FWIW -- Our local Regional Medical Complex Of Unlimited Ambition appears to be part of this trend. They closed a unit and are using the staff as floaters, are cutting casual employees, slashing overtime, etc. Non-medical staff I know have seen several scythings already.
My feeling is that they both blew up the endowment and got themselves into all sorts of trouble trying to be geniuses of structured cash flow management. I expect they'll be going to the (soon to be bankrupt, natch) state in about 6-9 months to beg for money.
In Western Canada, on Boxing Day, not a single ship of the Seaspan fleet was chartered. That's the first time this happened in 40 years. Seaspan controls all the towing of pulp mill good and services, as well as other resource goods in Western Canada. I talked to a friend of mine who has worked there for 20+ years and he says business is flat on its ass.
Recently talked to three hospital adminstrators in midwest and all were experiencing layoffs and low patient count. I asked if they thought it was recession related and all agreed they thought so. All are looking for major cuts in their budgets.
The US cannot afford to continue spending 15% of GDP on health care. This number may come down through change in government policy, or simply though market mechanisms, but come down it will.
We were laboring under a dropsical fulness of circulating medium. Nearly all of it is now called in by the banks, who have the regulation of the safety-valves of our fortunes, and who condense and explode them at their will. Lands in this State cannot now be sold for a year's rent; and unless our Legislature have wisdom enough to effect a remedy by a gradual diminution only of the medium, there will be a general revolution of property in this state.
Letter to William C. Rives, 1819:
Certainly no nation ever before abandoned to the avarice and jugglings of private individuals to regulate according to their own interests, the quantum of circulating medium for the nation -- to inflate, by deluges of paper, the nominal prices of property, and then to buy up that property at 1s. in the pound, having first withdrawn the floating medium which might endanger a competition in purchase. Yet this is what has been done, and will be done, unless stayed by the protecting hand of the legislature. The evil has been produced by the error of their sanction of this ruinous machinery of banks; and justice, wisdom, duty, all require that they should interpose and arrest it before the schemes of plunder and spoliation desolate the country.
We are being totally played - and the game is very old.
Bruce(Unrated) writes: Doe sthis mean big pharma is going to have trouble in 09 or is it just the hospital with a shortage of equipment needed to provide services?
Hospitals in America are so ludicrously overcapitalized and wasteful that it really beggars the imagination.
The only shortage of equipment that the regionals experience will be a reduction in planned growth reported as a capital shortfall.
I would expect the hammer to really fall on things like medical supply, big pharma, insurance, etc. The actual hospitals will be fine, their suppliers not so much. My feeling -- and maybe dryfly can explain otherwise if I'm offbase -- is that regional consolidation has left people up the supply chain vulnerable to consumer-side renegotiation.
Any spending is only recession-proof to the extent that there is someone willing and able to pay for it. As people lose jobs or take cuts in wages and benefits, both "willing" and "able" decrease. For some, a lot of procedures and medicines will start looking non-essential; for others, even essential care will simply be unaffordable.
A lot of hospitals added capacity like crazy the last few years - especially in high fee 'boutique' market niches... imaging, intensive cardio, cancer therapy, major surgical - etc. They tried like CRAZY to close ERs and primary care as they are money losers. Now with the economy tightening and companies cutting back on insurance & insurers challenging reimbursement... the hospitals face (1) fewer patients and (2) contested payments at the sametime their capital costs have skyrocketed.
And they are surprised??? Only one word applies: Hoocoodanode.
Hospitals in America are so ludicrously overcapitalized and wasteful that it really beggars the imagination. Comrade Byzantine_Ruins | Homepage | 01.12.09 - 10:24 am | #
Anecdotes I am hearing is people are either not paying or slow paying their hospital bills causing cash-flow problems. At the same time they are experiencing greater demand from un-insured patients.
I remember in the '80's many small hospitals either closed or were absorbed by university medical centers and "non-profit, religious affiliated" conglomerates. In fact, for the last twenty years, hospitals have been seesawing in ownership entities. Add in the HMO's blood-laden paws of grabbing a piece of the divvied-up patient population and hospitals. Universal care will revive the hospital systems. Health and malpractice insurance on the otherhand will be DOA.
It would be more comforting if the language was less conditional...
Russia 'to resume gas supplies'
Russia will resume pumping gas to third countries via Ukraine from Tuesday morning, following the completion of a monitoring deal, the EU says.
The Czech presidency of the EU made the announcement following the signing of a deal by Russia, Ukraine and the EU.
Hundreds of thousands of people in Europe have been left without gas since Russia turned off the taps over a contractual dispute with Ukraine.
Despite the deal, it may be some time before supplies return to normal.
BBC Europe Business Reporter Ben Shore says that in theory supplies could return to normal within 24 hours but a more likely time frame is 36 to 48 hours.
The news of a deal will come as a relief for countries such as Serbia and Bulgaria which rely almost entirely on Russian gas, delivered through Ukraine, to heat their homes, our correspondent says.
However, the row between Ukraine and Russia has further underlined the vulnerability of Europe's gas supply, he says.
International monitors
Alexander Medvedev, deputy chief executive of Russian gas giant Gazprom, told a news conference in Brussels: "If there are no obstacles... gas supplies will be restarted at 8 o'clock [0700 GMT].
"What most people don't understand is that this program was designed to the detail by Congress," Preston said. "Congress dotted the i's and crossed the t's for us, and unfortunately it has made this program tough to use."
"The three-year program was supposed to help 400,000 borrowers avoid foreclosure. But it has attracted only 312 applications since its October launch because it is too expensive and onerous for lenders and borrowers alike, Preston said in an interview."
Frank pukes on Bush:
"Rep. Barney Frank (D-Mass.), who helped steer the HUD program through Congress, said some of the federal bailout money should be used to revamp it. Frank acknowledged the initiative has its problems, but he blamed them on the Bush administration."
"That's partly their fault," said Frank, chairman of the House Financial Services Committee. "The administration was critical of the program and kept putting pressure on us to make it cheaper and more restrictive. . . . If it hadn't been for the Bush administration's opposition, we would have written it in a better way in the first place."
My mother, still alive and 79 years old, talked to me this weekend about Squirrel stew/soup...I thought she was joking...I suggested that between the fur, skin and bones that there wasn't much left...
She grew up in Iowa during the depression, and she said that squirrel was tasty, but had a wild taste, something like rabbit and deer...
Does anyone have recipes to take the wild taste out of squirrel for future reference...No shotgun use anticipated...
No squirrels, however my HOA has a lot of possum and mice that might help to flavor the old pot...Beats stone soup...
I would expect the hammer to really fall on things like medical supply, big pharma, insurance, etc. The actual hospitals will be fine, their suppliers not so much. My feeling -- and maybe dryfly can explain otherwise if I'm offbase -- is that regional consolidation has left people up the supply chain vulnerable to consumer-side renegotiation. Comrade Byzantine_Ruins | Homepage | 01.12.09 - 10:24 am | #
I think you are right EXCEPT for things like surgical equipment & devices (think laproscopes, defibrillators and such).... but in general 'Class Two' and lower devices & supplies are pretty much a commodity now & controlled by large buying 'cooperatives'... the suppliers have very little pricing power & margins are terrible. For the top tier stuff (surgicals & devices - the surgeons & specialist approve & the suppliers still get good money for superior product but they have to jump through a lot of hoops to prove it).
E.R.'s are treated as de facto walk in clinics for the uninsured and insured. It's easy enough to game the system that any unemployed moron can figure out to say they have crushing chest pain, or visual changes and buy themselves an admission from the beleagured E.R. doc who just wants to turf their GOMERS to whatever service they can. And these are the same docs under competing pressures to upcharge based on complexity of visit by admin, complete the entire workup in the ED so that hospital stays are down. Result is sky-high 10k work ups on bums complaining of headache trying to get out of the cold. Meanwhile, true emergencies, broken bones etc sit in the waiting room, hour after hour because there are no beds. And in the end, you just refuse to pay your bill as a negociating tactic to get a nifty 10-25% cut from the provider. Like Colt 45, it works every time.
The system is collapsing further every day. Anybody who works in healthcare watches it happen daily and will agree.
Chinese cooks, according to a recent NY Times article, soak fish in wine and other spirits before cooking solely to remove the "fishy" taste. Maybe there is a way to pre-soak wild meats in order to remove the "wild" taste.
Or serve with juniper berries, the traditional way to counterbalance the wild flavor.
Does anyone have recipes to take the wild taste out of squirrel for future reference...No shotgun use anticipated...
Any game meat needs to be aged. Too often it is shot, butchered and cooked. I prefer to age the meat in a refrigerator for two weeks (or walk in cooler for large game) before consumption. Additionally, you can soak the squirrel meat in a weak brine solution to improve taste. If properly prepared, it has a reasonable flavor....
Meanwhile, perhaps the hospitals were making a bit more money on "elective" procedures than generally realized, and those are evaporating with the economy?
Growing up in Southern MN, not during the depression, I can tell you that a squirrel that has been living on corn from the corn crib does not taste wild and makes a nice meal for a family of four. Cottontail rabbit is good too.
Use a .22 rifle; cartridges are much cheaper and you don't risk your teeth on lead pellets.
Looks like some scrutiny may be in order. Where is Conjure? He can evaluate the merits of the prognosticators, assign blame and dole out the proper punishment.....
Oh yeah. In the local Regional Medical Complex of Unlimited Ambition, my feeling is that you could easily die because they were too skimpy with the human capital budget to put enough nurses on your floor to staff it adequately.
That's day to day staffing expenses, those have to be kept down despite plentiful studies that show the more attention a patient receives, the better the prognosis. Instead, you get shoveled into a bed and treated like livestock by the skeleton staff of overworked lunatics who for some reason cling to the job.
But if you wanted to blow a hojillion dollars on a photogenic PET device, that would be found tomorrow.
This is interesting because medical spending is frequently considered recession proof
More evidence that the underlying sickness is not a "housing" bubble, but a credit bubble, in which all assets (i.e. anything that anyone wants) are overpriced and now experiencing deflation. Simple reversion to the mean.
Growing up in Southern MN, not during the depression, I can tell you that a squirrel that has been living on corn from the corn crib does not taste wild and makes a nice meal for a family of four. Cottontail rabbit is good too.
Use a .22 rifle; cartridges are much cheaper and you don't risk your teeth on lead pellets. Paul | 01.12.09 - 10:42 am | #
Same here - used a 22 w/ accurately sighted in scope - and also from S Minnesota but most of the squirrels I shot also ate a lot of acorns (all those oak knolls in S Minn) so tasted plenty gamy. The rabbits though were super fine as were the pheasants - literally bursting w/ corn when cleaned. Yummmy!
Well, think about it - the world's next two most expensive systems, Switzerland's and Germany's, spend are 1/3 less for health care which is considerably better than that which a typical Walmart store employee can expect, much less than Walmart employee's children can expect.
Lots of fat in the American system - lots and lots of fat.
A reduction of which just might lead to lower health care costs in and of itself.
Use a .22 rifle; cartridges are much cheaper and you don't risk your teeth on lead pellets
Another piece of advice... try to find a bolt-action rifle still chambered for the .22 short. Very, very cheap and subsonic, so not much louder than an air rifle. Still good out to about 60 yards once you hone your skillz.
The critters will get back to business much faster in the echoing hickory-and-pecan-surrounding-water amphitheatres where the hunting is best.
mal... that's because the fish being served is a garbage fish - they have fished the hell out of their seas like the Vietnamese, that is if pollution didn't kill them first!
People lose their job. People lose health care coverage. People stop running to the doctor for every little pain. People put off anything major (that can be put off) because it will come out of their pocket.
My copays for prescriptions are huge (terrible employer-sponsored health insurance plan). I would imagine that many folks will 'temporarily' stop to save money.
Some of these meds will be for treatment of pyschiatric disorders... so watch for an uptick the number of involuntary admissions to psych wards (and general craziness).
Architectural firms (particularly in the SF Bay Area) have been living on an unending supply of hospital expansion and seismic renovation. This work has definitely helped some offices make it thru slow times in the past. In the recent 6 months, many of the larger projects have had trouble getting financing and many of the hospital corps seem to believe the new administration won't be as friendly to their profit margins (and thus more conservative on outlook).
Another piece of advice... try to find a bolt-action rifle still chambered for the .22 short
The old gallery guns are a hoot. Many need to be re-barreled for accuracy due to firing a zillion rounds. I prefer my Ruger chambered in .17. Deadly accurate and fun to shoot...
But if you wanted to blow a hojillion dollars on a photogenic PET device, that would be found tomorrow.
Absolutely right, because you can market a PET scanner, or a 3T MRI. But putting up a billboard that says "1:1 ICU staffing" , or saying, "Our Nurses Wash Their Hands !" might save lives and positive affect otucomes, but it doesn't alter referral patterns, and pays the same DRG.
Another piece of advice... try to find a bolt-action rifle still chambered for the .22 short. Very, very cheap and subsonic, so not much louder than an air rifle. Still good out to about 60 yards once you hone your skillz.
The critters will get back to business much faster in the echoing hickory-and-pecan-surrounding-water amphitheatres where the hunting is best.
Apparatchik ZackAttack
Growing up, I used to use shorts to hunt bullfrogs. We had a small pond, roughly 30-60' ellipsoid. You take a flashlight, shine it over to the edge of the other side of the pond. You would get these shiny reflections that were bullfrogs. Aim at the reflection, pop!
Another piece of advice... try to find a bolt-action rifle still chambered for the .22 short. Very, very cheap and subsonic, so not much louder than an air rifle. Still good out to about 60 yards once you hone your skillz. Apparatchik ZackAttack | Homepage | 01.12.09 - 10:53 am | #
I know I am still here due to one of those evil for profit drug company studies.
