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01/18/2009

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frigeofs

–±–æ–ª—å—à–æ–µ —Å–ø–∞—Å–∏–±–æ!–í–∑—è–ª–∞ —Å–µ–±–µ —Ç–æ–∂–µ-–ø—Ä–∏–≥–æ–¥–∏—Ç—Å—è.

frigeofs

–±–æ–ª—å—à–æ–µ —Å–ø–∞—Å–∏–±–æ!–í–∑—è–ª–∞ —Å–µ–±–µ —Ç–æ–∂–µ-–ø—Ä–∏–≥–æ–¥–∏—Ç—Å—è.

frigeofs

–±–æ–ª—å—à–æ–µ —Å–ø–∞—Å–∏–±–æ!–í–∑—è–ª–∞ —Å–µ–±–µ —Ç–æ–∂–µ-–ø—Ä–∏–≥–æ–¥–∏—Ç—Å—è.

Jim

Can someone please explain to me how the government which is broke and cannot spend anything without printing the money and which has a debt of 12 trillion dollars presently can possibly solve the economic malaise. Not to mention that economic theory, regardless of its proximity to truth, is completely distorted by political pettiness and manipulation. By the way, why were not the 2 million at the inauguration at work? Maybe they thought that there would be a handout.

As to health care saving, there won't be any. The IT savings touted were based on a Rand study in 2005 which has become a fad concept pushed by politicians, vendors and the media. The Rand study was completely refuted by a Congressional Budget Office study in May 2008 and yet the politicians are still hawking the "savings". Why? The big vendors are charging physicians $50,000.00 per physician to install an office EHR system. Physicians won't spend that kind of money on a technology requiring space, personnel and constant maintenence. Think abaout it; Do you want your physician looking at a monitor and typing at a keyboard while you are trying to tell him/her about your chest pain. The UK National Health Service at the behest of Tony Blair tried to go electronic health record in 2004 and lost billions in that failure. It will now cost them three to four times as much for the redo if they had the money which they don't. There are better goals for the new people in Washington such as doing something about the 80 billion spent by Medicare each year in the last year of life. How about a mandatory advance directive at the time of social security registration. Everyone knows that there are vegetative patients kept alive in nursing homes so that families can keep getting the social security checks. Another big problem on the horizon is the looming shortage of good physicians and nurses.

http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm

Of course the politicians won't be honest enough to tell the country up front that any national health system will require big time rationing which they know the public will not accept up front.

Needless to say, I am not optimistic and might have to adopt the old economic theory of gold under the mattress like some of my friends in Europe are doing.

Oh. I almost forgot to ask, where do you think I should put my mattress with the gold in it to best deal with the 20% inflation coming down the road when the wheelbarrows are full of worthless dollars.

B Taxey

The current government medical spending is unsustainable (and an open invitation for fraud), yet there seems to no effort to set limits (income and asset threshholds) for seniors on Medicare who can easily afford to pay their own way. Further, why should our Congressional millionaires receive top benefits paid for by a workforce, much of which are told that their small company offers no health plan? Medicaid is being drained by many young people (unemployed by choice feigning disabilities), who, frankly need a kick in the butt. Makes no sense to me.

Bill (Booth MBA'83)

I'd like to comment on several of your observations regarding the relative impact of a public infrastructure stimulus package compared to a like amount of incentives for the private sector.

First, what we're observing in the private sector by way of the the financial system bailout program is that the receipt of government capital is not creating additional economic activity on the part of these institutions. Even if one takes into account labor market capacity issues in the occupations you've identified as being benefitted by the proposed government stimulus programs, at least this represents new and additional economic activity which will have a multiplier effect in the economy.

Secondly, you're also making an assumption that the resulting incremental additional deficits on the part of the federal government will not be offset by improved economic conditions which will increase tax revenues over what they would otherwise have been in the absence of this stimulus-driven activity. This is not the key driver of future deficits. Rather, the government needs to come up with a better approach to get entitlement/transfer program spending growth under control.

Finally, spending targeted at the specific industry I work in, health care, will produce near term tangible benefits if properly allocated. There is considerable inefficiency here due to information issues which could be improved upon by facilitating an interoperable health care/medical record infrastructure. Coupling this type of investment with incentives to increase the supply of primary and preventive care resources could provide a nice boost in worker productivity while helping to moderate future health care cost increases.

Sitssync

–£–≤–∞–∂–∞–µ–º—ã–π –∞–¥–º–∏–Ω–∏—Å—Ç—Ä–∞—Ç–æ—Ä –±–ª–æ–≥–∞, –∞ –≤—ã –æ—Ç–∫—É–¥–∞ —Ä–æ–¥–æ–º –±—É–¥–µ—Ç–µ?

