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Politics : View from the Center and Left -- Ignore unavailable to you. Want to Upgrade?


To: Ron who wrote (245395)2/24/2014 12:29:06 PM
From: Steve Lokness  Read Replies (1) | Respond to of 542911
 
I haven't read the book and since the first review on Amazon says it is "depressive as hell" - I'm not likely to.

Now having said that the review makes the suggestion that liberals and conservatives should work on common ground. BUT that is what I have been saying here for years and every time I suggest the need to compromise and work for bettering America - I'm lambasted as a nut job.

But that is wandering off topic; how do you control hospital cost when the ranks of those needing care is ballooning - and the services offered are growing exponentially?



To: Ron who wrote (245395)2/24/2014 12:30:02 PM
From: Sam  Respond to of 542911
 
Hmm, now I wonder why there is a shortage of doctors.

California doctors, insurers face off over reimbursement rates
By Tracy Seipel
tseipel@mercurynews.com
Posted: 02/23/2014 01:39:31 PM PST | Updated: about 6 hours ago
mercurynews.com

Lowering costs by forcing doctors and insurers to compete for millions of new patients is a primary goal of the nation's new health care law, but a group of gastroenterologists in the East Bay and internists near Chico are exposing a fissure in that plan.

There often aren't enough doctors to go around.

In parts of the state, the shortage of doctors participating in California's new insurance exchange is providing new leverage for medical providers to hold out for higher reimbursement rates from big insurance companies. And as a game of chicken unfolds behind the scenes between two powerful groups that are key to the law's success, the insurers are often caving in to the doctors, raising concerns that the trend could catch on and drive up the price of health insurance premiums on the exchange.

Medical costs are the largest component of a health insurance premium, said Darrel Ng, a spokesman for Anthem Blue Cross of California. And the higher those costs go, he said, "the higher the premium will likely be on the exchange in the future."

Many doctors are upset about the discounted reimbursement rates that insurers have imposed on them to keep premiums low on the Covered California exchange. The new rates -- as much as 30 percent lower than those paid by nonexchange plans -- took effect Jan. 1, when the new health care plans of hundreds of thousands of Californians kicked in.

The number of doctors who have had their old rates restored is still small compared to the 58,000 physicians that Covered California says are participating in the new marketplace.

Whether these side deals will ultimately raise rates on the new exchange isn't clear yet. But health care experts wonder what the trend portends for the success of the law, which depends on attracting hordes of consumers to lower-priced insurance policies.

As more people sign up for the expanded Medi-Cal program and private plans on the exchange, "there will be a surge in the demand for doctors," said Glenn Melnick, a health economist at the University of Southern California.

But because there's a fixed supply of physicians, he predicted, many doctors will be able to tell the insurers: "Wait a second. You delivered us a promise, and I'm busier than ever, and you need me. But I don't need to agree to a discount anymore."

Central to the standoff are state regulations that require insurers to provide their customers access to primary care physicians within 15 miles or 30 minutes of their homes. Plans also are required to have a primary care physician-to-patient ratio of 1 to 2,000, and an overall physician-to-patient ratio of 1 to 1,200. If for some reason the health plan does not have a particular type of specialist, the plan must find such a provider.

In many cases, the winners in the doctor-insurer faceoff are physicians in rural regions, where health care services are scarce. But the table-turning has also surfaced in the Bay Area and other metropolitan regions.

"Most doctors want to take care of patients," said Dr. Richard Thorp, president of the California Medical Association, a lobbying group that represents about 40,000 of the state's 104,000 licensed physicians. He's also an internist who belongs to a 12-member group practice in Paradise, near Chico, that was able to reinstate its old fees with Blue Shield of California.

"But they have to make an individual choice based on whether they can afford to service those contracts," Thorp said. "That is the reality."

Blue Shield and Anthem Blue Cross, two of the four largest insurers offering Covered California plans, acknowledged that they are reinstating some old rates.

Blue Shield spokesman Steve Shivinsky said the insurer has restored rates for 1,400 California physicians, many of whom practice in rural areas, to ensure adequate medical care is available. Yet he said that's still "a tiny fraction" of the majority of its 35,000 network physicians who signed new contracts to participate and agreed to accept discounted rates in exchange for more patient volume.

Dr. Mark Kogan, a San Pablo gastroenterologist, is one of the physicians who used the law of supply and demand to make the case for higher rates.

Along with 18 colleagues at Northern California Gastroenterology Consultants, he already sees plenty of patients. So when Blue Shield last year offered the group more business from new Covered California enrollees -- but at 30 percent less -- the group declined.

"We basically told them, 'We cannot do that,' " Kogan recalled. "We would lose money by seeing those patients."

That put Blue Shield in a bind. Without access to those 19 gastroenterologists who work out of seven East Bay offices, where would its subscribers go?

By mid-January, Blue Shield backed down and agreed to pay the group of specialists its current rates if the doctors would take on the insurer's exchange patients.

The issue of discounted fees surfaced at Thursday's Covered California board meeting after Kim Griffin, chairwoman of Medical Office Managers of the Peninsula, told the board in a letter that because some insurers are discounting fees for exchange customers, "many of us have opted out."

That doesn't surprise Thorp and Kogan, who say there is a misconception among the public that access to more patients means more money.

"If you are pricing a service for less than it costs you to provide it," Thorp said, "you cannot make that up in volume."



