

It provided a magnificent glimpse of the Iranian people, their resourcefulness and their desire to be part of the world, too. 

The TCFF brings films from around the world to the people attending. The festival is about the directors and some producers. They are respected at the festival and attend parties dedicated to the Directors of independent film. There is a great deal going on all the time.

Come and visit, it is worth it. There is even an Open Space where films are shown every evening for free. There is also cutting edge technology at a venue called "The Woz." Dutmers Theater is a specialized venue where thought is the experiment. 

Hope to see you there!

Ianian director Asghar Farhadi (“A Separation”) made global headlines for boycotting the 2017 Oscars in protest of President Donald Trump’s travel ban. Despite the backlash, Farhadi won the Best Foreign Language Oscar for his minimalist masterpiece—a simmering domestic thriller with masterful Hitchcockian suspense and twists. Married couple Eman and Rana are starring together in a local production of Arthur Miller’s “Death of a Salesman” when a violent assault upends their lives. Eman is disastrously driven to seek revenge, more motivated than he realizes by his portrayal of Willy Loman, a character who similarly struggled with his inability to provide for his wife. A climactic final act brings the parallel between Miller’s play and Eman and Rana’s lives to a quietly devastating conclusion. Tragic and transcendent, it will leave you breathless.


44 years of believing the Republican rhetoric has produced Republican radicals and not conservatives.

The Trumpcare repeal is not about the American people regardless of the two years that are suppose to reform the Affordable Care Act. He plays the American people for fools.

Does anyone believe that the Affordable Care Act will be reformed in the two year window of the Trumpcare repeal bill? Heck, no. Those two years will be another election slogan of "Repeal Obamacare." There won't be a replacement and the American people know that.

The Trump Care act is exactly that, another Republican rhetorical political trump card for political volleys. 

DNC Chairman Perez needs to stop the infighting.

How many times does it have to be said, "The Democratic Party needs to be the party of the people, 24/7 and 50 states all the time." Not just during election seasons that bring about victory, but, all the time. That means the DNC has an organized effort to promote their policies and vision. 

NO MORE CHEAP SEATS. When the DNC invests in an American Vision that is real and works, the country will come together.

Tom Perez has a tough job. The 2016 elections were not only invaded by Russians, they were divisive within the party with a missing generation finding their own voice in Senator Bernie Sanders. At this point, Tom Perez should be meeting with Senator Sanders and finding in roads to keep the democracy, NOT JUST THE PARTY, but the American democracy intact.

As a side note, Kid Rock is running for US Senator. The Republican grassroots pundits are look to Kid Rock, not "The Rock" as an icon to drive Democrats to their side.

July 24, 2017
By Alex Seitz-Wald

Providence, R.I. — Democrats (click here) have a very rare opportunity coming up to win when it matters most — if they can get their base to pay attention.
The upcoming slate of governors races combines an unusually favorable map for Democrats with a strong chance to influence the once-in-a-decade congressional redistricting process. That process helps determine how many seats each party holds in the House, and Republican success at the controlling the process has helped the party achieve dominance in Congress.
Washington politicos and grassroots activists alike often overlook governors races, and that’s especially true in the Democratic Party, which is years behind the GOP when it comes to investing in state races.
The party is down to just 16 out of 50 governors, the fewest in recent decades. It lost nearly 1,000 state legislative seats during President Barack Obama's eight years in the White House.
“We’ve been annihilated at the local level,” Virginia Gov. Terry McAuliffe, a former national party chairman, told NBC News at the National Governors Association conference here last weekend. “My problem with the party is, we raise billions of dollars in the presidential year and then go away for four years until the next one.”...

The Kushner family has come full circle. They have their own private manager to make Chinese investors happy.

July 24, 2017
By James Hohmann

...Party planner Lynne Patton, (click here) who helped plan Eric Trump’s wedding but had no professional experience in housing, was appointed last month to  head the Department of Housing and Urban Development’s office for the region that covers New York and New Jersey....

The Washington Post makes the point Trump doesn't place experienced and disciplined professionals into government positions. In this case Trump has placed an inexperienced person into a government office. That very government office oversees the region of the country where the Kushners have placed their families real estate interests and where they are bringing their Chinese investors banking on a HB5 Visa as their ultimate coup against communism.

That might seem really cool, to allow communists into the American democracy, but, the reason they are here is to pad the pockets of Trump's in-laws. 

There are conscious decisions being made to increase the Trump family wealth from within the Oval Office. That is more than unethical. Trump is using the power of the USA, its policies and treasury to increase his personal wealth. Just that simple.

The Trump White House is still denying Russia had anything to do to interfere with the 2016 elections. Well. If I were Trump I'd be denying it, too.

