http://www.intheav.com/AV Lover's Blognointheav.comintheav.com RSS-generatorhttp://www.intheav.com/blogs/avlover/2010/03/20/you-are-already-paying-for-itFor Whom the (Health Care) Bill Tolls by David Katz, M.D. Huffington Post, March 19, 2010 It comes down to this: people who can't afford health insurance don't get any. People who can't afford health care get it anyway when life or limb is on the line. Insurance companies generally make decisions when all is relatively calm. Even a time of crisis for an insurance company is a slow-motion crisis, such as deciding whether to cover on-going cancer treatment. It lacks the urgency of a bullet hole to the chest, for the insurance company if not the patient. Rarely, if ever, do people writhe, retch, seize, or bleed on an insurance company's floor. But they do exactly that in ambulances, ERs, and ICUs every day. Insurance companies enjoy the luxury of saying 'no.' Hospitals do not. My lab, and my practice, are located in Griffin Hospital in Derby, CT. Griffin is a Yale-affiliated, not-for-profit, community hospital. It is also a model for its industry, with no offense to any others that are as well. Griffin routinely achieves almost unprecedented marks for patient satisfaction; it routinely bests its peer group for clinical benchmarks; it has, traditionally, done well financially; its inclusion among Fortune's '100 best companies to work for' has become little less than an annual tradition; and it is the international headquarters for Planetree, an organization dedicated to patient-centered care that routinely attracts delegations from around the world to see how it's done. Not too shabby for a fairly small hospital in one of the smallest cities in one of the smaller states in the US. But my hospital -- my well-run hospital -- is now hurting. Confronted by the recession that we all know is a difficult burden, and the failure to reform health care which some but not all of us recognize as fiscally toxic -- my hospital is hurting. I am confident Griffin will weather the storm successfully. But the challenges and strains are considerable, and undeniable. Leaving aside this particular patient and its particular prognosis, let's talk about the pathology. Our health care system is what's sick. The rest is just the inevitable contagion that occurs when a spreadable malady is not treated at the source. Those writhing, retching, seizing, bleeding patients get treated. Thank goodness, despite the egregious deficiencies in our approach to healthcare, for all that make us the stand-out disgrace among civilized countries, we don't just leave people to bleed in the street. Our common humanity kicks in, and they get treated -- even if they have no insurance. They get treated if they are poor. They get treated if they are not poor, but self-employed and uninsured. They get treated even if they are unemployed. They get treated if they can't afford their co-pay or deductible. They get treated even if the charges will drive them to bankruptcy. They get treated in an emergency no matter what, and the bill comes later. But when it does come due, it doesn't get paid. So hospitals -- which have to say yes when insurance companies say no -- simply have to absorb those costs. In what other industry do you have to provide services to those who can't pay for them? How can healthcare be treated like any other 'commodity,' when its 'manufacturers' are obligated to give it away for free? Hospitals may try to pass their unpaid bills on to the rest of us by charging more for their services than they otherwise would. These charges are passed along to insurance companies which, of course, pass them back to us. Are you worried about paying for the care of the uninsured out of your taxes? You are paying for that care right now out of your insurance premiums. And, since the uninsured and under-insured don't seek discretionary care, but rather wait until they have no choice because they are in a real crisis, the care you (and I) are paying for is ... lousy. We pay to manage a crisis that need never have occurred if only earlier, discretionary, preventive care had been provided. But that doesn't happen, because nobody is paying for that. So the uninsured and under-insured wait for a crisis -- and the huge bill that comes along with it. And then all of us pay that bill. It's a tax, but not called a tax. It's a tax over which we have no control, a tax not subject to our vote, a tax that is insidious, invisible, and unidentifiable. And, it's a tax that pays for the worst possible kind of care -- crisis intervention for preventable crises. And, yes: it is taxation without representation (unless you have a friend on your insurance company's board of directors who cares about representing you). Remember the direct cause of the original 'Tea Party' in Boston? Taxation without representation! Health care premiums bloated by the unpaid bills of the uninsured are a tax, and you are paying it now. For