If most people read the studies and saw how "efficacy" was calculated, they'd probably never take a prescription drug.
Only in America can you broadly prescribe a drug that reduces incidence from 3/2000 to 1.5/2000 and in a controlled setting with cherry picked patients no less. 50% reduction rate, Woohoo!
The most important physician in the hospital nowadays is the ED doc, because they are the first to see such potential cash cows as the r/o cardiac event, r/o stroke patients. Especially the ones with good (i.e. any) insurance. These patients subsequently could go on to get mega-imaged, and mega-workup in the hospital. Lucrative workups pay the bills for the rest of the patients ( and the hospital owned physicans, nurses, etc). Lucrative workups also reward the non-hospital owned docs who make their bones in the outpatient world, and suffer the inpatient/hospital based work only because they can generate more referrals from these admits.
Self-pay and the underinsured/non insured of course are treated the same as the rest. (ahem)
Dave of SV(Unrated) writes: \tmy sister is a doctor and she says her office has seen a measurable downturn in customers because they can not afford co-pay! Dave of SV | 01.12.09 - 10:38 am | #
Screw the co-pay... my brother-in-law just lost his I.T. job, and is looking down the barrel of a COBRA payment that's as big as his current mortgage payment. No way can he afford it... so that's a chunk of change taken out of health care. Take this story x100000 and the health-care industry don't look so "recession-proof".
Duke of Con Dao(Excellent) writes: Comrade Byzantine_Ruins... see previous thread over your Nixon Admin remarks... I usuallyy respect what you have to say but that was a 'yahoo remark'
That's fine. I'm not really going to cross steel with you over it.
Here's what I think:
I have seen enough Nixon worship by the useless failures of my generation who "grew" from bigoted, racist, entitled little white boys of poor character to bigoted, racist, entitled middle age white men of poor character.
Their fathers should have kept them under stricter discipline, told them fewer lies and infected them with less of their loathesome sense of bigoted, racist white entitlement.
Sorry about whatever your involvement in it was, be it admiration or complicity, it was a historic evil. I'm not going to take time to excoriate you for it because I'm sure you're intelligent enough to have well-justified prejudices, just like me.
Maybe you knew him and he was an honorable man. If so, you should have kept his grave better-tended, because it has become a grove of poisonous weeds.
I think you should consider why people feel the way they do about the matter -- I am certainly aware why I feel the way I do about his fans. I think it was the start of a historic compromise in the conduct of the Republic that Ford did not disassemble his retinue utterly, and what makes this error different from many other excusable errors is where we stand today and what role his memory has played in it.
I will have this argument in my elder years with those who would rehabilitate the memory of Bush II, and that too will spring from Ford's misguided mercy.
That's pretty much where it's going to stand from my side. You are welcome to agree, disagree, respect me more, respect me less. That is your choice. My perceptions are mine, my commitment to the Republic absolute, and this is part of my perception of what is necessary for the Republic.
My mother, 79 years old, english teacher and grew up in the last depression, I have asked her to set up a website on the the way she lived through GDI...To date, she has refused my requests...
Maybe the other older experienced GDI survivors may want to do so...Us youngsters, who were raised on McD and TacoB*ll, could use some assistance in survival...
More evidence that Healthcare should not be a for profit business.
With very few exceptions (e.g. U. of Phoenix), most of higher education is non-profit, yet the inflation rates in health care and higher education are roughly the same. I hate to cast such a wide net, but the only difference in the non-profit and for profit models that the non-profits have to increase their expenses as to meet their non-profit status.
This is an example of medical insurance in the 20's and 30's...My Grandfather had an extra tooth the protruded beyond the normal row of teeth...He pulled that extra tooth out with a pair of pliers...
I can not confirm this, just the family story that has been passed down...
Screw the co-pay... my brother-in-law just lost his I.T. job, and is looking down the barrel of a COBRA payment that's as big as his current mortgage payment. DCRogers | 01.12.09 - 11:07 am | #
If Illinois didn't have quasi-socialized medicine (if you had group insurance and COBRA runs out, you can get it), I'd be forced to take the first job with bennies that I was offered.
The only reason For Profit looks attractive is because they are externalizing the costs of indigent care to the not-for-profit as the following clearly reveals. Do you people really think such a For-Profit model is humane considering where we're headed, economically? So many advocates for a Banana Republic.
Maybe the other older experienced GDI survivors may want to do so...Us youngsters, who were raised on McD and TacoB*ll, could use some assistance in survival...
just a thought, if the system is collapsing... Anonymous | 01.12.09 - 11:13 am | #
Actually it is a good idea and it doesn't have to be crazy out of the blue stuff - just practical survival skillz - my Mom (depression era herself) taught all us kids how to do stuff like that... believe it or not I'll probably have the last of my thanksgiving leftovers tonight IN JANUARY - after picking the carcass I boiled all the bones to make a broth/stock (big turkey - produced almost a half gallon & pretty concentrated too) then broke it up into smaller batches and froze it to use later (since I live in Minnesota I froze it outside & left it in a 'cooler' on my porch along w/other stuff - has stayed frozen ever since)... probably using the last of the broth tonight to make soup.
People have so so many of these tricks it's almost insane not to share...
O' by the way, my very same grandpa had six fingers and toes...I know I will catch all kind of comments, but what the heck, it should provide an interesting comment or two, so fire away..
By the way the doctor removed the extra digits at birth...
Don't know if there was incest in the family line...just to cut off at the beginning, this statement...
Basel Too makes an important point re the profit/non-profit comparison of hospitals and higher education, to which I have something to add below:
Basel Too writes:
More evidence that Healthcare should not be a for profit business.
With very few exceptions (e.g. U. of Phoenix), most of higher education is non-profit, yet the inflation rates in health care and higher education are roughly the same. I hate to cast such a wide net, but the only difference in the non-profit and for profit models that the non-profits have to increase their expenses as to meet their non-profit status.
Keep in mind that there is a divide between public universities and private universities, although both are non-profit. The tuition cost of attending public universities is roughly 1/4 to 1/8 of the private universities at full price, and the private universities effectively have a sliding fee scale via financial aid.
Furthermore, the public universities are decreasingly public funded. The states have been reducing their contributions for twenty years or more.
I have not seen an inflation adjusted chart comparing public university tuition over time. But my sense is that back when Jackie Robinson's tuition at UCLA was $50 and when CUNY was free (totally free?) it was cheaper to go to college.
Basel Too-um I hate to tell you but an entities status as for or non profit has absolutely nothing to do with whether it makes a profit or the level of its expenses. Any entity that does make a profit will not exist for long. What does matter is that a non profit cannot share its profit with owners or shareholders.
GM decides to use a South Korean firm to supply batteries for the Volt car--two days after GM says they need more bailout money than $13.4 billion recently pledged. El Cliffo | Homepage | 01.12.09 - 11:25 am | #
Looks like a prepackaged bankruptcy in the not-to-distant future to me...
More evidence that Healthcare should not be a for profit business.
Morocco Bama | 01.12.09 - 10:55 am | #
Comrade Bear (tj & the bear)(Unrated) writes:
How do you deal with people that run deliberately unhealthy lives?
I have an incentive plan for them, it's called "being sick and unhealthy sucks" and "dying sucks."
The idea that supply and demand applies to free health care in the sense that people will intentionally make themselves sick to get themselves some more free healthcare is just insane. Nobody likes being sick. Nobody likes being in the hospital. Those places are uncomfortable and awful. A few crazies will smash their hands with hammers to get vicodin, a few crazies will demand to talk to a primary care doctor about their cats because they're lonely, but beyond that, there will be no line of mooching patients because having health procedures done to you sucks and is frightening.
Now, what about this guy who drives a motorcycle without a helmet, eats fried chicken despite being overweight and soforth? Those people will do that anyway, with or without free health care. Should you pay for it in a perfect system? Maybe. Maybe not.
Finally, people over-attribute illness to unhealthy behaviors. For some reason, we feel the need to attribute blame. Poor people are fat and obese not because they're lazy, but because the food they have available to them sucks. Many cancer patients and the people most hit by chronic, expensive disease aren't bad people who made bad choices, they're just unlucky. You people are insane.
Squirrel gun is the best tool. Over/under 22 short/410 shotgun. The shotgun is for nest clearing. Lots of good eats in there at the right time of year.
Off topic, but I am curious if there are any readers/contributors to this blog who remember the Great Depression (even during your childhood). You would have to be pushing 80 now... I know a couple of geriatric bloggers (not intended as derisive term), but don't recall anyone mentioned personal recollection of the bad old days in this forum.
Anonymous writes:
O' by the way, my very same grandpa had six fingers and toes...I know I will catch all kind of comments, but what the heck, it should provide an interesting comment or two, so fire away..
Extra digits is a common feature in inbred communities, doesn't take much to do it. There's a town in New jersey called Dover that had been around since colonial days, but was relatively isolated until the Government built what became Route 46. Used to be lots of 6 fingered folks, but any relations were distant ones.
Exactly, Canary. Do you people really want the likes of Hank Paulson calling shots on your healthcare? Where do you think that will get you. Collateralized Debt Obligations on people's lives. Betting on health outcomes.
I expect Viatical Insurance to be a booming business in the years to come as people cash in early on theor lives in order to maintain their superficial, materialistic lifestyles.
Squirrel gun is the best tool. Over/under 22 short/410 shotgun. The shotgun is for nest clearing. Lots of good eats in there at the right time of year. Bob | Homepage | 01.12.09 - 11:29 am | #
You leave a lot of meat up in the tree uncollected when 'nest clearing' - not a respected way to hunt in my part of the world. Not judging, just sayin'...
Hoopajoops, LTD(Excellent) writes: The idea that supply and demand applies to free health care in the sense that people will intentionally make themselves sick to get themselves some more free healthcare is just insane.
No no, he's selfish and wants to enforce a schedule of lifestyle choices on you that minimize your carry expense to him.
I remember the depression. They talked all about it in that movie, Kit Kittredge. In the end, it worked out good. Plus, Mommy bought me the doll and clothes. Only $450 !
I went to a Catholic school in the south, and I can relate to dealing with tons of smooth-handed racist white boys (and girls I might add).
Nixon started a party that has yet to tragically (finally) end. We have gone on a serious bender...
The funny thing they say about addiction to various prescription drugs is that the length of time you're on the slide roughly corresponds to the time you'll spend depressed and malaised afterward.
Morocco Bama writes:
Exactly, Canary. Do you people really want the likes of Hank Paulson calling shots on your healthcare?
I see this the other way around.
Hank Paulson IS and HAS BEEN calling the shots on the economy (and thereby everything else) because the majority of the population has been scared into thinking that taxing the rich and providing public services and offering universal health care is evil socialism.
It is time to throw out not just Bush and Cheney and Paulson, etc, but the bogeymen they used to scare the majority into voting for tax cuts for the rich.
Off topic, but I am curious if there are any readers/contributors to this blog who remember the Great Depression (even during your childhood). You would have to be pushing 80 now... I know a couple of geriatric bloggers (not intended as derisive term), but don't recall anyone mentioned personal recollection of the bad old days in this forum.
ztexas | 01.12.09 - 11:31 am
My FIL was a kid and boy does he tell stories. They did very well for themselves because they lived on a farm. They could grow their own produce, milk their own cows, and they got extra gas rations they used to send mom to work for the extra cash to make ends meet.
I don't believe Americans as a society could live like that for long.
dryfly(Unrated) writes: A lot of hospitals added capacity like crazy the last few years - especially in high fee 'boutique' market niches... imaging, intensive cardio, cancer therapy, major surgical - etc. They tried like CRAZY to close ERs and primary care as they are money losers. Now with the economy tightening and companies cutting back on insurance & insurers challenging reimbursement... the hospitals face (1) fewer patients and (2) contested payments at the sametime their capital costs have skyrocketed.
And they are surprised??? Only one word applies: Hoocoodanode.
You see a lot of hospitals in the same area with competing specialty centers, leading to overcapacity. The problem is that the nonprofits are being run like profit-making businesses, leading to oversupply and, eventually, disaster. Instead of the $$$ for medical facilities in region being spent in a coordinated manner.
I wonder what will happen to Sutter Health, the giant "nonprofit" health conglomerate that's dominating over Northern California healthcare. For a "nonprofit" it's pretty damned predatory about moving into new territory and trying to outcompete the existing profit- and non-profit hospitals and clinics.
um I hate to tell you but an entities status as for or non profit has absolutely nothing to do with whether it makes a profit or the level of its expenses. Any entity that does make a profit will not exist for long. What does matter is that a non profit cannot share its profit with owners or shareholders.
Canary- You conflate tax exempt 501(c)(3) status with nonprofit status, which is strictly a creature of state law, and not the federal tax code. Nonprofit status, especially in the healthcare context, is more than just taxation.
Off topic, but I am curious if there are any readers/contributors to this blog who remember the Great Depression (even during your childhood). You would have to be pushing 80 now... I know a couple of geriatric bloggers (not intended as derisive term), but don't recall anyone mentioned personal recollection of the bad old days in this forum. ztexas | 01.12.09 - 11:31 am | #
Me either - mostly get second hand stuff from kids of depression babies - like myself. I'd love to hear recollections but I only get that from my in-laws [in their 80s and they don't blog - they barely email]...
It would be great to hear more first hand recollections from a wide swath of the population... this round of difficulty will be somewhat different but it never hurts to hear how previous generations solved similar problems... better than having to reinvent the wheel over and over.
[Barney] Frank wants at least $50bn of the Tarp funds to be used to help homeowners via loan guarantees or incentives to encourage loan modifications. . . AND. . . Eliminate government profit sharing of appreciation over market value of home at time of refinancing.