Trump is pushing health care reform or better said, destruction because it is the bright shiny object in the room, not because the American people believe his policies are better than the ones that existed before.

As the Washington Post said, "...This gets less attention than other story lines, but it has been a hallmark of the president’s first six months in power...." 

Go, figure.
"Morning Papers"

The Rooster


Poland is struggling to maintain it's democracy, too.

July 24, 2017
By Rick Lyman

Warsaw — Poland’s president defied expectations (click here) on Monday and vetoed two proposed laws that would have given the right-wing governing party direct control of the judiciary, in a move that had been widely condemned as a violation of democratic norms.

Poles had taken to the streets by the tens of thousands over the past week to protest the laws and to call on the president, Andrzej Duda, to veto them.

The European Union, which Poland joined in 2004, had warned Warsaw that adoption of the new laws — which the bloc’s officials said threatened the independence of the judiciary and the rule of law — would draw a sharp rebuke, potentially including court action and legal sanctions.

“I feel that the reform in this shape will not increase the sense of security and justice,” Mr. Duda said at a midmorning news conference, just before scheduled meetings with leaders of the Supreme Court and the National Council of the Judiciary, both of which would have been dramatically restructured under the proposed laws.

Later in the morning, Mr. Duda said that he would sign a third bill, which reorganizes Poland’s local courts, giving the justice minister the power to select the heads of each of the regional courts...

A middle class does not thrive under oppression. Poland is a case in point. If I were a Wall Street company and old widgets it would be in my best interest to sell as many widgets as possible. Where then are the consumers of the widgets?

Are consumers at the pinnacle of wealth? No. Why? Because they are ONLY one percent. Is my consumer the poor? No. The poor primarily have subsistence income and can't afford the widgets. The best and strongest consumers is a very healthy middle class with a sufficient income to thrive and buy widgets.

The problem with the wealthy is their need for greed. They want more and more money rather than sufficient wealth. That results in robbing the Middle Class of their disposable income limiting the number of different widgets the Middle Class can afford.

Diversifying an economy (making it local), as Warsaw has done, increasing the exposure to OPPORTUNITY to thrive by employing more people and increasing the average income to a household guarantees a vibrant Middle Class, taxable income for the local government and services to people that increase their quality of life.

Being civilized is having a Middle Class. The Middle Class is where opportunity happens. It is where there is income not necessary to 'just pay the bills.' It is the place where education matters and increases a country's brain trusts. The Middle Class and it's unions are the most important function of a democracy. 

Poland embraced unions and there is no reason to end that enthusiasm. No reason at all. Employers do just fine when there are unions as it increases their consumer base. Warsaw, Poland is now a city of opportunity. A place where much is possible. To oppress the Middle Class now with a dictatorship in the courts is not only a bad idea based in principles and ideology, it is dangerous and will collapse the economy the Polish people have build in the last few decades.

November 4, 2015

Warsaw, Poland: Lamb rogan amritsari (click here) at an authentic Indian restaurant. Bánh mì, one of the world’s great sandwiches, prepared by an elderly Vietnamese woman. Beef goulash and rice-stuffed grape leaves at an authentic Georgian eatery. Weisse beer and bratwurst at a German beer hall. Sushi at a tiny but excellent sushi bar.

During my week of investment research in Poland, the only cuisine I didn’t eat was, well, Polish — though, to be fair, I was treated to a tasting menu built around traditional Polish ingredients at Poland’s only Michelin-starred restaurant.

Still, my point is this: This is Warsaw, formerly of bleak and bleary communist fame. Less than a generation ago, restaurant culture here did not exist. The best you could hope for was a so-called milk bar, a government-subsidized cafeteria offering the most basic soups, fried chops and pierogi (and, of course, milk). They were set up during the communist era as a place for workers to eat dinner away from home every once in a while for a miniscule amount of zloty, the Polish currency....

...It’s an opportunity that will likely see Poland’s middle class emerge as the best investment to make over the coming decade....

"Good Night, Moon"

The new moon

0.8 days old moon

0.7 percent lit

July 22, 2017
By Joe Rao

It seems (click here) that everyone is eagerly awaiting the shady drama that will be enacted in the skies over North America on Aug. 21. It is a play whose script was written eons ago: On that third Monday in August, the celestial wanderings of the sun, Earth and moon will cause our natural satellite to pass directly in front of the sun, resulting in a total eclipse on Aug. 21.
The narrow band of totality, averaging some 70 miles (113 kilometers) wide and stretching about 2,500 miles (4,023 km) from the Pacific coast of Oregon to the Atlantic coast of South Carolina, will provide a spectacle that has not been seen from any part of the contiguous United States in nearly 40 years.
To say that this has been an eagerly awaited astronomical event is an understatement.