To: Ron who wrote (245395)2/24/2014 5:44:38 PM
From: Alex MG  Read Replies (1) | Respond to of 542911
 
The GOP, Race and Ted Nugent:
If you won’t Denounce Nazi Insults, What does that Say about You?
By Juan Cole | Feb. 22, 2014

Musician Ted Nugent called President Barack Obama a ‘subhuman mongrel.’ Greg Abbott, the Republican who wants to be the next governor of Texas, though Abbott brought Nugent along on two campaign appearances, has not denounced him for this language.

On Friday, Nugent “apologized” (though “not to president Obama”) for using the language insofar as it embarrassed other Republicans associated with him. That is, he did not actually apologize at all.

Sarah Palin said of Abbott, “if he’s good enough for Ted Nugent, he’s good enough for me!” Sen. Ted Cruz, quizzed on Nugent’s language, replied that he was sure that President Obama’s Hollywood friends had also said some extreme things.

Really, Ted? This comment is just “extreme”? And which liberal in the film industry has said anything like that?

The fact is that the Republican Party today has a problem with race. Not across the board, but it is there. The Party is disproportionately made up of self-conceived white southerners with some white Midwesterners and westerners, allied with Wall Street big money. It has even lost the majority of Asian Americans and Arab-Americans, and can’t get even a plurality of Latinos or more than a handful of African-Americans (traditionally Republicans before the 1970s) to vote for it. The Tea Party and other currents in the party often express white male rage about the rise of the minorities, and the party’s refusal to consider immigration reform is rooted in that rage.

Although a few Republican figures such as John McCain and Rand Paul have condemned Nugent, most have kept quiet, as has Abbott himself. Mostly it is bad form to bring up the German National Socialists in contemporary political debate, to the point where there is a rule, “Godwin’s law,” that mentioning Nazism is a sign that an internet dispute has gone on too long. Godwin’s law did not specify that mentioning Nazism causes the mentioned to lose the debate; that did The Economist put a principle forward in 2007. In general, I agree, and discourage my commenters from resorting to Nazi analogies.

But in rare cases someone does or says something that is clearly Nazi in character (e.g. the Neo-Nazis themselves).

Calling an African-American politician “subhuman” and a “mongrel” is not ordinary everyday garden-variety racism. Deploying stereotypes would be racism. The word “mongrel” (German ‘Mischling’) implies that there is something wrong with someone being of a mixed racial heritage. The Nazis believed that there are “races” (there aren’t), that races can be more or less “pure,” that some races are better than others (Teutons better than Slavs, e.g., with Africans and Semites at the bottom of the heap). They believed that there were some subhuman races, “Untermenschen.” They therefore held that it is wrong to allow a mixing of races. Hitler believed that Americans would be easy to defeat because we are a “mongrel people.”

Nugent’s phrase is straight from Mein Kampf. If Republicans such as Abbott and Palin won’t denounce this language, then the GOP has a much bigger race problem than even its most trenchant critics could have imagined.

Not only are people actually all mixed up, 5% of our genes are from the Neanderthals, a different species of the human genus! (Most Africans lack this heritage, since the mixing with Neanderthals happened in Eurasia after some homo sapiens sapiens left Africa around 70,000 years ago; but since some Eurasians wandered back down into Africa, some Africans do have Neanderthal heritage as well as Eurasian heritage). Since all contemporary human beings are descended from African progenitors who lived 120,000 to 200,000 years ago in South Africa, all of us have black ancestors. White skin is an adaptation to low ultraviolet ray levels in northern climes, since it produces vitamin D deficiency. (In South Africa, black skin protects against too high UV ray levels, which can damage fetuses). But humans couldn’t live up in northern Europe during the last glacial maximum, roughly the period 40,000 to 13,000 years ago. So the humans who went back into Europe at the end of the last big glaciation were black, and the desirability of lighter skin to let the UV rays through to fetuses for vitamin D production gradually selected for lighter and lighter skin. But as recently as 7,000 years ago, humans inhabiting Spain had black skin along with, sometimes, blue eyes.

Get over it, white supremacists. Great-grandma was African.

All Europeans probably have a common ancestor as recently as a thousand years ago. All Europeans have some recent Near Eastern and black African inheritance via Umayyad Spain, with its Berbers, Arabic-speakers, and soldiers and slaves from West Africa, not to mention an older inheritance from the Phoenicians. Archeologists found Chinese laborers in Rome 2000 years ago, and I guarantee you that all Europeans have some genetic inheritance from those guys, assuming they had children with other slaves. As genetic history develops as a discipline, we are finding people of African heritage in England, of European heritage in China, etc., etc.

Even Hitler had Sephardic Jewish ancestry from North Africa.

Americans don’t think that different peoples are better or worse one than the other. We don’t have a racial hierarchy. For one thing, we are too mixed up to understand ourselves as “racial” in the Nazi way. Our “Slavs” intermarried with our Teutons. None of them is more or less human; they’re all human at the same level. If we can only finally get rid of the stupid, invented category of “white” (pushed by Catholic Europeans who wanted to join the Protestant elite), we’ll be much better off.

President Obama is a typical American, not exceptional. But more, he is a typical human being.

Fox Cable News, a.k.a Republican Party Central, has largely declined to cover the Nugent scandal, and only Bernard Goldman has denounced the language he used.

If Greg Abbott won’t explicitly dissociate himself from Nugent, after publicly campaigning with him, then he doesn’t deserve to be governor of Texas, because he is behaving in an un-American way.

Nugent wraps himself in the flag, but lifting language from America’s greatest enemy is not patriotism. Millions of Americans risked their lives to fight this ideology. One of my uncles was at the Battle of the Bulge. This is not a case of a rocker acting out. It is treasonous.