The New Yorker profiles him in the January 12 issue saying, among much else,
"But in Congress he is thought of no longer as a liberal of the old school (which he is) but also as a grind. His expertise is in one of the least glamorous subjects on the national agenda - housing, particularly rental housing for poor people - and he is using that knowledge to confront the nation's economic crisis. 'For Barney, the question has always been: What works? What can government do to see that people have the decent necessities of life?' his sister Ann Lewis, the longtime Democratic activist, says. 'Now he's right there. Barney's been preparing for this moment for his entire life.'"
Well if that's a fair appraisal of Representative Frank, and particularly of the focus of his expertise, I think many of us will recognize the problem.
Dentists still use pliers. And the cocaine they give you is basically the same your grandpa used.
1 currency soon [yogi] | 01.12.09 - 11:24 am | #
Great Grandpa - had some of that old school health insurance - he cut his leg pruning a tree, it got infected...doctor made a house call, his oldest son (Grandpa) helped hold him down on the kitchen table for the amputation.
Repeat it often enough, and it becomes true. Just like "real estate never goes down, they aren't making any more land etc."
Dr. Feelbad | 01.12.09 - 10:20 am | #
correct. the masses require a new mythology of a secure path to wealth now that the dream of achieving riches by doing nothing but living in your own house and working a middle-class 9-to-5 have been dashed against the rocks. and predictably people will pour into the market since everybody has the same clever idea at once.
Off topic, but I am curious if there are any readers/contributors to this blog who remember the Great Depression (even during your childhood). You would have to be pushing 80 now... I know a couple of geriatric bloggers (not intended as derisive term), but don't recall anyone mentioned personal recollection of the bad old days in this forum. ztexas | 01.12.09 - 11:31 am | #
Hardly anybody here that old -- 1929er, maybe, but I don't see him around. My mom had to leave school and home in eighth grade and make her way as live-in kitchen help or mother's helper in homes and ranches. Her mom kicked her out of the house because her husband had died and she'd hooked up with a new guy who didn't want anyone else's kids around. So Grandma took care of herself. Life was hard, and so were people. My father's family were Okies, and they did indeed lose their farm and flee the dustbowl in the '20s; he was five years old when that happened. They did have a few bucks set aside and managed to buy a little land out in the Central Valley that they could subsist on while the sons and daughters went out to work as they could.
My mother from the depression (79)has a lot of stories about the depression in Iowa...
She is more than happy to provide them to me...since I am interested...
In the future, If anyone"s interested, I will forward to you all...
One story she has provided(around 8 y-o), was that my grandpa, her father, living in Iowa, was a born and bread republican...During the Depression, he voted for the first time and every time for a democrat until the day he died in the 1970's...
Talk about the bubble of all bubbles...health care spending and health care salaries. Eventually, there will be a choice between making MDs, PAs, RNs, and drug companies rich, and dying sooner than planned. In California, they welcome illegal aliens through the doors because they're very profitable patients- paid for by the California taxpayers. Illegals even have a special line in the emergency room, because they assume that they have no medical insurance. Go ahead BHO- give them all "free" health care. While you're at it, give the entire world "free" health care. You might as well, because they're all coming here.
My grandfather left school to 'work' for the family as a teen during the depression. He 'gigged' snapping turtles in the river for food and pay.
Just takes a stick in one hand and an adequate weapon in another (blunt object or 'gigging spear'), get the turtle to attack the stick and a quick poke does the trick (unless you have some aggression issues then the blunt object I guess).
From what he told me, turtle meat is quite tasty and Turtle soup was a pretty common meal "back in the day".
*
Re: Healthcare. We took our son in for a visit to the pediatrician. He has asthma that flares when he catches a chest cold. Our ped. was busy so one of the founding partners of the clinic treated him. She told my wife that her son also had asthma and thought she should explain to my wife what the condition was, plans, etc. Of course we had a son with the condition, and knew what asthma was as -uh- we had been treating at this location for a little over 2 years for it.
My wife found the experience odd, then we get the bill. On top of our regular charge for a routine office visit was a fee for $400 bucks. When we inquired with insurer they stated that the physician had billed for excessive time. We then called the ped's office and were informed that anyting over 10 minutes in client contact generated an extra (flat) charge!
So the doctor giving unsolicited, unnecessary 'advice' for about 15 minutes generated at total bill of 800 dollars.
My depression MOM, has told me, that in Iowa, Hotel owners/managers would not rent to bankers apartments above the 2nd floor, because they were jumping out of the windows...
Just what she remembered and it has been a long time ago and not sure the percentage doing so...
dryfly writes: A lot of hospitals added capacity like crazy the last few years - especially in high fee 'boutique' market niches... imaging, intensive cardio, cancer therapy, major surgical - etc. They tried like CRAZY to close ERs and primary care as they are money losers. Here in Southern California, a particularly high-stakes version of "E.R. hopscotch" is played out as all the different hospitals want to avoid being the "closest" E.R. to the 'hoods, where the ambulances helpfully transport large numbers of uninsured, high-cost patients to the "nearest" hospital in a continuing stream. "Nearest" is all that matters... hospitals try hard to close a branchs on the edge just to re-open a few miles in a safer direction (that is, a direction that has another hospital in-between, to act as the legal catchment.)
The process has continued so long around L.A.'s famed "South Central" and Compton that their nearest E.R. is now in Irvine, in neighboring Orange County. (Must make for some long, tense, ambulance rides on our famously congested expressways!)
Lets not forget bad debts as folks cannot pay and the home the hospital expected to get as settlement is not worth much.
I am not sure if credit cards will do charge backs to the medical community as folks cannot pay credit cards or chose to limit credit.
On the other side, the pay in advance doctor's offices that check credit before hand will not have bad debt but much fewer customers and they reject folks.
Asthma you say...what a joke that is. In the Northern California valley, the air is so bad that nearly 1/2 of kids have asthma. Instead of determining the root of the problem, parents just blindly give their children steroids to inhale. Steroids that are known to stunt growth and who knows what else (just look at Arnold). Our son had a persistent cough that improved considerably when we vacationed in upstate NY. Upon returning to CA, it worsened. They prescribed him the same toxic-inhalator that they prescribe everyone. We eventually figured out he was eating too many Cheerios and removed it completely from his diet. The cough (which lasted several months) cleared up within a month and never returned after being an issue for 3-4 years. We also kept a humidifier in his room for dry spells (common in CA), which helped coughs from colds to break-up faster. Most childhood illnesses can be attributed to what they eat and their environment.
In California, they welcome illegal aliens through the doors because they're very profitable patients- paid for by the California taxpayers. Illegals even have a special line in the emergency room, because they assume that they have no medical insurance.
I'll say it again. The notion of an E.R. as "emergency care," is quaint, but not accurate. It's mostly a walk-in clinic, used by people paradoxically smart enough to know how to game the system. The dumb masses who have health insurance and/or a legitimate need end up waiting endlessly as they keep getting triaged to the end of the line by desk workers.
There is a reason ER docs burn out so fast and spectacularly.
dryfly(Excellent) writes: \tDoes anyone have recipes to take the wild taste out of squirrel for future reference... Anonymous | 01.12.09 - 10:34 am | #
It's 'game' it is going to taste 'gamey'. Get used to it.
\t dryfly | \t \t \t \t01.12.09 - 10:39 am | # dryfly | 01.12.09 - 10:39 am | #
Remove all of the fat, and throw in a little bacon fat to replace. This trick works for squirrel, and especially raccoon. Seriously! You could also soak it in milk or baking soda to tenderize it.
In California, they welcome illegal aliens through the doors because they're very profitable patients- paid for by the California taxpayers.
Riot Grill | 01.12.09 - 12:02 pm | #
money soon to be replaced with IOUs. it doesn't take much brilliance to figure out how that one's going to work out. the term "paid" will have to be redefined.
My grandparents both lived through the GD. It definitely had an impact on the rest of their lives - nothing goes to waste (saving and reusing aluminum foil,) distrust of the stock market and banks, etc. And my grandpa HATED rabbit. Had to eat it too many times, he said.
I remember that they said they used to (this seems silly) each bring a tablespoon of coffee down to one neighbor's house and brew up coffee for their domino session. I guess it was the only way to ensure everybody did their share with no excuses.
First, neither she or I had been to the doctor in maybe 5 years. Aside from the time I had some x-rays because of straining my arm and blood pressure, etc and her because she thought she had some kind of virus/flu symptoms. Plus routine stuff like physical, dental, new glasses. In short, preventive medicine (we do have very good insurance).
Second, we haven't been to a fast food place during that time either. Also, both of us are very careful in our diets, both have each (on purpose) lost 10 pounds or so since retirement, stay fit, exercise (to a limited extent).
I wonder if there is any relation between the two. I suspect so.
I learned a lot from depression folks as a young person. Government did crap for them and reality the paid zip in taxes as well. Sadly today I see young people in a warped reality of government owing them something especially protection from themselves. Sadly Government is just as lost trying to give it to them. The poor are not Royalty. Poverty is the reason to study and work hard to escape the Gators bite. What are we getting for our education investment of $120+ K-12 public education? OB wants to spend more. I want what I paid for first.
Eventually we're going to end up with some combination of privately- and publicly-financed health care. Now would be a good time for Uncle to start building hospitals and clinics, as government takeovers of existing facilities could prove awkward.
Oddly, the depression era folk with whom I talked said that eventually - once the stuff got going - government did indeed do things that helped them. What sucked was the period from about 1928-1933 -- BEFORE all the government help got started.
Heh...yeah, it's kind of hard to get an MRI when you're laid off and don't have insurance.
bobn - Love the TJ quotes...dead on...and you're right, it is an old game, as old as the Republic.
This "private government" stunt (government of by and for private profit) was first pulled off by the Federalists - Jefferson's opponents - who were, in so many ways, the same set of interests that make up the business wing of the GOP (the rest of the GOP are the useful idiots wing).
Another Great Depression story.
Both sets of grandparents left Los Angeles for lack of work and joined other family members in purchasing or leasing orchards in the IE. Most lived and worked on the farm, the others took what work they could find. One was a butcher at the local grocery store. No squirrels for them, even with rationing. They grew most of what they ate.
Bunch of comments from me. Re medicine/hospitals: I read that people are cutting back on elective surgery (not willing to spend money at this time). Also, hospitals in certain states like California and Florida have a high percentage of illegal aliens and poor people who can't/don't pay for services. If there isn't enough money available then hospitals aren't going to spend huge amounts on fancy new equipment.
As for general costs, I complained to my doctor about being charged $200 for ONE shot. (This is a very large HMO in northeastern PA.) He said he has no idea what ANYTHING costs a patient because of the dizzying insurance programs that he can't possibly keep track of. Then I argued with the main office over the price because I knew they were charging me more than they would charge an insurer because I did not have any insurance coverage. They would not lower the price and even fought with me over a payment schedule--they didn't want to give me one. So I pretty much told them to fuck off and they'd get paid when I felt like it. I sent them $25 a month.
Now that I have Medicare, the doctors are trying to send me for all sorts of tests, whether I want them or need them. So they're finding new problems I didn't know I had. But when it comes to prescriptions, now I check out alternatives before I decide to fill them. For the last one, for a statin drug for cholesterol, instead I took a cheaper supplement called Red Yeast Rice (with no side effects) and it lowered my cholesterol by 25%.
Now about survival skills: I can knit, crochet, weave and spin my own yarn. But it takes a lot of work; it's easier to buy clothes in a thrift shop. I have friends who make their own liquor (the stuff is fabulous); it's not hard to do but takes time. I also do canning, and I grow certain foods via container gardening. Again, it takes time and energy. Anyone who has studied the pioneers knows that all their efforts went into just surviving the elements. Food, fuel and shelter were the main priorities.
I don't know if the average person, used to fast food restaurants and living in sound bites, is willing or able to go back two hundred years. And doing these "survival skills" costs money. You need a lot of equipment for canning and those big pots take up a lot of room. To make your own liquor you need two glass carboys plus equipment. However, once you get past the initial outlay, you can do very well for yourself.
Well, I am certain that if we are all covered by universal health care, and it costs little to be insured for medical problems with an early retirement, you will see massive numbers of doctors over 55 retire when this comes around. Period.
But if you wanted to blow a hojillion dollars on a photogenic PET device, that would be found tomorrow. \t Comrade Byzantine_Ruins | \t \t \tHomepage | \t01.12.09 - 10:48 am | # Look, western medicine is practiced using the principals of evidence based medicine. Controlled studies are done with a specific purpose to delineated efficacy of a new drug or imaging procedure. By doing the study with sufficient staticial power to validate the out come as staticially significant. Let's take PET scanning, the modern equipment from GE costs $1-2MM, paid as a lease with service, upgrades and maintainance included. Many well controlled studies have shown that PET scanning for certain types of cancer changes the staging 30% of the time. So if you have a lung cancer patient that was staged as curable by conventional means and gets a PET scan that shows distant metastases, you will save that patient the pain and suffering of going throught surgery, chemo, follow up studies... and instead put them on a tract of palliative care, quality of life focused. Saving the patient unnecessary procedures and their insurance company/Medicare tens of thousands of dollars. Over utilization of imaging can be a problem, but most of that is from CYA, medico-legal issues and patient demand from their doctors for the latests/most modern treatment.
Following is an email we received from my husband's folks. Mid-80's. Pertinent to the subjects be discussed here.
"We are keeping the doctors busy. If it was not for Medicare we would have gone under. Of course if the doctors knew you didn't have Medicare and insurance they would not find as much wrong with you. Take Versie to Beaumont Monday the Next day I have one with the doctor whose been working on my plumbing. Go to V.A. on the 30th.Versie has appointments with two different eye doctors next month. We have become a nation of pill poppers, but we are living longer. We would like to make a trip out there next summer. Maybe our new president will send us a little money. He is bailing out every body else. The last depression we had plenty to buy but no money. The next one will have money but nothing to buy. I had better quit before I start crying. Let us hear from you."