Jack

Jim; I'll try a few of these, but it sounds as though you're having a very bad day.

Can someone please explain to me how the government which is broke and cannot spend anything without printing the money and which has a debt of 12 trillion dollars presently can possibly solve the economic malaise.

JJJJJJJJJJJJ well that's a complex one, but I'd just comment that the US government is one of the few entities that can borrow very long term at pretty low rates of interest. That strikes me as being viable means of paying for long neglected infrastructure repairs and upgrades as well as providing some of the incentives to conserve energy we now waste as well as helping us contain more of our dollars HERE by spurring more energy alternatives. Forget the past; we've been caught, again, flat footed and now is a good time to make the transition that various, earlier tax proposals, not passed, would have spurred over the intervening decades.

""Not to mention that economic theory, regardless of its proximity to truth, is completely distorted by political pettiness and manipulation. By the way, why were not the 2 million at the inauguration at work? Maybe they thought that there would be a handout."

JJJJ Whew! Let's see 600 private jets flew in, while Congress gave out 150,000 tickets that one suspects did not go to the unemployed, many came from nearby and while a lot of job benefits have disappeared, I think many still get a few vacation days per year. I don't have much concern about six tenths of one percent of our population showing up for this historic event; aren't there about the same number sitting in sports stadiums fairly often?

""As to health care saving, there won't be any. The IT savings touted were based on a Rand study in 2005 which has become a fad concept pushed by politicians, vendors and the media. The Rand study was completely refuted by a Congressional Budget Office study in May 2008 and yet the politicians are still hawking the "savings". Why?""

JJJJJJJJJJ Not sure. I've always trusted CBO more than OMB which appears more politically driven but would insurance and medical lobbyists have something to do with the variance?

"" The big vendors are charging physicians $50,000.00 per physician to install an office EHR system. Physicians won't spend that kind of money on a technology requiring space, personnel and constant maintenence.""

JJJJJJJJ My thought is that the horse and buggy days of so many individual cottage Doc shops is coming to an end. Small banks figured out that they could not compete with new software that the bigs had and have been merging for a long time. (I hope these efficiencies of scale are not confused with those "going rogue" and losing themselves along the way.)

"" Think abaout it; Do you want your physician looking at a monitor and typing at a keyboard while you are trying to tell him/her about your chest pain.""

JJJJJJJJJ Well, I'm a VA patient, at times in AK and at others in OK. So my experience is that of the physician in either place looking at my nearly complete record and asking ME about health issues. He/she then TYPES legible notes into MY record. Then he reviews prescriptions taken, updates them w/ generating any cryptic notes on bits of paper which then go to the efficient fulfillment center where they're typically mailed to my home. BTW they price shop too, paying just 40% of what the new Medicare D pays for the same thing.


""The UK National Health Service at the behest of Tony Blair tried to go electronic health record in 2004 and lost billions in that failure. It will now cost them three to four times as much for the redo if they had the money which they don't.""

JJJJJJJJJ Hmmmmmm perhaps the VA can pick up a few bucks selling copies of their system? It really does work, and it's kind of reassuring that most of my med record is available in the states and abroad by typing in first letter of last name and last four SS digits.


""There are better goals for the new people in Washington such as doing something about the 80 billion spent by Medicare each year in the last year of life. How about a mandatory advance directive at the time of social security registration. Everyone knows that there are vegetative patients kept alive in nursing homes so that families can keep getting the social security checks.""

JJJJJJJJJ Whew! Truth is the SS of Medicaid patients in nursing homes goes into the pot with the rest. No advantage to family members. Kinda tough to know just when to pull the plug on your Dad or Mom.


Another big problem on the horizon is the looming shortage of good physicians and nurses.

http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm

Of course the politicians won't be honest enough to tell the country up front that any national health system will require big time rationing which they know the public will not accept up front.""

JJJJJJJJJJ Oh? Currently we spend/waste 18% of GDP that is rapidly rising while the civilized nations are spending 8-12% of typically smaller GDP for universal health care. As for "rationing" I have LONG wondered what $10,000,000 CEO's of "insurance" companies bring to the party, or what benefit there is in court or other wrangling over who is covered or who gets the bill. Yeah, I'd ration the hlll out of these wasteful overhead items.

""Needless to say, I am not optimistic and might have to adopt the old economic theory of gold under the mattress like some of my friends in Europe are doing.""

JJJJJJJJJJ I thought you were something of a pessimist. Yup.