better or worse, insurance companies have more than one means to deal with hospital charges. They can, up to a point, pass those expenses on to us. But their other option is simply to refuse to pay them in full. Hospitals charge Y, and insurers pay X. Once again, hospitals are left to absorb the difference. Why? Because they don't have the luxury of telling a patient retching, writhing, seizing, bleeding up to 'Y' to just knock it off when they get to 'X.' "You've met your insurance company's quota for hemorrhaging -- stop bleeding now!" doesn't seem to work. The so-called health care system in this country is a travesty, a daily violation of human rights, a quintessential example of taxation without representation, a farce, a tragedy, a national embarrassment. It kills people daily. Sometimes, it also kills hospitals. And if it kills a hospital that was doing a good job, it kills even more people. If you are worried about taxes and the costs of health care reform, you should ask yourself for whom the current unpaid healthcare bills toll. They toll for thee. Dr. David L. Katz; www.davidkatzmd.com Sat, 20 Mar 2010 03:14:41 +0000http://www.intheav.com/blogs/avlover/2009/11/01/california-s-deficit-of-common-sense"The state has plenty of money and resources. What we've been lacking is a real-world discussion about how we distribute them." Los Angeles Times OPINION by Rebecca Solnit, Nov 1, 2009 California is rich. Even in the midst of a drought, we have lots of water, and in the midst of a recession, we have lots of money. The problem is one of distribution, not of actual scarcity. This is the usual problem of the United States, which is not just the richest and most powerful nation on Earth now, but on Earth ever, and one of the most blessed in terms of natural resources. We just collectively make loopy decisions about how to distribute the money and water, and we could make other decisions. Whether or not those priorities will change, we could at least have a reality-based conversation about them. Take water. My friend Derek Hitchcock, a biologist working to restore the Yuba River, likes to say that California is still a place of abundance. He recently showed me a Pacific Institute report and other documents to bolster his point. They show that about 80% of the state's water goes to agriculture, not to people, and half of that goes to four crops -- cotton, rice, alfalfa and pasturage (irrigated grazing land) -- that produce less than 1% of the state's wealth. Forty percent of the state's water. Less than 1% of its income. Meanwhile, we Californians are told the drought means that ordinary households should cut back -- and probably most should -- but the lion's share of water never went to us in the first place, and we should know it. Americans usually have fantastic visions of where our resources come from and go. A lot of Americans seem to believe that the federal government spends tons of money, rather than a small percentage of the federal budget, on the arts and foreign aid; but in fact, about half of discretionary spending goes to the military -- the largest and most expensive military the world has ever seen, one that costs nearly as much as all the other militaries put together. In discussing the national financial crisis, the military was never really on the chopping block, even though its budget could, with a little paring, provide healthcare, education, environmental restoration, some cool climate-change adaptation and all the other pieces of a good society and a great nation. Do we really need several hundred military bases in more than 125 countries? And all those expensive toys? And the research programs to do things like weaponize insects? Do we need them more than we need to keep children healthy? Speaking of poor children reminds me of Sitting Bull, as good an authority on our economy as anyone, even if he wasn't an economist and even though he died in 1890. After the Lakota were defeated, he joined Buffalo Bill's Wild West show for a season, but he never got ahead financially. He gave the bulk of his earnings to the street urchins who hung around the show. He was shocked that a nation powerful enough to conquer his people couldn't or wouldn't feed its own future. The white man was good at production, he concluded, but bad at distribution. It's the same today. We have enough in this nation to feed, clothe, shelter, educate and provide medical care to everyone. If the will was there. In California, the story is the same in spades. Take our state budget crisis. A British newspaper recently ran a rather melodramatic piece about California as a failed state and compared us to Iceland. It was a wacky comparison. Iceland went bankrupt because its bankers spent lots of money they didn't have. California is in conniptions because it has lots of money it won't spend. I'm not talking about raising individual taxes, though it would certainly make sense to revisit Proposition 13, and we'd have