People have mentioned slowdown in hospitals' fee-for-service receipts, but consider too the slowdown in "charitable" donations to hospitals, which many hospitals depend on heavily.
Health care is weird - recessions are marked by significant cost increases for many reasons, the spike peaks just as the recession ends and then prices fall, often too far. Every business is putting a hold on capital expenditures - keeping the $ in the bank just in case....
I ate fried frog legs 20+ years ago on a trip to the Okefenokee Swamp. They were okay...like really small chicken legs. I've wondered about some of the tempura dishes I've ordered since then.
My grandparents told a lot of Depression stories. All the adult children on one side along with their spouses and children in a couple of cases moved back in with my great-grandparents so that they had 15 people under one roof.
My grandmother told me about eating "ketchup soup" which was obtained by ordering a cup of hot water at a restaurant and pouring ketchup into it.
When my grandfather died in the 80s, I was charged with cleaning out his closets. I found a large box full of condiments from fast-food places in one. I asked my grandmother about it. Evidently despite a long and relatively successful career followed by a comfortable retirement,he was still hoarding stuff like that 50 years later out of fear that it would happen again.
Riot Grill, there is a lot of CYA as malpractice premiums esclate and cost of litigation increases. Patient satisfaction is also very important in maintainging the physicians reputation in the community, so the MD has to cater to the patient's demands to a certain extent. Most subacute clinic visits by patients can follow a script that includes epidemology, i.e. what flu is going around, info is obtained from the CDC, how old is your patient, co-morbidities, and a usually successful out come is achieved in one visit; "you have the flu, drink fluids, take tylenol for your fever". ER is a different animal, huge money looser as the uninsured go here. They are the most scriped subspeciality out there as chest pain, stroke, trauma all follow preset flow charts. Its the few cold hungry homeless, and uninsured "clinic visits" that cost the system so much money. OB/Gyn is one of the most litigated subspecialities as one bad outcome "baby" can cost millions in future payments to the malpractice carrier. But a pregnant couple that have a relatively normal gestation and delivery all follow a script of office visits, ultrasound, advice... This is why the nurse midwife/nurse practioner/nurse anestasis model works so well.
"This is why the nurse midwife/nurse practioner/nurse anestasis model works so well."
Exactly. Run the script, follow the algorithm. So much of medicine is reduced to this approach, for better and for worse.
Better : you don't need to engage the system every time your child has the sniffles...you go to the minute clinic at Target and done/done.
Worse : Natural childbirth in a tub of warm water with your shaman and NP standing by. Works great except when it doesn't. Then you need a real doctor with specialized training in a high tech hospital that you can sue into next week.
Some times, bad things happen to good people for no reason. When they do, you need a fall guy/girl. And if that person has an M.D. after their name, more's the better.
Heathcare and government remain the last 2 bubbles. For healthcare the solution will include doing less things to more people, especially the elderly. Letting nature take its course is occasionaly a humane option. Means testing will also occur so that all that lifestyle care for rich old people will no longer be free. Free hips and knees for all. End it now. Government will shrink only with the destruction of the economy. This may have already begun.
My wife is a RN and employed at a local hospital. Most area hospital systems have hiring freezes even though you keep hearing that there's a great need for nurses.
My RN wife also thinks that not everyone should get the same level of care. She thinks people should be told how much the procedure's would cost and they should pick. She goes against the everyone's entitled attitude that's typical in that enviroment.
She tells me all the time about the 'regulars'. People who are there so often for 'pain'. They bring personal effects from home and setup their rooms with family photos and stuff. We are very conservative but we both believe this is where they'd be better off at home smoking some pot for their 'pain' rather than occupying a hospital bed at $900 a day.
What the feds need to do is subsidize cigarette smoking. With the states all umblically tied to the tobacco settlements of a decade ago, while at the same time, strapped for cash to fund Medicaid, etc., it would simultaneously juice revenue and decrease Medicaid expenditures (through decreased life expectancy of the smokers.)
Does anyone have recipes to take the wild taste out of squirrel for future reference...
Anonymous
It's 'game' it is going to taste 'gamey'. Get used to it.
dryfly"
Game needs to be marinated. Recipes abond, and it is an art form... classic cooking in "old Europe". Excellent with an old Bourgogne wine, err sorry I guess that will have to be left out in the present circumstances:-))
but why do you guys have to eat meat? anyone here is a vegan? I am not but I seem to eat like one (lentils do just fine)
Morocco Bama writes:
If the hospital isn't getting paid, something has to give.
HG | 01.12.09 - 3:04 pm | #
That would be life expectancy.
Morocco Bama | 01.12.09 - 3:17 pm | #
not necessarily- hospitals are where those really nasty drug resistant bacteria hang out. Maybe if we stop buying all the latest equipment we can get back to real health care.
I work as a doc in a big east coast specialty hospital: 1. Business is booming. People sicker than ever. Some pressure on payor mix, only a little more than usual. 2. Capital spending is shut down for the entire health care system that my hospital is in. Tens of millions of spending not gonna happen. We are told that it is because of reserve losses related to the market, not decreased revenues. 3. It is ILLEGAL for hospitals to coordinate care and funnel patients to chosen providers. Laws passed by Congress (thanks mr. Stark). Patient "choice" pre-empts coordination among instiutions. Write your rep.
Hospital Capital equipment in my 4 hospital system basically froze in Q4. Cancer patients are stretching out the time between CT Scans and MRI's and they are cutting back in other ways- healthcare is not completely inelastic.
More uninsured patients are seeking care. Medi-Cal (every Medicaid program for that matter) doesn't even cover the cost of care of those patients.
HealthCare may have been recession -proof in the past, but like real estate and CDO's, past performance is no guarantee of future results.
Regarding Depression-era health care, there is a chapter about health care in a Depression-era memoir called "Little Heathens" by Mildred Kalish. Absolutely everything they could take care of at home, they did. The author even got treated for what they thought was a blood infection, at home.
I'm a mom of three little kids, and they used to go to the doctor a lot for normal things: well child visits, ear infections, coughs at night interfering with their sleep. Now they have all of their immunizations and they don't get sick quite as often. Also, we have a health care savings account with a big deductable, so it's more obvious that we (and not the insurance company) are spending the money on those little items.
We go to the doctor a lot less now. Now the doctors say that most ear infections are viral and go away on their own, so you just treat them for pain at home. Honey is a great cough suppressant. Studies have shown that it does better than some over-the-counter cough medicines. Gargling salt water and cayenne is supposed to be good for sore throats. The internet is a big help in finding home remedies. The internet can also help you to know whether or not a condition is something worth going to the doctor about. You can look up symptoms online, and if you find out that it's nothing to worry about you can save your money.
Sounds "shovel ready" to me.
Bueller?
What, people stopped to read the article or something?
ever been a better time to buy and sell livers.
Hospital CapEx ended Q4 because of who is going to be sitting in the White House in a week.
FWIW -- Our local Regional Medical Complex Of Unlimited Ambition appears to be part of this trend. They closed a unit and are using the staff as floaters, are cutting casual employees, slashing overtime, etc. Non-medical staff I know have seen several scythings already.
My feeling is that they both blew up the endowment and got themselves into all sorts of trouble trying to be geniuses of structured cash flow management. I expect they'll be going to the (soon to be bankrupt, natch) state in about 6-9 months to beg for money.
We need to use some TARP funds to subsidize Big Macs for everyone, preferably with a dose of E Coli.
Also, perhaps we should bring back cholera and diptheria to get the economy humming again.
Medical spending is recession-proof
Medical-related jobs are recession proof.
People don't stop getting sick.
Non-profit hospitals are a great business model.
Repeat it often enough, and it becomes true. Just like "real estate never goes down, they aren't making any more land etc."
Doe sthis mean big pharma is going to have trouble in 09 or is it just the hospital with a shortage of equipment needed to provide services?
In Western Canada, on Boxing Day, not a single ship of the Seaspan fleet was chartered. That's the first time this happened in 40 years. Seaspan controls all the towing of pulp mill good and services, as well as other resource goods in Western Canada. I talked to a friend of mine who has worked there for 20+ years and he says business is flat on its ass.
Recently talked to three hospital adminstrators in midwest and all were experiencing layoffs and low patient count. I asked if they thought it was recession related and all agreed they thought so. All are looking for major cuts in their budgets.
popeye, what exactly did you buy and then double up on when you pulled the stops ?
I don't know, Dr. Feelbad.
William W. McGuire, CEO of UnitedHealth Group) received compensation of $124.8 million in 2005.
Some medical spending seems to be humming right along. See you in the E.R.!
The US cannot afford to continue spending 15% of GDP on health care. This number may come down through change in government policy, or simply though market mechanisms, but come down it will.
Thomas Jefferson on Bank-Driven Real Estate Bubbles, courtesy of Wikiquote:
Letter to John Adams (7 November 1819):
We were laboring under a dropsical fulness of circulating medium. Nearly all of it is now called in by the banks, who have the regulation of the safety-valves of our fortunes, and who condense and explode them at their will. Lands in this State cannot now be sold for a year's rent; and unless our Legislature have wisdom enough to effect a remedy by a gradual diminution only of the medium, there will be a general revolution of property in this state.
Letter to William C. Rives, 1819:
Certainly no nation ever before abandoned to the avarice and jugglings of private individuals to regulate according to their own interests, the quantum of circulating medium for the nation -- to inflate, by deluges of paper, the nominal prices of property, and then to buy up that property at 1s. in the pound, having first withdrawn the floating medium which might endanger a competition in purchase. Yet this is what has been done, and will be done, unless stayed by the protecting hand of the legislature. The evil has been produced by the error of their sanction of this ruinous machinery of banks; and justice, wisdom, duty, all require that they should interpose and arrest it before the schemes of plunder and spoliation desolate the country.
We are being totally played - and the game is very old.
Bruce(Unrated) writes:
Doe sthis mean big pharma is going to have trouble in 09 or is it just the hospital with a shortage of equipment needed to provide services?
Hospitals in America are so ludicrously overcapitalized and wasteful that it really beggars the imagination.
The only shortage of equipment that the regionals experience will be a reduction in planned growth reported as a capital shortfall.
I would expect the hammer to really fall on things like medical supply, big pharma, insurance, etc. The actual hospitals will be fine, their suppliers not so much. My feeling -- and maybe dryfly can explain otherwise if I'm offbase -- is that regional consolidation has left people up the supply chain vulnerable to consumer-side renegotiation.
bobn | Homepage | 01.12.09 - 10:23 am | #
A year and some back there was a regular poster here with the handle "engineered depression" - fits.
Frank wants at least $50bn of the Tarp funds to be used to help homeowners via loan guarantees or incentives to encourage loan modifications
AND
Eliminate government profit sharing of appreciation over market value of home at time of refinancing.
http://www.house.gov/apps/list/press/financialsvcs_dem/hr384.pdf
Any spending is only recession-proof to the extent that there is someone willing and able to pay for it. As people lose jobs or take cuts in wages and benefits, both "willing" and "able" decrease. For some, a lot of procedures and medicines will start looking non-essential; for others, even essential care will simply be unaffordable.
A lot of hospitals added capacity like crazy the last few years - especially in high fee 'boutique' market niches... imaging, intensive cardio, cancer therapy, major surgical - etc. They tried like CRAZY to close ERs and primary care as they are money losers. Now with the economy tightening and companies cutting back on insurance & insurers challenging reimbursement... the hospitals face (1) fewer patients and (2) contested payments at the sametime their capital costs have skyrocketed.
And they are surprised??? Only one word applies: Hoocoodanode.
This is the direction I see Universal health care going. No profits stop advancement and equipment.
"Just let them bleed out. Come back in 5 minutes and they should be dead. Save the company thousands"
Hospitals in America are so ludicrously overcapitalized and wasteful that it really beggars the imagination.
Comrade Byzantine_Ruins | Homepage | 01.12.09 - 10:24 am | #
Worse yet - misallocated capital.
Anecdotes I am hearing is people are either not paying or slow paying their hospital bills causing cash-flow problems. At the same time they are experiencing greater demand from un-insured patients.
Watch your fingers. VIX is climbing fast.
I remember in the '80's many small hospitals either closed or were absorbed by university medical centers and "non-profit, religious affiliated" conglomerates. In fact, for the last twenty years, hospitals have been seesawing in ownership entities. Add in the HMO's blood-laden paws of grabbing a piece of the divvied-up patient population and hospitals. Universal care will revive the hospital systems. Health and malpractice insurance on the otherhand will be DOA.
Plenty of "recession proof" theories going into the waste bin right about now.
It would be more comforting if the language was less conditional...
Russia 'to resume gas supplies'
Russia will resume pumping gas to third countries via Ukraine from Tuesday morning, following the completion of a monitoring deal, the EU says.
The Czech presidency of the EU made the announcement following the signing of a deal by Russia, Ukraine and the EU.
Hundreds of thousands of people in Europe have been left without gas since Russia turned off the taps over a contractual dispute with Ukraine.
Despite the deal, it may be some time before supplies return to normal.
BBC Europe Business Reporter Ben Shore says that in theory supplies could return to normal within 24 hours but a more likely time frame is 36 to 48 hours.
The news of a deal will come as a relief for countries such as Serbia and Bulgaria which rely almost entirely on Russian gas, delivered through Ukraine, to heat their homes, our correspondent says.
However, the row between Ukraine and Russia has further underlined the vulnerability of Europe's gas supply, he says.
International monitors
Alexander Medvedev, deputy chief executive of Russian gas giant Gazprom, told a news conference in Brussels: "If there are no obstacles... gas supplies will be restarted at 8 o'clock [0700 GMT].
"[We] will all hope it will happen tomorrow."
BBC NEWS | Europe | Russia 'to resume gas supplies'
did anyone listen to W give his last press conference. The guy was dropping the "depression" word like Jas Jain.