""Oh. I almost forgot to ask, where do you think I should put my mattress with the gold in it to best deal with the 20% inflation coming down the road when the wheelbarrows are full of worthless dollars.""

JJJJJJJJJ Well, at first we've the deflation to get through, and surely in the area of housing, stock or other ownership of most of our companies your mattress dollar is likely to buy more next week than this, but remember banks are backed by FDIC and are paying a smidgeon of interest as well.

Inflationary times? Those of us "of a certain age" have lived much of our lives in them as the buck lost 90% of its value so at some point the traditional stores of productive RE, stocks, and a dab of gold or gold mines, and bonds that reflect the inflationary premium are the traditional hedges.

Cheers and best of luck! Sorry there aren't any guarantees and that we HAVE been so hollowed out in the recent past, but in messes of the past it seems that if we do the "bright" thing at each turn we'll muddle through somehow. Hope I've lessened your pessimism a bit, Jack

Jim

Jack,

Hope you are right on all counts but I don't think so. Thanks for trying to cheer me up, though. Do you really think that the United States Government is going to cut the waste out of their health care budget? Good luck. And for those of us who have worked some in the VA system, no one holds it up as the model although I do have to give you that their EHR system is very, very good as is the military's. I would only point out that the rest of health care is not the military or the VA and might not respond well to a totalitarian approach.
Allow me to point out as well that most of the European healthcare systems are close to insolvency, there are VERY long waits for hospital care and in England there is no care for end stage renal disease(for example) if one is over 55 years. Talk about pulling the plug on mom and dad!!!

By the way, do you take anything to make yourself so happy or are you just an eternal optimist?

Dayday

–û–ø—É—Ç–µ—Ç—å –∫–∞–∫ –∏–Ω—Ç–µ—Ä–µ—Å–Ω–æ, –≤–æ –∑–∞–¥–≤–∏–≥–∞–µ—Ç–µ. –ö–ª–∞—Å—Å!

Jack

Jim: Thanks! especially for being a good sport! Just a follow up to say I don't think the Medicare (fee schedule) model is the ideal for the US.

One thing about the VA model is that they're stuck with taking care of all eligible Vets, so I'd assume their mission statement is pretty simple; "take care of em and strive for efficiency and cost reduction". Naturally that leaves the possibility, even likelihood of underserving, that is perhaps balanced by "the board" being elected representatives.

So I'm drawn to a model that might combine universality with some elements of competition to restrain costs. Perhaps it's a bit like HMO's of today at which the consumer subscribes with their voucher. I'd hope they'd compete on service? much as airlines used to before dereg, and that the consumer would have something like a "bill of rights" that would provide an outside opinion etc to avoid the rumored underservice of today's HMO's.

I'd expect we'd see bigger healthcare facilities than is typical today so as to more efficiently utilize costly MRI and Electronic Records but with consumer choice of primary physician etc.

It's not easy to design what is best and probably especially tough with "pols" doing the designing! But I'm trying to get away from all the wrestling over a "procedure" cost schedule that can never be up to date or reward wholistic care over procedures.

But, sometimes I joke about what a car or computer would cost if done under our current fee for service medical model with a door specialist, followed by "a good transmission guy" and finally another who "does paint" each with their own billing and malpractice insurance problems.

Ha! but for now it looks like "they" are going to drive us all into the maw of "insurance" providers, but once we realize we're all in one big pool, and the costs are still running away, we will ask what $10 million insurance CEO's are providing, and for that matter what their whole paperwork nightmare provides. If they want to be in the medical field they've plenty of retained earnings could easily go into the healthcare provider side.

I dunno.......... it's a shot!

"By the way, do you take anything to make yourself so happy or are you just an eternal optimist?"

Well, much like Obama's speech and that of Clinton's I too would like to hope that "what's right with America outweighs what is wrong with America" and that we've enough wealth and momentum to prevail, though we do have quite a "turnaround" task ahead of us.

And........ speaking of matters renal, I'm happy that I'm well over 55 and still have one kidney left after a thrombosis shut one of them down, and politely picked an organ to shutdown that has a back up though it wasn't much fun at the time with the VA providing price-shopped coumadin and otherwise rather good health! If you're a practitioner, know that while we may be frustrated at the delivery system that we're extremely appreciative of the docs, nurses and all!

MemSweem

–°–ø–∞—Å–∏–±–æ. –ü—Ä–æ—Å—Ç–æ —Å–ø–∞—Å–∏–±–æ, –∑–∞ –∫—Ä–∞—Å–∏–≤—ã–µ –º—ã—Å–ª–∏ –≤—Å–ª—É—Ö. –í —Ü–∏—Ç–∞—Ç–Ω–∏–∫.