an extra billion dollars if we hadn't phased out estate taxes. But look at corporate taxes! According to the nonpartisan California Budget Project, if we taxed corporations the way we did in 1981, we'd have $8.4 billion more coming in. That would wipe out more than a third of the budget shortfall that led to the draconian cuts (and cover about what we spend annually on the world's second-biggest prison system). We're home to the fifth-largest corporation in the world, Chevron, whose profits were $24 billion last year. Chevron has lobbied to keep corporate taxes low and to avoid paying an oil severance tax -- a tax on oil taken out of the ground (and we're abundant in oil too, for better or worse). Texas charges one, but we don't. A few years ago, Chevron worked hard to defeat Proposition 87, which would've levied a severance tax capped at 6% of the oil's value -- but Sarah Palin's Alaska raised its severance tax to 25%, a figure that would bring in an estimated $4 billion or more. Examine the way that we changed corporate income tax policy in the crisis years of 2008-2009 to give a small number of corporations tens of millions of dollars a year in tax breaks -- $33.1 million apiece, on average, for nine corporations; $23.5 million to six others, according to the California Budget Project. There's money there, ripe for the picking, and powerful forces to prevent that from ever happening -- or maybe weak forces, because it's our Republican legislative minority that prevents us from ever achieving the supermajority to raise taxes (and our weak Democratic majority that goes along with crazy tax cuts amid a crisis). Turning California into a Third World nation where the environment is neglected, a lot of people are genuinely desperate and a lot of the young have a hard time getting an education or just can't get one doesn't benefit anyone. We're not poor in money or water. We've just chosen to allocate them in ways that benefit tiny minorities at the expense of the rest of us. We should at least have a conversation about how we distribute our abundant resources. Derek is right: California is a place of abundance, except when it comes to political sense. Rebecca Solnit, a product of California public schools from kindergarten to graduate school, is the author most recently of "A Paradise Built in Hell: The Extraordinary Communities That Arise in Disaster." Copyright © 2009, The Los Angeles Times Sun, 01 Nov 2009 09:40:32 +0000http://www.intheav.com/blogs/avlover/2009/10/01/the-looting-of-america-les-leopoldHere is a great article by Les Leopold: It's great to know that during the worst economic crisis since the Great Depression, the wealth of the 400 richest Americans, according to Forbes, actually increased by $30 billion. Well golly, that's only a 2 percent increase, much less than the double digit returns the wealthy had grown accustomed to. But a 2 percent increase is a whole lot more than losing 40 percent of your 401k. And $30 billion is enough to provide 500,000 school teacher jobs at $60k per year. Collectively, those 400 have $1.57 trillion in wealth. It's hard to get your mind around a number like that. The way I do it is to imagine that we were still living during the great radical Eisenhower era of the 1950s when marginal income tax rates hit 91 percent. Taxes were high back in the 1950s because people understood that constraining wild extremes of wealth would make our country stronger and prevent another depression. (Well, what did those old fogies know?) Had we kept those high progressive taxes in place, instead of removing them, especially during the Reagan era, the Forbes 400 might each be worth "only" $100 million instead of $3.9 billion each. So let's imagine that the rest of their wealth, about $1.53 trillion, were available for the public good. What does $1.53 trillion buy? It's more than enough to insure the uninsured for the next twenty years or more. It's more than enough to create a Manhattan Project to solve global warming by developing renewable energy and a green, sustainable manufacturing sector. And here's my favorite: It's more than enough to endow every public college and university in the country so that all of our children could gain access to higher education for free, forever! Instead, we embarked on a grand experiment to see what would happen if we deregulated finance and changed the tax code so that millionaires could turn into billionaires. And even after that experiment failed in the most spectacular way, our system seems trapped into staying on the same deregulated path. Instead of free higher education, health care and a sustainable economy, we got a fantasy finance boom and bust on Wall Street which crashed the real economy. We have our 400 billionaires, and we have 29 million unemployed and underemployed Americans. We have an infrastructure in shambles. We have an environment in crisis. We have a health care system that would make Rube Goldberg proud. And we