Remember Big Franks previous housing bill?
HUD Chief pukes on Frank:
"What most people don't understand is that this program was designed to the detail by Congress," Preston said. "Congress dotted the i's and crossed the t's for us, and unfortunately it has made this program tough to use."
"The three-year program was supposed to help 400,000 borrowers avoid foreclosure. But it has attracted only 312 applications since its October launch because it is too expensive and onerous for lenders and borrowers alike, Preston said in an interview."
Frank pukes on Bush:
"Rep. Barney Frank (D-Mass.), who helped steer the HUD program through Congress, said some of the federal bailout money should be used to revamp it. Frank acknowledged the initiative has its problems, but he blamed them on the Bush administration."
"That's partly their fault," said Frank, chairman of the House Financial Services Committee. "The administration was critical of the program and kept putting pressure on us to make it cheaper and more restrictive. . . . If it hadn't been for the Bush administration's opposition, we would have written it in a better way in the first place."
HUD Chief Calls Aid on Mortgages A Failure - washingtonpost.com
Big Frank is never responsible for what he does because its all Bushs fault.
This is interesting because medical spending is frequently considered recession proof
Which is a crazy notion given our crazy non-system of health care/health insurance.
From earlier threads, but interesting...
My mother, still alive and 79 years old, talked to me this weekend about Squirrel stew/soup...I thought she was joking...I suggested that between the fur, skin and bones that there wasn't much left...
She grew up in Iowa during the depression, and she said that squirrel was tasty, but had a wild taste, something like rabbit and deer...
Does anyone have recipes to take the wild taste out of squirrel for future reference...No shotgun use anticipated...
No squirrels, however my HOA has a lot of possum and mice that might help to flavor the old pot...Beats stone soup...
I would expect the hammer to really fall on things like medical supply, big pharma, insurance, etc. The actual hospitals will be fine, their suppliers not so much. My feeling -- and maybe dryfly can explain otherwise if I'm offbase -- is that regional consolidation has left people up the supply chain vulnerable to consumer-side renegotiation.
Comrade Byzantine_Ruins | Homepage | 01.12.09 - 10:24 am | #
I think you are right EXCEPT for things like surgical equipment & devices (think laproscopes, defibrillators and such).... but in general 'Class Two' and lower devices & supplies are pretty much a commodity now & controlled by large buying 'cooperatives'... the suppliers have very little pricing power & margins are terrible. For the top tier stuff (surgicals & devices - the surgeons & specialist approve & the suppliers still get good money for superior product but they have to jump through a lot of hoops to prove it).
The health care system is a joke.
E.R.'s are treated as de facto walk in clinics for the uninsured and insured. It's easy enough to game the system that any unemployed moron can figure out to say they have crushing chest pain, or visual changes and buy themselves an admission from the beleagured E.R. doc who just wants to turf their GOMERS to whatever service they can. And these are the same docs under competing pressures to upcharge based on complexity of visit by admin, complete the entire workup in the ED so that hospital stays are down. Result is sky-high 10k work ups on bums complaining of headache trying to get out of the cold. Meanwhile, true emergencies, broken bones etc sit in the waiting room, hour after hour because there are no beds. And in the end, you just refuse to pay your bill as a negociating tactic to get a nifty 10-25% cut from the provider. Like Colt 45, it works every time.
The system is collapsing further every day. Anybody who works in healthcare watches it happen daily and will agree.
Chinese cooks, according to a recent NY Times article, soak fish in wine and other spirits before cooking solely to remove the "fishy" taste. Maybe there is a way to pre-soak wild meats in order to remove the "wild" taste.
Or serve with juniper berries, the traditional way to counterbalance the wild flavor.
It has taken about four or five years to bring down Mainstreet in my County.
We did'nt see the cliff diving that is seen in some towns and cities.
The hospitals began to have problems with Medicaid tighting along with layoffs from manufacturing.
No jobs no insurance no healthcare.
It seems a little early to extrapolate from Hologic to health care in general.
Hologic, Inc. is a leading developer, manufacturer and supplier of premium diagnostics, medical imaging systems and surgical products . . . .
I wonder if Hologic also makes the machine that goes ping:
YouTube - Monty Python - Hospital Sketch
I always wondered about that.
my sister is a doctor and she says her office has seen a measurable downturn in customers because they can not afford co-pay!
Does anyone have recipes to take the wild taste out of squirrel for future reference...No shotgun use anticipated...
Any game meat needs to be aged. Too often it is shot, butchered and cooked. I prefer to age the meat in a refrigerator for two weeks (or walk in cooler for large game) before consumption. Additionally, you can soak the squirrel meat in a weak brine solution to improve taste. If properly prepared, it has a reasonable flavor....
Does anyone have recipes to take the wild taste out of squirrel for future reference...
Anonymous | 01.12.09 - 10:34 am | #
It's 'game' it is going to taste 'gamey'. Get used to it.
Squirrel + vinegar + warm percolator = complaints from other dev team members.
Wow, serious discussion on squirrel meat.
Meanwhile, perhaps the hospitals were making a bit more money on "elective" procedures than generally realized, and those are evaporating with the economy?
Growing up in Southern MN, not during the depression, I can tell you that a squirrel that has been living on corn from the corn crib does not taste wild and makes a nice meal for a family of four. Cottontail rabbit is good too.
Use a .22 rifle; cartridges are much cheaper and you don't risk your teeth on lead pellets.
Ex-Gov. Huckabee squirrel recipe was fried in a popcorn popper w/butter,salt and pepper
Use a .22 rifle; cartridges are much cheaper and you don't risk your teeth on lead pellets.
Paul | 01.12.09 - 10:42 am |
Word. Once I sank my teeth into some pellets in a pheasant. Not pleasant.
I'm waiting for the long pig recipes myself. Probably going to be the easiest protein source in the case of major doom.
Looks like some scrutiny may be in order. Where is Conjure? He can evaluate the merits of the prognosticators, assign blame and dole out the proper punishment.....
Why So Little Self-Recrimination Among Economists? « naked capitalism
Comrade Byzantine_Ruins... see previous thread over your Nixon Admin remarks... I usuallyy respect what you have to say but that was a 'yahoo remark'
[vor writes:
Anecdotes I am hearing is people are either not paying or slow paying their hospital bills causing cash-flow problems]
Fed govt mandated critical care funded by states at a time when state budgets are crumbling. I hear that is a difficulty for hospitals...
dryfly(Excellent) writes:
Worse yet - misallocated capital.
Oh yeah. In the local Regional Medical Complex of Unlimited Ambition, my feeling is that you could easily die because they were too skimpy with the human capital budget to put enough nurses on your floor to staff it adequately.
That's day to day staffing expenses, those have to be kept down despite plentiful studies that show the more attention a patient receives, the better the prognosis. Instead, you get shoveled into a bed and treated like livestock by the skeleton staff of overworked lunatics who for some reason cling to the job.
But if you wanted to blow a hojillion dollars on a photogenic PET device, that would be found tomorrow.
Sounds like HUD chief said Bush was wrong Frank was right. Next question.
This is interesting because medical spending is frequently considered recession proof
More evidence that the underlying sickness is not a "housing" bubble, but a credit bubble, in which all assets (i.e. anything that anyone wants) are overpriced and now experiencing deflation. Simple reversion to the mean.
Growing up in Southern MN, not during the depression, I can tell you that a squirrel that has been living on corn from the corn crib does not taste wild and makes a nice meal for a family of four. Cottontail rabbit is good too.
Use a .22 rifle; cartridges are much cheaper and you don't risk your teeth on lead pellets.
Paul | 01.12.09 - 10:42 am | #
Same here - used a 22 w/ accurately sighted in scope - and also from S Minnesota but most of the squirrels I shot also ate a lot of acorns (all those oak knolls in S Minn) so tasted plenty gamy. The rabbits though were super fine as were the pheasants - literally bursting w/ corn when cleaned. Yummmy!
Well, think about it - the world's next two most expensive systems, Switzerland's and Germany's, spend are 1/3 less for health care which is considerably better than that which a typical Walmart store employee can expect, much less than Walmart employee's children can expect.
Lots of fat in the American system - lots and lots of fat.
A reduction of which just might lead to lower health care costs in and of itself.
Jobless people are obviously more healthy. Jobs are bad for your health.
Use a .22 rifle; cartridges are much cheaper and you don't risk your teeth on lead pellets
Another piece of advice... try to find a bolt-action rifle still chambered for the .22 short. Very, very cheap and subsonic, so not much louder than an air rifle. Still good out to about 60 yards once you hone your skillz.
The critters will get back to business much faster in the echoing hickory-and-pecan-surrounding-water amphitheatres where the hunting is best.
mal... that's because the fish being served is a garbage fish - they have fished the hell out of their seas like the Vietnamese, that is if pollution didn't kill them first!
People lose their job. People lose health care coverage. People stop running to the doctor for every little pain. People put off anything major (that can be put off) because it will come out of their pocket.
I can see all this.
Downturn must also be bad for big pharma.
My copays for prescriptions are huge (terrible employer-sponsored health insurance plan). I would imagine that many folks will 'temporarily' stop to save money.
Some of these meds will be for treatment of pyschiatric disorders... so watch for an uptick the number of involuntary admissions to psych wards (and general craziness).
Architectural firms (particularly in the SF Bay Area) have been living on an unending supply of hospital expansion and seismic renovation. This work has definitely helped some offices make it thru slow times in the past. In the recent 6 months, many of the larger projects have had trouble getting financing and many of the hospital corps seem to believe the new administration won't be as friendly to their profit margins (and thus more conservative on outlook).
More evidence that Healthcare should not be a for profit business.
Another piece of advice... try to find a bolt-action rifle still chambered for the .22 short
The old gallery guns are a hoot. Many need to be re-barreled for accuracy due to firing a zillion rounds. I prefer my Ruger chambered in .17. Deadly accurate and fun to shoot...
Morocco Bama writes:
More evidence that Healthcare should not be a for profit business.
hmmm...health care as a utility?
interesting.
--bh
Mal,
My mother confirmed your recipes for getting out the wild taste...She said that these solutions are incorporated in old recipes.
She said this morning, that wine/vinegar was also used...
Someone needs to organize and/or start a site on how to cook food that is acceptable to the modern American pallet, using local wildlife...
Must say, we will really have to be desperate, when cats and dogs become one of our food groups, instead of beef, pork, lamb and chicken/turkeys...
More evidence that Healthcare should not be a for profit business.
Morocco Bama | 01.12.09 - 10:55 am | #
How do you deal with people that run deliberately unhealthy lives?
But if you wanted to blow a hojillion dollars on a photogenic PET device, that would be found tomorrow.
Absolutely right, because you can market a PET scanner, or a 3T MRI. But putting up a billboard that says "1:1 ICU staffing" , or saying, "Our Nurses Wash Their Hands !" might save lives and positive affect otucomes, but it doesn't alter referral patterns, and pays the same DRG.
Riot Grill | 01.12.09 - 10:58 am | #
Spot on and more to the point, the real customer of the hospital is the physician - the gatekeeper of revenues - aka insured patients.
"More evidence that Healthcare should not be a for profit business."
No profit, no extra effort, no cutting edge technology. Bad idea.
I know I am still here due to one of those evil for profit drug company studies.
Another piece of advice... try to find a bolt-action rifle still chambered for the .22 short. Very, very cheap and subsonic, so not much louder than an air rifle. Still good out to about 60 yards once you hone your skillz.
The critters will get back to business much faster in the echoing hickory-and-pecan-surrounding-water amphitheatres where the hunting is best.
Apparatchik ZackAttack
Growing up, I used to use shorts to hunt bullfrogs. We had a small pond, roughly 30-60' ellipsoid. You take a flashlight, shine it over to the edge of the other side of the pond. You would get these shiny reflections that were bullfrogs. Aim at the reflection, pop!
Oh great, now do we get recipes for bullfrog?
Another piece of advice... try to find a bolt-action rifle still chambered for the .22 short. Very, very cheap and subsonic, so not much louder than an air rifle. Still good out to about 60 yards once you hone your skillz.
Apparatchik ZackAttack | Homepage | 01.12.09 - 10:53 am | #
Yup.
Oh great, now do we get recipes for bullfrog?
Damn tasty.....
Just need some flour, salt, pepper and some hot grease for the froglegs
.
Quite good and served in restaurants as well.
Just need some flour, salt, pepper and some hot grease for the froglegs
.
Comrade Tech Sargent Chen | 01.12.09 - 11:02 am | #
Plus it goes great w/ rice... tempura for unemployed rednecks.
Yeah, actually did have froglegs once ina French restaurant as a kid. Tastes like chicken!
tempura for unemployed rednecks.
dryfly | 01.12.09 - 11:04 am | #
LO
It's officially Peak Critters.
That was supposed to be LOL!!!
I know I am still here due to one of those evil for profit drug company studies.
If most people read the studies and saw how "efficacy" was calculated, they'd probably never take a prescription drug.
Only in America can you broadly prescribe a drug that reduces incidence from 3/2000 to 1.5/2000 and in a controlled setting with cherry picked patients no less. 50% reduction rate, Woohoo!
The most important physician in the hospital nowadays is the ED doc, because they are the first to see such potential cash cows as the r/o cardiac event, r/o stroke patients. Especially the ones with good (i.e. any) insurance. These patients subsequently could go on to get mega-imaged, and mega-workup in the hospital. Lucrative workups pay the bills for the rest of the patients ( and the hospital owned physicans, nurses, etc). Lucrative workups also reward the non-hospital owned docs who make their bones in the outpatient world, and suffer the inpatient/hospital based work only because they can generate more referrals from these admits.
Self-pay and the underinsured/non insured of course are treated the same as the rest. (ahem)
It's a sick world in the hospitals.