Jim

Jack,

The link below will take you to, in my opinion, a useful study of the current European systems in some detail such that one gets a pretty good idea of what might work in the USA. My original reading took about two hours but it is well worth the time to dispell misconceptions about what is already out there.

http://www.euro.who.int/document/OBS/hcs8countries.pdf

In addition, below is a link to a review of Daniel Callahan's approach to health care rationing. You can delve deeper into Callahan's work by visiting the website for The Hastings Center, a prominent bioethics think tank founded by Callahan.

http://www.richard-t-hull.com/publications/callahan_review_setting_limits.pdf

Cheers.

thargego

–ü–æ –º–æ–µ–º—É —É –í–∞—Å —É–∫—Ä–∞–ª–∏ —ç—Ç—É —Å—Ç–∞—Ç—å—é –∏ –ø–æ–º–µ—Å—Ç–∏–ª–∏ –Ω–∞ –¥—Ä—É–≥–æ–º —Å–∞–π—Ç–µ. –Ø –µ—ë —É–∂–µ –≤–∏–¥–µ–ª–∞.

UnsewesDrown

–î–æ–±–∞–≤–∏–ª –≤ —Å–≤–æ–∏ –∑–∞–∫–ª–∞–¥–∫–∏. –¢–µ–ø–µ—Ä—å –±—É–¥—É –≤–∞—Å –Ω–∞–º–Ω–æ–≥–æ –ø–æ—á–∞—â–µ —á–∏—Ç–∞—Ç—å!

Jack

Jim... Thanks! I'm interested enough to slog through those but it'll take a while! So far AUS seems to have the "advantage" that they dedicate about 8% of GDP so could solve some of their problems by dedicating a couple more percent as well as looking for more efficiencies.

Speaking of which, it seems that US industry "downsized" and got rid of many middle managers, I suspect with help from even that era's computerization etc. but it seems to me that other than our great productive areas of farming and mfg that we've a LOT of built in bloat and inefficiencies. Were we to honestly cut out a fair amount of fat GDP per capita would rise, wages SHOULD rise, and we'd have a much easier time paying for H/C, SS and caring for our elders.

reoliIdionee

–û—Ç–ª–∏—á–Ω—ã–π –ø–æ—Å—Ç, –ø—Ä–æ—á–∏—Ç–∞–≤ –Ω–µ—Å–∫–æ–ª—å–∫–æ —Å—Ç–∞—Ç–µ–π –Ω–∞ —ç—Ç—É —Ç–µ–º—É –ø–æ–Ω—è–ª, —á—Ç–æ –≤—Å—ë —Ç–∞–∫–∏ –Ω–µ –ø–æ—Å–º–æ—Ç—Ä–µ–ª —Å –¥—Ä—É–≥–æ–π —Å—Ç–æ—Ä–æ–Ω—ã, –∞ –ø–æ—Å—Ç –∫–∞–∫-—Ç–æ –æ—á–µ–Ω—å –∑–∞–∏–Ω—Ç–µ—Ä–µ—Å–æ–≤–∞–ª.

Ranielle


–î–∞–Ω–Ω—ã–µ –∏–Ω—Ç–µ—Ä–µ—Å–Ω—ã, –±—ã–ª–æ –±—ã –µ—â–µ —É –æ—Å–Ω–æ–≤–Ω–æ–π –º–∞—Å—Å—ã –ø–æ–ª—å–∑–æ–≤–∞—Ç–µ–ª–µ–π –∂–µ–ª–∞–Ω–∏–µ —á—Ç–æ-—Ç–æ –¥–µ–ª–∞—Ç—å, –∞ –Ω–µ —Ç–æ–ª—å–∫–æ –±—Ä–æ–¥–∏—Ç—å –ø–æ –∏–Ω—Ç–µ—Ä–Ω–µ—Ç—É. –í—Å–µ –ø—É—Å–∫–∞–µ—Ç—Å—è –Ω–∞ —Å–∞–º–æ—Ç–µ–∫, –Ω–∞—Ä–æ–¥ –æ—Ç—Å—Ç—Ä–∞–Ω—è–µ—Ç—Å—è –æ—Ç —Ç–æ–≥–æ, —á—Ç–æ –¥–µ–ª–∞–µ—Ç, –∏–ª–∏ –Ω–µ –¥–µ–ª–∞–µ—Ç –Ω–∏—á–µ–≥–æ –≤–æ–≤—Å–µ. "–ñ–∏–∑–Ω—å –Ω–µ–≤–æ–∑–º–æ–∂–Ω–æ –ø–æ–≤–µ—Ä–Ω—É—Ç—å –Ω–∞–∑–∞–¥. –ò –≤—Ä–µ–º—è –Ω–∏ –Ω–∞ –º–∏–≥ –Ω–µ –æ—Å—Ç–∞–Ω–æ–≤–∏—à—å...", —Å–ª–æ–≤–∞ –∏–∑ –ø–µ—Å–Ω–∏ –ü—É–≥–∞—á–æ–≤–æ–π, –∫—Å—Ç–∞—Ç–∏.