have the worst income distribution since 1929. I hazard to guess that each and every Forbes 400 member could get by with a net worth of $100 million. I don't think that would kill their entrepreneurial drive or harm our economy--in fact it would be a major boon to the economy to step back from the edge of such massive concentration of wealth. The real problem is getting there form here. A wealth tax that kicks in when you become worth more than $100 million would be a good start. The Eisenhower tax rate on adjustable gross income over $3 million a year would help as well. And please let's not call it socialism, now that we've placed the entire financial sector on welfare to the tune of over $13 trillion in subsidies and guarantees. (By the way, the yearly budget outlays for means tested programs for low income citizens is about $350 billion per year. So Wall Street's welfare is about 37 times as large as welfare for poor.) So if narrowing the income/wealth gap isn't socialism, what is it? It's the America that thrived in the 1950s and 1960s. It's the America that created a middle-class and vowed never to let the financial gamblers return us to another depression. It's an America that put its people to work and built an infrastructure that was the envy of the world. Where's Dwight David Eisenhower when we need him? Les Leopold is the author of The Looting of America: How Wall Street's Game of Fantasy Finance destroyed our Jobs, Pensions and Prosperity, and What We Can Do About It, Chelsea Green Publishing, June 2009. Thu, 01 Oct 2009 15:28:07 +0000http://www.intheav.com/blogs/avlover/2009/09/11/city-never-made-a-dime-from-walmart-in-ten-yearsCity never made a dime from Walmart in ten years! City left to hustle for fiscal fix as Wal-Mart swaps locations The Desert Sun September 27, 2005 September 27, 2005 In less than a month, the Wal-Mart in Cathedral City is expected to close and on the same day, a new Super Wal-Mart is set to open in Palm Springs.The closure of one of Cathedral City's largest sources of sales tax comes shortly before the city expects to lose another "big box" store, the Sam's Club on Date Palm Drive. The city hopes to quickly find occupants for both of the difficult-to-fill buildings. Wal-Mart is targeting Oct. 26 as the date to close the Cathedral City store and open the Palm Springs super store, according to Cathedral City store management and Stan Rothbart, the Beverly Hills developer of the Palm Springs property. The combination of the two closures - the Wal-Mart next month and the Sam's Club in 2006 - has Cathedral City officials sore at the giant Arkansas conglomerate that owns both. That's because Cathedral City gave Wal-Mart financial incentives that continued until last year. The store has been in town for nearly 10 years. "Wal-Mart loves to tell you they're a good corporate neighbor, they take care of the community; and that's just wrong, they're not," Cathedral City Mayor Pro-tem Greg Pettis said. "They come into a community and (we) anticipate we're going to make some long-term money and in essence we reimburse them for the sales tax they generate. They haven't done anything for this community." Pettis was referring to the $850,000 that Cathedral City reimbursed Wal-Mart for infrastructure improvements around the store. The maximum amount of the reimbursement under the deal - $850,000 - was reached last year. A new Wal-Mart store on the corner of Ramon and Crossley roads in Palm Springs will replace the existing store. The 33-acre lot also will be home to a Bank of America, PET-sMART, Del Taco and Office Depot, according to Rothbart. Meanwhile, Cathedral City officials are looking to several other projects, including the expansion of five car dealerships and two new drug stores on Landau Boulevard and Vista Chino, to offset the loss in sales-tax revenue that will come with the Wal-Mart move, Economic Development Director Paul W. Shillcock said. Corporate Wal-Mart officials did not return calls for comment. http://www.stormfront.org/forum/sitemap/index.php/t-237504.html "To offset the loss in sales-tax revenue?" There wasn't any revenue. Note: This is the same Stan Rothbart who developed the Wal-Mart Supercenter on 10th West and O, to close the one on Rancho Vista Boulevard, and who is trying to develop a Wal-Mart by Quartz Hill High School.Fri, 11 Sep 2009 13:44:17 +0000http://www.intheav.com/blogs/avlover/2009/09/10/did-wood-group-tell-the-truthFinally an email arrived from Quartz Hill Cares, with the excuse that it has been a busy summer. It says that no suit was filed on the Lane Ranch project. One of the project proponents stated at the public meeting that he had talked with the leader of Quartz Hill Cares and they could work together. I have revised this posting to more accurately reflect the facts presented by a blogger, below. I feel the posting and the comments that have started have value, so rather than delete it, I revised it.Thu, 10 Sep 2009 12:39:22 +0000