Dave of SV(Unrated) writes:
\tmy sister is a doctor and she says her office has seen a measurable downturn in customers because they can not afford co-pay!
Dave of SV | 01.12.09 - 10:38 am | #
Screw the co-pay... my brother-in-law just lost his I.T. job, and is looking down the barrel of a COBRA payment that's as big as his current mortgage payment. No way can he afford it... so that's a chunk of change taken out of health care. Take this story x100000 and the health-care industry don't look so "recession-proof".
the shadow knows...
GE Capital does not want to be forced to repossess some very expensive MRI machines so they can sit in storage
GE Health isn't sure what budget they have to cut if they suddenly have a year's worth of inventory
GE CEO Immelt must be wishing the $135 billion loan from the FRB via CP purchases was just a little bit larger
I prefer this approach.
OhioHealth - Not-for-profit Healthcare
"If most people read the studies and saw how "efficacy" was calculated, they'd probably never take a prescription drug."
What is better, death? I got a list of side affects and other damage from the cure. Life is a chance every day you get out of bed.
Duke of Con Dao(Excellent) writes:
Comrade Byzantine_Ruins... see previous thread over your Nixon Admin remarks... I usuallyy respect what you have to say but that was a 'yahoo remark'
That's fine. I'm not really going to cross steel with you over it.
Here's what I think:
I have seen enough Nixon worship by the useless failures of my generation who "grew" from bigoted, racist, entitled little white boys of poor character to bigoted, racist, entitled middle age white men of poor character.
Their fathers should have kept them under stricter discipline, told them fewer lies and infected them with less of their loathesome sense of bigoted, racist white entitlement.
Sorry about whatever your involvement in it was, be it admiration or complicity, it was a historic evil. I'm not going to take time to excoriate you for it because I'm sure you're intelligent enough to have well-justified prejudices, just like me.
Maybe you knew him and he was an honorable man. If so, you should have kept his grave better-tended, because it has become a grove of poisonous weeds.
I think you should consider why people feel the way they do about the matter -- I am certainly aware why I feel the way I do about his fans. I think it was the start of a historic compromise in the conduct of the Republic that Ford did not disassemble his retinue utterly, and what makes this error different from many other excusable errors is where we stand today and what role his memory has played in it.
I will have this argument in my elder years with those who would rehabilitate the memory of Bush II, and that too will spring from Ford's misguided mercy.
That's pretty much where it's going to stand from my side. You are welcome to agree, disagree, respect me more, respect me less. That is your choice. My perceptions are mine, my commitment to the Republic absolute, and this is part of my perception of what is necessary for the Republic.
One of my Dr's is having a snit with my insurance. They billed my last visit as "out of network" while the dr claims they are "in network"
Probably more strong arm tactics to get dr's to comply with their outrageous cost savings measures.
My mother, 79 years old, english teacher and grew up in the last depression, I have asked her to set up a website on the the way she lived through GDI...To date, she has refused my requests...
Maybe the other older experienced GDI survivors may want to do so...Us youngsters, who were raised on McD and TacoB*ll, could use some assistance in survival...
just a thought, if the system is collapsing...
More evidence that Healthcare should not be a for profit business.
With very few exceptions (e.g. U. of Phoenix), most of higher education is non-profit, yet the inflation rates in health care and higher education are roughly the same. I hate to cast such a wide net, but the only difference in the non-profit and for profit models that the non-profits have to increase their expenses as to meet their non-profit status.
Nixon was a Dick.
Markets set to rally on Heath Ledger's Golden Globe win.
Markets set to rally on Heath Ledger's Golden Globe win.
the shadow | 01.12.09 - 11:15 am |
Thats good stuff right there. Probably not far off the mark either.
Mmmm... Bullfrog...
So, is anybody else watching USD/JPY today?
89.02/89.03
This is an example of medical insurance in the 20's and 30's...My Grandfather had an extra tooth the protruded beyond the normal row of teeth...He pulled that extra tooth out with a pair of pliers...
I can not confirm this, just the family story that has been passed down...
No comment on medical or dental insurance...
Screw the co-pay... my brother-in-law just lost his I.T. job, and is looking down the barrel of a COBRA payment that's as big as his current mortgage payment.
DCRogers | 01.12.09 - 11:07 am | #
If Illinois didn't have quasi-socialized medicine (if you had group insurance and COBRA runs out, you can get it), I'd be forced to take the first job with bennies that I was offered.
I've seen predictions that the Yen will go to 81...that's going to kill any exporting that Japan thinks they are going to do.
Ciao
MS
PCA isn't here currently, but EEM breaking support at 24.17
Driving up the Santa Cruz coast yesterday, passed a farm's big sign, "PONY RIDES - FOR ADULTS AND CHILDREN"
Then a real estate sign,
then another sign, "PONIES FOR SALE"
Told a story better than burmashave signs.
I've just found a good supplier, now how do I write paulson?
The only reason For Profit looks attractive is because they are externalizing the costs of indigent care to the not-for-profit as the following clearly reveals. Do you people really think such a For-Profit model is humane considering where we're headed, economically? So many advocates for a Banana Republic.
New Study Finds Not-For-Profit Community Hospitals Serve Majority of State's Medi-Cal, Charity Care and Emergency Room Patients. | North America > United States from AllBusiness.com
Citi taking a beating...Better hurry up with that second half of the TARP I can see C's rump sticking out from under the old TARP...
Maybe the other older experienced GDI survivors may want to do so...Us youngsters, who were raised on McD and TacoB*ll, could use some assistance in survival...
just a thought, if the system is collapsing...
Anonymous | 01.12.09 - 11:13 am | #
Actually it is a good idea and it doesn't have to be crazy out of the blue stuff - just practical survival skillz - my Mom (depression era herself) taught all us kids how to do stuff like that... believe it or not I'll probably have the last of my thanksgiving leftovers tonight IN JANUARY - after picking the carcass I boiled all the bones to make a broth/stock (big turkey - produced almost a half gallon & pretty concentrated too) then broke it up into smaller batches and froze it to use later (since I live in Minnesota I froze it outside & left it in a 'cooler' on my porch along w/other stuff - has stayed frozen ever since)... probably using the last of the broth tonight to make soup.
People have so so many of these tricks it's almost insane not to share...
O' by the way, my very same grandpa had six fingers and toes...I know I will catch all kind of comments, but what the heck, it should provide an interesting comment or two, so fire away..
By the way the doctor removed the extra digits at birth...
Don't know if there was incest in the family line...just to cut off at the beginning, this statement...
This situation is also Bush's fault. We can thank him for the decline in hospital spending.
In fact, there is almost no problem the country faces today that cannot be blamed on Bush.
Dentists still use pliers. And the cocaine they give you is basically the same your grandpa used.
Basel Too makes an important point re the profit/non-profit comparison of hospitals and higher education, to which I have something to add below:
Basel Too writes:
More evidence that Healthcare should not be a for profit business.
With very few exceptions (e.g. U. of Phoenix), most of higher education is non-profit, yet the inflation rates in health care and higher education are roughly the same. I hate to cast such a wide net, but the only difference in the non-profit and for profit models that the non-profits have to increase their expenses as to meet their non-profit status.
Keep in mind that there is a divide between public universities and private universities, although both are non-profit. The tuition cost of attending public universities is roughly 1/4 to 1/8 of the private universities at full price, and the private universities effectively have a sliding fee scale via financial aid.
Furthermore, the public universities are decreasingly public funded. The states have been reducing their contributions for twenty years or more.
I have not seen an inflation adjusted chart comparing public university tuition over time. But my sense is that back when Jackie Robinson's tuition at UCLA was $50 and when CUNY was free (totally free?) it was cheaper to go to college.
Public and non-profit are not the same.
This situation is also Bush's fault. We can thank him for the decline in hospital spending.
In fact, there is almost no problem the country faces today that cannot be blamed on Bush.
Alfred | 01.12.09 - 11:23 am | #
I blame God for creating Bush in his image.
GM decides to use a South Korean firm to supply batteries for the Volt car--two days after GM says they need more bailout money
than $13.4 billion recently pledged.
Wait til the Obama team unveils their plan for a single-payer national health care program.
I see this as inevitable. It helps solve several crises: medicare funding, state/municipal shortfalls, even automakers...
We spend twice as much on health care as other developed countries, it's basically the only over-funded sector in our economy.
Anyone investing in health care now, should consider what will happen to these shares if Obama unveils a single-payer program at some point.
Basel Too-um I hate to tell you but an entities status as for or non profit has absolutely nothing to do with whether it makes a profit or the level of its expenses. Any entity that does make a profit will not exist for long. What does matter is that a non profit cannot share its profit with owners or shareholders.
"Peak Critters"
Brilliant!
Bazooka Hank exclusively on CNBC in 5 minutes. Expect softballs.
GM decides to use a South Korean firm to supply batteries for the Volt car--two days after GM says they need more bailout money than $13.4 billion recently pledged.
El Cliffo | Homepage | 01.12.09 - 11:25 am | #
Looks like a prepackaged bankruptcy in the not-to-distant future to me...
More evidence that Healthcare should not be a for profit business.
Morocco Bama | 01.12.09 - 10:55 am | #
Comrade Bear (tj & the bear)(Unrated) writes:
How do you deal with people that run deliberately unhealthy lives?
I have an incentive plan for them, it's called "being sick and unhealthy sucks" and "dying sucks."
The idea that supply and demand applies to free health care in the sense that people will intentionally make themselves sick to get themselves some more free healthcare is just insane. Nobody likes being sick. Nobody likes being in the hospital. Those places are uncomfortable and awful. A few crazies will smash their hands with hammers to get vicodin, a few crazies will demand to talk to a primary care doctor about their cats because they're lonely, but beyond that, there will be no line of mooching patients because having health procedures done to you sucks and is frightening.
Now, what about this guy who drives a motorcycle without a helmet, eats fried chicken despite being overweight and soforth? Those people will do that anyway, with or without free health care. Should you pay for it in a perfect system? Maybe. Maybe not.
Finally, people over-attribute illness to unhealthy behaviors. For some reason, we feel the need to attribute blame. Poor people are fat and obese not because they're lazy, but because the food they have available to them sucks. Many cancer patients and the people most hit by chronic, expensive disease aren't bad people who made bad choices, they're just unlucky. You people are insane.
Squirrel gun is the best tool. Over/under 22 short/410 shotgun. The shotgun is for nest clearing. Lots of good eats in there at the right time of year.
With regard to my grandpa's extra tooth, kinda like Jewel, except more prominent...
yogi, am I the only that smells Citi burning? I wonder if Hank will say anything about TARPing them some more?
Off topic, but I am curious if there are any readers/contributors to this blog who remember the Great Depression (even during your childhood). You would have to be pushing 80 now... I know a couple of geriatric bloggers (not intended as derisive term), but don't recall anyone mentioned personal recollection of the bad old days in this forum.
Anonymous writes:
O' by the way, my very same grandpa had six fingers and toes...I know I will catch all kind of comments, but what the heck, it should provide an interesting comment or two, so fire away..
Extra digits is a common feature in inbred communities, doesn't take much to do it. There's a town in New jersey called Dover that had been around since colonial days, but was relatively isolated until the Government built what became Route 46. Used to be lots of 6 fingered folks, but any relations were distant ones.
Exactly, Canary. Do you people really want the likes of Hank Paulson calling shots on your healthcare? Where do you think that will get you. Collateralized Debt Obligations on people's lives. Betting on health outcomes.
I expect Viatical Insurance to be a booming business in the years to come as people cash in early on theor lives in order to maintain their superficial, materialistic lifestyles.
Life Settlement at Life Settlement Systems: Senior Settlement, Life Insurance Settlement, Senior Life Settlement, Life Settlement Company
Bob_in_MA writes:
"We spend twice as much on health care as other developed countries . . ."
And Joe Shmoe adds: we have higher rates of morbidity, mortality, and dementia (we re-elected Bush).
Single payer plans work and capitalism continues to work quite well in Germany, France, and Canada.
Bob in MA is probably right to mind the issue as an investor, but that's always the case.
Squirrel gun is the best tool. Over/under 22 short/410 shotgun. The shotgun is for nest clearing. Lots of good eats in there at the right time of year.
Bob | Homepage | 01.12.09 - 11:29 am | #
You leave a lot of meat up in the tree uncollected when 'nest clearing' - not a respected way to hunt in my part of the world. Not judging, just sayin'...
Hoopajoops, LTD(Excellent) writes:
The idea that supply and demand applies to free health care in the sense that people will intentionally make themselves sick to get themselves some more free healthcare is just insane.
No no, he's selfish and wants to enforce a schedule of lifestyle choices on you that minimize your carry expense to him.
It's a good time to eat or be eaten by a squirrel.
I remember the depression. They talked all about it in that movie, Kit Kittredge. In the end, it worked out good. Plus, Mommy bought me the doll and clothes. Only $450 !
Who needs hospitals anyway? Our cars are being repossessed, and we can't afford to eat so much any more, so we will all be fit soon.
Righteous smackdown from CB Ruins...
I went to a Catholic school in the south, and I can relate to dealing with tons of smooth-handed racist white boys (and girls I might add).
Nixon started a party that has yet to tragically (finally) end. We have gone on a serious bender...
The funny thing they say about addiction to various prescription drugs is that the length of time you're on the slide roughly corresponds to the time you'll spend depressed and malaised afterward.
Recovery in 30 years...
It's a good time to eat or be eaten by a squirrel.
Nuts...
It's too late for a single payer system now, the transition would be politically impossible (pols in the pocket of insurance companies).
You need an American Tommy Douglas. Unfortunately, politicians like that don't really exist anymore.
Morocco Bama writes:
Exactly, Canary. Do you people really want the likes of Hank Paulson calling shots on your healthcare?