Nurigooguids

–∞ –≤–æ—Ç –≤–æ–ø—Ä–æ—Å–∏–∫ –º–æ–∂–Ω–æ? –£ –≤–∞—Å –≤—Ä–µ–º—è –ø–æ—Å–ª–µ –ø–æ—Å—Ç–∞ —É–∫–∞–∑–∞–Ω–æ. –≠—Ç–æ –º–æ—Å–∫–æ–≤—Å–∫–æ–µ? –ó–∞—Ä–∞–Ω–µ–µ —Å–ø–∞—Å–∏–±–æ!

Tsar Nikolau

Проклатые русские сабочонки – шат ап олърэди!

alieks

–æ—á–µ–Ω—å –∑–∞–Ω–∏–º–∞—Ç–µ–ª—å–Ω–æ –±—ã–ª–æ –ø–æ—á–∏—Ç–∞—Ç—å

Jack

Private sector efficiency?

http://www.thedailybeast.com/blogs-and-stories/2009-01-22/john-thains-87000-rug/

Thain’s top 16 outrages.

1) $2,700 for six wall sconces.
2) $5,000 for a mirror in his private dining room.
3) $11,000 for fabric for a "Roman Shade.”
4) $13,000 for a chandelier in the private dining room.
5) $15,000 for a sofa.
6) $16,000 for a "custom coffee table.”
7) $18,000 for a “George IV Desk.”
8) $25,000 for a "mahogany pedestal table.”
9) $28,000 for four pairs of curtains.
10) $35,000 for something called a "commode on legs.”
11) $37,000 for six chairs in his private dining room.
12) $68,000 for a "19th Century Credenza" in his office.
13) $87,000 for a pair of guest chairs.
14) $87,000 for an area rug in Thain's conference room and another area rug for $44,000.
15) $230,000 to his driver for one year’s work.
16) $800,000 to hire celebrity designer Michael Smith, who is currently redesigning the White House for the Obama family for just $100,000.

.......... and "due diligence?"

Just last week, Bank of America announced that Merrill has suffered an unexpected loss of $1.79 billion for the fourth quarter of 2008, nearly collapsing BofA's purchase. Bank of America CEO Ken Lewis said that without $138 billion in government assistance, including the infusion of $20 billion from the federal government he would have pulled out of the Merrill deal, which was approved by BofA shareholders in early December.

Thain has come under pressure in recent weeks after several top executives at Merrill, including brokerage chief Bob McCann and investment banking head Greg Fleming, abruptly resigned from the firm citing differences with Thain. People close to Lewis say his relationship with Thain was further strained by the recent massive loss. Lewis himself has faced withering criticism for rushing the buy Merrill for $28 billion after less than two days of due diligence.

Odonadimmeno

–û—á–µ–Ω—å –∏–Ω—Ç–µ—Ä–µ—Å–Ω–æ, –Ω–æ –≤—Å–µ –≤ –±—É–¥—É—â–µ–º —Ö–æ—Ç–µ–ª–æ—Å—å –±—ã –µ—â–µ –ø–æ–±–æ–ª—å—à–µ —É–∑–Ω–∞—Ç—å –æ–± —ç—Ç–æ–º. –û—á–µ–Ω—å –ø–æ–Ω—Ä–∞–≤–∏–ª–∞—Å—å –≤–∞—à–∞ —Å—Ç–∞—Ç—å—è!

Soogma

Опубликовал на своем блоге вашу статью, и напечатол там конечно-же обратную ссылку на вас. Но вот зашел посмотреть поевился ли трекбек, а его нет…

tassactormat

–ò–Ω—Ç–µ—Ä–µ—Å–Ω–æ –∏ –ø–æ–∑–Ω–æ–≤–∞—Ç–µ–ª—å–Ω–æ, –∞ –±—É–¥–µ—Ç –µ—â–µ —á—Ç–æ-—Ç–æ –ø–æ —ç—Ç–æ–π —Ç–µ–º–µ?

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