I see this the other way around.
Hank Paulson IS and HAS BEEN calling the shots on the economy (and thereby everything else) because the majority of the population has been scared into thinking that taxing the rich and providing public services and offering universal health care is evil socialism.
It is time to throw out not just Bush and Cheney and Paulson, etc, but the bogeymen they used to scare the majority into voting for tax cuts for the rich.
Off topic, but I am curious if there are any readers/contributors to this blog who remember the Great Depression (even during your childhood). You would have to be pushing 80 now... I know a couple of geriatric bloggers (not intended as derisive term), but don't recall anyone mentioned personal recollection of the bad old days in this forum.
ztexas | 01.12.09 - 11:31 am
My FIL was a kid and boy does he tell stories. They did very well for themselves because they lived on a farm. They could grow their own produce, milk their own cows, and they got extra gas rations they used to send mom to work for the extra cash to make ends meet.
I don't believe Americans as a society could live like that for long.
dryfly(Unrated) writes:
A lot of hospitals added capacity like crazy the last few years - especially in high fee 'boutique' market niches... imaging, intensive cardio, cancer therapy, major surgical - etc. They tried like CRAZY to close ERs and primary care as they are money losers. Now with the economy tightening and companies cutting back on insurance & insurers challenging reimbursement... the hospitals face (1) fewer patients and (2) contested payments at the sametime their capital costs have skyrocketed.
And they are surprised??? Only one word applies: Hoocoodanode.
You see a lot of hospitals in the same area with competing specialty centers, leading to overcapacity. The problem is that the nonprofits are being run like profit-making businesses, leading to oversupply and, eventually, disaster. Instead of the $$$ for medical facilities in region being spent in a coordinated manner.
I wonder what will happen to Sutter Health, the giant "nonprofit" health conglomerate that's dominating over Northern California healthcare. For a "nonprofit" it's pretty damned predatory about moving into new territory and trying to outcompete the existing profit- and non-profit hospitals and clinics.
um I hate to tell you but an entities status as for or non profit has absolutely nothing to do with whether it makes a profit or the level of its expenses. Any entity that does make a profit will not exist for long. What does matter is that a non profit cannot share its profit with owners or shareholders.
Canary- You conflate tax exempt 501(c)(3) status with nonprofit status, which is strictly a creature of state law, and not the federal tax code. Nonprofit status, especially in the healthcare context, is more than just taxation.
These are the end times. Squirrels have discovered coffee.
Off topic, but I am curious if there are any readers/contributors to this blog who remember the Great Depression (even during your childhood). You would have to be pushing 80 now... I know a couple of geriatric bloggers (not intended as derisive term), but don't recall anyone mentioned personal recollection of the bad old days in this forum.
ztexas | 01.12.09 - 11:31 am | #
Me either - mostly get second hand stuff from kids of depression babies - like myself. I'd love to hear recollections but I only get that from my in-laws [in their 80s and they don't blog - they barely email]...
It would be great to hear more first hand recollections from a wide swath of the population... this round of difficulty will be somewhat different but it never hurts to hear how previous generations solved similar problems... better than having to reinvent the wheel over and over.
Morocco Bama
I think you just found the next bubble - Viaticals.
Heck, I am more worried about my 65 lb chow mutt...If push comes to shove, the question is who eats who...
PS:Inside the house dog...Trade off between security and possibly becoming his meal...
PS@:Must remember to keep the dog food bowl full at all times...
7 y.o girl, spectacular analysis!
[Barney] Frank wants at least $50bn of the Tarp funds to be used to help homeowners via loan guarantees or incentives to encourage loan modifications. . . AND. . . Eliminate government profit sharing of appreciation over market value of home at time of refinancing.
The New Yorker profiles him in the January 12 issue saying, among much else,
"But in Congress he is thought of no longer as a liberal of the old school (which he is) but also as a grind. His expertise is in one of the least glamorous subjects on the national agenda - housing, particularly rental housing for poor people - and he is using that knowledge to confront the nation's economic crisis. 'For Barney, the question has always been: What works? What can government do to see that people have the decent necessities of life?' his sister Ann Lewis, the longtime Democratic activist, says. 'Now he's right there. Barney's been preparing for this moment for his entire life.'"
Well if that's a fair appraisal of Representative Frank, and particularly of the focus of his expertise, I think many of us will recognize the problem.
Dentists still use pliers. And the cocaine they give you is basically the same your grandpa used.
1 currency soon [yogi] | 01.12.09 - 11:24 am | #
Great Grandpa - had some of that old school health insurance - he cut his leg pruning a tree, it got infected...doctor made a house call, his oldest son (Grandpa) helped hold him down on the kitchen table for the amputation.
I work in Video Post/Design...
Dec-Jan we worked on a campaign for a regional branch of a national health insurance company....
They dropped around half a mil on the ads...I'll leave it at that.
I'm not really sure what to infer from this, just thought someone would find it interesing
Paulson:
"No one is saying TARP $ shouldn't have been given."
Pitchfork him, Maria. (How did she get this job?)
"great transparency" according to Hank...
King Henry Paulson: The Great Transparent.
Medical spending is recession-proof
Medical-related jobs are recession proof.
People don't stop getting sick.
Non-profit hospitals are a great business model.
Repeat it often enough, and it becomes true. Just like "real estate never goes down, they aren't making any more land etc."
Dr. Feelbad | 01.12.09 - 10:20 am | #
correct. the masses require a new mythology of a secure path to wealth now that the dream of achieving riches by doing nothing but living in your own house and working a middle-class 9-to-5 have been dashed against the rocks. and predictably people will pour into the market since everybody has the same clever idea at once.
Off topic, but I am curious if there are any readers/contributors to this blog who remember the Great Depression (even during your childhood). You would have to be pushing 80 now... I know a couple of geriatric bloggers (not intended as derisive term), but don't recall anyone mentioned personal recollection of the bad old days in this forum.
ztexas | 01.12.09 - 11:31 am | #
Hardly anybody here that old -- 1929er, maybe, but I don't see him around. My mom had to leave school and home in eighth grade and make her way as live-in kitchen help or mother's helper in homes and ranches. Her mom kicked her out of the house because her husband had died and she'd hooked up with a new guy who didn't want anyone else's kids around. So Grandma took care of herself. Life was hard, and so were people. My father's family were Okies, and they did indeed lose their farm and flee the dustbowl in the '20s; he was five years old when that happened. They did have a few bucks set aside and managed to buy a little land out in the Central Valley that they could subsist on while the sons and daughters went out to work as they could.
Paulson: There has been great transparency in bank aid so far
My mother from the depression (79)has a lot of stories about the depression in Iowa...
She is more than happy to provide them to me...since I am interested...
In the future, If anyone"s interested, I will forward to you all...
One story she has provided(around 8 y-o), was that my grandpa, her father, living in Iowa, was a born and bread republican...During the Depression, he voted for the first time and every time for a democrat until the day he died in the 1970's...
Talk about the bubble of all bubbles...health care spending and health care salaries. Eventually, there will be a choice between making MDs, PAs, RNs, and drug companies rich, and dying sooner than planned. In California, they welcome illegal aliens through the doors because they're very profitable patients- paid for by the California taxpayers. Illegals even have a special line in the emergency room, because they assume that they have no medical insurance. Go ahead BHO- give them all "free" health care. While you're at it, give the entire world "free" health care. You might as well, because they're all coming here.
My grandfather left school to 'work' for the family as a teen during the depression. He 'gigged' snapping turtles in the river for food and pay.
Just takes a stick in one hand and an adequate weapon in another (blunt object or 'gigging spear'), get the turtle to attack the stick and a quick poke does the trick (unless you have some aggression issues then the blunt object I guess).
From what he told me, turtle meat is quite tasty and Turtle soup was a pretty common meal "back in the day".
*
Re: Healthcare. We took our son in for a visit to the pediatrician. He has asthma that flares when he catches a chest cold. Our ped. was busy so one of the founding partners of the clinic treated him. She told my wife that her son also had asthma and thought she should explain to my wife what the condition was, plans, etc. Of course we had a son with the condition, and knew what asthma was as -uh- we had been treating at this location for a little over 2 years for it.
My wife found the experience odd, then we get the bill. On top of our regular charge for a routine office visit was a fee for $400 bucks. When we inquired with insurer they stated that the physician had billed for excessive time. We then called the ped's office and were informed that anyting over 10 minutes in client contact generated an extra (flat) charge!
So the doctor giving unsolicited, unnecessary 'advice' for about 15 minutes generated at total bill of 800 dollars.
My depression MOM, has told me, that in Iowa, Hotel owners/managers would not rent to bankers apartments above the 2nd floor, because they were jumping out of the windows...
Just what she remembered and it has been a long time ago and not sure the percentage doing so...
For what its worth...
dryfly writes:
A lot of hospitals added capacity like crazy the last few years - especially in high fee 'boutique' market niches... imaging, intensive cardio, cancer therapy, major surgical - etc. They tried like CRAZY to close ERs and primary care as they are money losers.
Here in Southern California, a particularly high-stakes version of "E.R. hopscotch" is played out as all the different hospitals want to avoid being the "closest" E.R. to the 'hoods, where the ambulances helpfully transport large numbers of uninsured, high-cost patients to the "nearest" hospital in a continuing stream. "Nearest" is all that matters... hospitals try hard to close a branchs on the edge just to re-open a few miles in a safer direction (that is, a direction that has another hospital in-between, to act as the legal catchment.)
The process has continued so long around L.A.'s famed "South Central" and Compton that their nearest E.R. is now in Irvine, in neighboring Orange County. (Must make for some long, tense, ambulance rides on our famously congested expressways!)
Lets not forget bad debts as folks cannot pay and the home the hospital expected to get as settlement is not worth much.
I am not sure if credit cards will do charge backs to the medical community as folks cannot pay credit cards or chose to limit credit.
On the other side, the pay in advance doctor's offices that check credit before hand will not have bad debt but much fewer customers and they reject folks.
Bad mouthing Paulson is duly deserved however you have not seen anything yet. Wait until "timmy" gets the keys.
If you think it can't get any worse....wait.
FRBNY owns the gov't and has for some time.
Ciao
MS
New thread...
Wait until "timmy" gets the keys.
Timmay!
MS were you the guy who assumed Geithner was Jewish?
Don't forget the Turtle:
Asthma you say...what a joke that is. In the Northern California valley, the air is so bad that nearly 1/2 of kids have asthma. Instead of determining the root of the problem, parents just blindly give their children steroids to inhale. Steroids that are known to stunt growth and who knows what else (just look at Arnold). Our son had a persistent cough that improved considerably when we vacationed in upstate NY. Upon returning to CA, it worsened. They prescribed him the same toxic-inhalator that they prescribe everyone. We eventually figured out he was eating too many Cheerios and removed it completely from his diet. The cough (which lasted several months) cleared up within a month and never returned after being an issue for 3-4 years. We also kept a humidifier in his room for dry spells (common in CA), which helped coughs from colds to break-up faster. Most childhood illnesses can be attributed to what they eat and their environment.
In California, they welcome illegal aliens through the doors because they're very profitable patients- paid for by the California taxpayers. Illegals even have a special line in the emergency room, because they assume that they have no medical insurance.
I'll say it again. The notion of an E.R. as "emergency care," is quaint, but not accurate. It's mostly a walk-in clinic, used by people paradoxically smart enough to know how to game the system. The dumb masses who have health insurance and/or a legitimate need end up waiting endlessly as they keep getting triaged to the end of the line by desk workers.
There is a reason ER docs burn out so fast and spectacularly.
dryfly(Excellent) writes:
\tDoes anyone have recipes to take the wild taste out of squirrel for future reference...
Anonymous | 01.12.09 - 10:34 am | #
It's 'game' it is going to taste 'gamey'. Get used to it.
\t dryfly | \t \t \t \t01.12.09 - 10:39 am | #
dryfly | 01.12.09 - 10:39 am | #
Remove all of the fat, and throw in a little bacon fat to replace. This trick works for squirrel, and especially raccoon. Seriously! You could also soak it in milk or baking soda to tenderize it.
dryfly says: ...just sayin'
The under part of the gun was used wrt the level of income and number of mouths to feed. This from my grandfather. I am 56.
North central Missouri. Lowest 10th percentile of income in the USA. Lots of squirrels. Little work available.
So long moonshine equipment, short tax preparers.
In California, they welcome illegal aliens through the doors because they're very profitable patients- paid for by the California taxpayers.
Riot Grill | 01.12.09 - 12:02 pm | #
money soon to be replaced with IOUs. it doesn't take much brilliance to figure out how that one's going to work out. the term "paid" will have to be redefined.
My grandparents both lived through the GD. It definitely had an impact on the rest of their lives - nothing goes to waste (saving and reusing aluminum foil,) distrust of the stock market and banks, etc. And my grandpa HATED rabbit. Had to eat it too many times, he said.
I remember that they said they used to (this seems silly) each bring a tablespoon of coffee down to one neighbor's house and brew up coffee for their domino session. I guess it was the only way to ensure everybody did their share with no excuses.
Brontide(Unrated) writes:
\tSo long moonshine equipment, short tax preparers.
\t Brontide | \t \t \t \t01.12.09 - 12:07 pm | #
Brontide | 01.12.09 - 12:07 pm | #
Don't you mean "revenuers"?
money soon to be replaced with IOUs.
\t ResistanceIsFeudal | \t \t \t \t01.12.09 - 12:08 pm | #
ResistanceIsFeudal | 01.12.09 - 12:08 pm | #
Isn't that what money is?
My wife mention couple of things a few days ago.
First, neither she or I had been to the doctor in maybe 5 years. Aside from the time I had some x-rays because of straining my arm and blood pressure, etc and her because she thought she had some kind of virus/flu symptoms. Plus routine stuff like physical, dental, new glasses. In short, preventive medicine (we do have very good insurance).
Second, we haven't been to a fast food place during that time either. Also, both of us are very careful in our diets, both have each (on purpose) lost 10 pounds or so since retirement, stay fit, exercise (to a limited extent).
I wonder if there is any relation between the two. I suspect so.
I learned a lot from depression folks as a young person. Government did crap for them and reality the paid zip in taxes as well. Sadly today I see young people in a warped reality of government owing them something especially protection from themselves. Sadly Government is just as lost trying to give it to them. The poor are not Royalty. Poverty is the reason to study and work hard to escape the Gators bite. What are we getting for our education investment of $120+ K-12 public education? OB wants to spend more. I want what I paid for first.
Anatole Kaletsky
"Near-zero interest rates and even a tax on bank deposits are necessary to force those with cash to use it productively."
Crazy proposal. How many people would withdraw their cash from the bank and deposit it in their mattress?
Eventually we're going to end up with some combination of privately- and publicly-financed health care. Now would be a good time for Uncle to start building hospitals and clinics, as government takeovers of existing facilities could prove awkward.
Isn't that what money is?
xxxxx | 01.12.09 - 12:09 pm | #
if someone will accept the IOU in lieu of another form of payment, sure. seashells would work too if both parties agreed. if not... well, not so much.
Economist Moe Howard,
Oddly, the depression era folk with whom I talked said that eventually - once the stuff got going - government did indeed do things that helped them. What sucked was the period from about 1928-1933 -- BEFORE all the government help got started.
It wasn't perfect, but it helped.
Heh...yeah, it's kind of hard to get an MRI when you're laid off and don't have insurance.
bobn - Love the TJ quotes...dead on...and you're right, it is an old game, as old as the Republic.
This "private government" stunt (government of by and for private profit) was first pulled off by the Federalists - Jefferson's opponents - who were, in so many ways, the same set of interests that make up the business wing of the GOP (the rest of the GOP are the useful idiots wing).
Ok, that's my monthly political driveby.
Another Great Depression story.
Both sets of grandparents left Los Angeles for lack of work and joined other family members in purchasing or leasing orchards in the IE. Most lived and worked on the farm, the others took what work they could find. One was a butcher at the local grocery store. No squirrels for them, even with rationing. They grew most of what they ate.
Intuitive Surgical is the poster child for the thread. How does this chart look?
http://finance.yahoo.com/q/bc?s=ISRG&t=6m&l=on&z=m&q=l&c=
Lets try again....
Put your hands in the air...Wheeeee!
Bunch of comments from me. Re medicine/hospitals: I read that people are cutting back on elective surgery (not willing to spend money at this time). Also, hospitals in certain states like California and Florida have a high percentage of illegal aliens and poor people who can't/don't pay for services. If there isn't enough money available then hospitals aren't going to spend huge amounts on fancy new equipment.
As for general costs, I complained to my doctor about being charged $200 for ONE shot. (This is a very large HMO in northeastern PA.) He said he has no idea what ANYTHING costs a patient because of the dizzying insurance programs that he can't possibly keep track of. Then I argued with the main office over the price because I knew they were charging me more than they would charge an insurer because I did not have any insurance coverage. They would not lower the price and even fought with me over a payment schedule--they didn't want to give me one. So I pretty much told them to fuck off and they'd get paid when I felt like it. I sent them $25 a month.
Now that I have Medicare, the doctors are trying to send me for all sorts of tests, whether I want them or need them. So they're finding new problems I didn't know I had. But when it comes to prescriptions, now I check out alternatives before I decide to fill them. For the last one, for a statin drug for cholesterol, instead I took a cheaper supplement called Red Yeast Rice (with no side effects) and it lowered my cholesterol by 25%.
Now about survival skills: I can knit, crochet, weave and spin my own yarn. But it takes a lot of work; it's easier to buy clothes in a thrift shop. I have friends who make their own liquor (the stuff is fabulous); it's not hard to do but takes time. I also do canning, and I grow certain foods via container gardening. Again, it takes time and energy. Anyone who has studied the pioneers knows that all their efforts went into just surviving the elements. Food, fuel and shelter were the main priorities.
I don't know if the average person, used to fast food restaurants and living in sound bites, is willing or able to go back two hundred years. And doing these "survival skills" costs money. You need a lot of equipment for canning and those big pots take up a lot of room. To make your own liquor you need two glass carboys plus equipment. However, once you get past the initial outlay, you can do very well for yourself.
At least we are sure Hologic's name didn't come from a fancy consultant with focus groups.
Ho Logic seems like a dispute between two women on the Jerry Springer Show.
Crazy proposal. How many people would withdraw their cash from the bank and deposit it in their mattress?
shadowjack62
how about $25 per $100 withdrawal fees at the atm! that'll save the banks.
Well, I am certain that if we are all covered by universal health care, and it costs little to be insured for medical problems with an early retirement, you will see massive numbers of doctors over 55 retire when this comes around. Period.
But if you wanted to blow a hojillion dollars on a photogenic PET device, that would be found tomorrow.
| \t01.12.09 - 10:48 am | #
\t Comrade Byzantine_Ruins | \t \t \tHomepage
Look, western medicine is practiced using the principals of evidence based medicine. Controlled studies are done with a specific purpose to delineated efficacy of a new drug or imaging procedure. By doing the study with sufficient staticial power to validate the out come as staticially significant. Let's take PET scanning, the modern equipment from GE costs $1-2MM, paid as a lease with service, upgrades and maintainance included. Many well controlled studies have shown that PET scanning for certain types of cancer changes the staging 30% of the time. So if you have a lung cancer patient that was staged as curable by conventional means and gets a PET scan that shows distant metastases, you will save that patient the pain and suffering of going throught surgery, chemo, follow up studies... and instead put them on a tract of palliative care, quality of life focused. Saving the patient unnecessary procedures and their insurance company/Medicare tens of thousands of dollars.
Over utilization of imaging can be a problem, but most of that is from CYA, medico-legal issues and patient demand from their doctors for the latests/most modern treatment.
Following is an email we received from my husband's folks. Mid-80's. Pertinent to the subjects be discussed here.
"We are keeping the doctors busy. If it was not for Medicare we would have gone under. Of course if the doctors knew you didn't have Medicare and insurance they would not find as much wrong with you. Take Versie to Beaumont Monday the Next day I have one with the doctor whose been working on my plumbing. Go to V.A. on the 30th.Versie has appointments with two different eye doctors next month. We have become a nation of pill poppers, but we are living longer. We would like to make a trip out there next summer. Maybe our new president will send us a little money. He is bailing out every body else. The last depression we had plenty to buy but no money. The next one will have money but nothing to buy. I had better quit before I start crying. Let us hear from you."
People have mentioned slowdown in hospitals' fee-for-service receipts, but consider too the slowdown in "charitable" donations to hospitals, which many hospitals depend on heavily.
Uffish Thought writes:
Look, western medicine is practiced using the principals of evidence based medicine.
LOL ! ! You've never been to an E.R., modern OB/GYN or peds office recently. Medicine is practice on C.Y.A. basis.
Health care is weird - recessions are marked by significant cost increases for many reasons, the spike peaks just as the recession ends and then prices fall, often too far. Every business is putting a hold on capital expenditures - keeping the $ in the bank just in case....
I ate fried frog legs 20+ years ago on a trip to the Okefenokee Swamp. They were okay...like really small chicken legs. I've wondered about some of the tempura dishes I've ordered since then.
My grandparents told a lot of Depression stories. All the adult children on one side along with their spouses and children in a couple of cases moved back in with my great-grandparents so that they had 15 people under one roof.
My grandmother told me about eating "ketchup soup" which was obtained by ordering a cup of hot water at a restaurant and pouring ketchup into it.
When my grandfather died in the 80s, I was charged with cleaning out his closets. I found a large box full of condiments from fast-food places in one. I asked my grandmother about it. Evidently despite a long and relatively successful career followed by a comfortable retirement,he was still hoarding stuff like that 50 years later out of fear that it would happen again.
Riot Grill, there is a lot of CYA as malpractice premiums esclate and cost of litigation increases. Patient satisfaction is also very important in maintainging the physicians reputation in the community, so the MD has to cater to the patient's demands to a certain extent.
Most subacute clinic visits by patients can follow a script that includes epidemology, i.e. what flu is going around, info is obtained from the CDC, how old is your patient, co-morbidities, and a usually successful out come is achieved in one visit; "you have the flu, drink fluids, take tylenol for your fever".
ER is a different animal, huge money looser as the uninsured go here. They are the most scriped subspeciality out there as chest pain, stroke, trauma all follow preset flow charts. Its the few cold hungry homeless, and uninsured "clinic visits" that cost the system so much money.
OB/Gyn is one of the most litigated subspecialities as one bad outcome "baby" can cost millions in future payments to the malpractice carrier. But a pregnant couple that have a relatively normal gestation and delivery all follow a script of office visits, ultrasound, advice... This is why the nurse midwife/nurse practioner/nurse anestasis model works so well.
This isn't suprising given that people can't afford to pay their medical bills.
If the hospital isn't getting paid, something has to give.
If the hospital isn't getting paid, something has to give.
HG | 01.12.09 - 3:04 pm | #
That would be life expectancy.
"This is why the nurse midwife/nurse practioner/nurse anestasis model works so well."
Exactly. Run the script, follow the algorithm. So much of medicine is reduced to this approach, for better and for worse.
Better : you don't need to engage the system every time your child has the sniffles...you go to the minute clinic at Target and done/done.
Worse : Natural childbirth in a tub of warm water with your shaman and NP standing by. Works great except when it doesn't. Then you need a real doctor with specialized training in a high tech hospital that you can sue into next week.
Some times, bad things happen to good people for no reason. When they do, you need a fall guy/girl. And if that person has an M.D. after their name, more's the better.
Heathcare and government remain the last 2 bubbles. For healthcare the solution will include doing less things to more people, especially the elderly. Letting nature take its course is occasionaly a humane option. Means testing will also occur so that all that lifestyle care for rich old people will no longer be free. Free hips and knees for all. End it now. Government will shrink only with the destruction of the economy. This may have already begun.
My wife is a RN and employed at a local hospital. Most area hospital systems have hiring freezes even though you keep hearing that there's a great need for nurses.
even though you keep hearing that there's a need for great nurses.
My RN wife also thinks that not everyone should get the same level of care. She thinks people should be told how much the procedure's would cost and they should pick. She goes against the everyone's entitled attitude that's typical in that enviroment.
She tells me all the time about the 'regulars'. People who are there so often for 'pain'. They bring personal effects from home and setup their rooms with family photos and stuff. We are very conservative but we both believe this is where they'd be better off at home smoking some pot for their 'pain' rather than occupying a hospital bed at $900 a day.
What the feds need to do is subsidize cigarette smoking. With the states all umblically tied to the tobacco settlements of a decade ago, while at the same time, strapped for cash to fund Medicaid, etc., it would simultaneously juice revenue and decrease Medicaid expenditures (through decreased life expectancy of the smokers.)
Just sayin'...
Does anyone have recipes to take the wild taste out of squirrel for future reference...
Anonymous
It's 'game' it is going to taste 'gamey'. Get used to it.
dryfly"
Game needs to be marinated. Recipes abond, and it is an art form... classic cooking in "old Europe". Excellent with an old Bourgogne wine, err sorry I guess that will have to be left out in the present circumstances:-))
but why do you guys have to eat meat? anyone here is a vegan? I am not but I seem to eat like one (lentils do just fine)
Morocco Bama writes:
If the hospital isn't getting paid, something has to give.
HG | 01.12.09 - 3:04 pm | #
That would be life expectancy.
Morocco Bama | 01.12.09 - 3:17 pm | #
not necessarily- hospitals are where those really nasty drug resistant bacteria hang out. Maybe if we stop buying all the latest equipment we can get back to real health care.
I work as a doc in a big east coast specialty hospital:
1. Business is booming. People sicker than ever. Some pressure on payor mix, only a little more than usual.
2. Capital spending is shut down for the entire health care system that my hospital is in. Tens of millions of spending not gonna happen. We are told that it is because of reserve losses related to the market, not decreased revenues.
3. It is ILLEGAL for hospitals to coordinate care and funnel patients to chosen providers. Laws passed by Congress (thanks mr. Stark). Patient "choice" pre-empts coordination among instiutions. Write your rep.
Hospital Capital equipment in my 4 hospital system basically froze in Q4. Cancer patients are stretching out the time between CT Scans and MRI's and they are cutting back in other ways- healthcare is not completely inelastic.
More uninsured patients are seeking care. Medi-Cal (every Medicaid program for that matter) doesn't even cover the cost of care of those patients.
HealthCare may have been recession -proof in the past, but like real estate and CDO's, past performance is no guarantee of future results.
Regarding Depression-era health care, there is a chapter about health care in a Depression-era memoir called "Little Heathens" by Mildred Kalish. Absolutely everything they could take care of at home, they did. The author even got treated for what they thought was a blood infection, at home.
I'm a mom of three little kids, and they used to go to the doctor a lot for normal things: well child visits, ear infections, coughs at night interfering with their sleep. Now they have all of their immunizations and they don't get sick quite as often. Also, we have a health care savings account with a big deductable, so it's more obvious that we (and not the insurance company) are spending the money on those little items.
We go to the doctor a lot less now. Now the doctors say that most ear infections are viral and go away on their own, so you just treat them for pain at home. Honey is a great cough suppressant. Studies have shown that it does better than some over-the-counter cough medicines. Gargling salt water and cayenne is supposed to be good for sore throats. The internet is a big help in finding home remedies. The internet can also help you to know whether or not a condition is something worth going to the doctor about. You can look up symptoms online, and if you find out that it's nothing to worry about you can save your money.