No one wants to be an innocent victim of human violence. The recent attacks in Paris, Mali, Lebanon and elsewhere show that if nothing else is prospering in the world, hate is. But, if you can gain the perspective, these all represent small scale violence by weak players in the world's political and religious arena.
I just received a reminder from Doctors Without Borders about the tragedy at Kunduz. You may recall that Kunduz is a city of about 300,000 people in Afghanistan to the northeast of Kabul, not very far from the Tajikistan border. The Taliban briefly occupied the city in September. The "central" government took it back fifteen days later in October, with help from American troops and warplanes.
The hospital operated by Doctors Without Borders was struck by a U.S. Air Force AC-130 gunship, an awesome weapon of war and successor to the AC-47 used to mass murder peasants during the Vietnam War.
Hospitals, as long as they function as hospitals, are never fair targets in war, the same as trucks and tents marked with Red Cross identification. For details on why the Kunduz massacre was a war crime, see Protection of Medical Services Under International Law.
This is not the sort of incident that happens by accident, nor do the circumstances around the massacre look accidental in any way. This is not a case of stray bullets from the AC-130 missing a legitimate target and then hitting some doctors, nurses, and patients. The Hospital Was the Target.
And that is the kind of thing that is controlled from the White House Situation Room. Whether President Barack Obama was actually in the situation room and made the call will probably become publicly available in about 60 years.
I have no sympathy for anyone who kills civilians, whether Presidents of the United States (or other nations) or freelance Islamists or any other political/social/religious group. So I have sympathy with the victims in Paris, and no sympathy for the perps, including the chain of command above them, right up to the Caliph.
The difference I have with most Americans [Trigger alert: prepare to be shocked by an opinion] is that I don't think the victims of American President Barack Obama (and the many war criminal President predecessors) are in any essential way different than the victims of Abu Bakr al-Baghdadi, or Osama Bin Laden, or for that matter Pol Pot, Trotsky, General Franco or anyone else. The government of the United States was established by violence; almost all governments are. It does not matter to me whether violence is used to establish a republic or an Islamic State, it is wrong because it is violence, and particularly wrong when it is violence against civilians.
In particular, I am not a fan of the French government. To me the French monarchs starting with Charlemagne, Napoleon, the French imperialists who conquered Vietnam and other colonies, Philippe Petain, and the leaders who recently bombed Raqqa are just slight variations on the Abu Bakr al-Baghdadi theme.
The American people have no learning curve. They are not told the facts, and if a few people learn a few facts, they are swiftly swept aside by a torrent of daily woes. We could have learned a lot from the Somalia disaster, but most Americans don't even know there was a Somalia disaster, much less how American foreign policy and military stupidity drove that nation to disaster, step by step. Somalians can now choose between a corrupt and inept U.S. puppet government and an al-Qaeda aligned opposition.
Which is not much different than choosing between the Democratic Party and the Republican Party. There was a time when I thought the people of Mendocino County, California, would find their way out of that trap, but with the Bernie Sanders phenomena, I see that too much marijuana and too-little fact checking, and thinking things through, makes escape impossible. Bernie has vowed to destroy the Islamic State. And how does that differ from every other power-hungry American politician?
It can be tempting to say that the victims in Paris were is some sense fair targets because they allowed their government to bomb Syria in the preceding weeks. This is the type of argument used by the British Empire and the American Empire during World War II to justify carpet bombing Japanese and German civilians during World War II. This argument leads to the excusing (by the perpetrators, anyway) of all killings of civilians.
Every nation should police its own government to prevent war crimes. George Bush, Dick Cheney, Barack Obama and all their gang should be tried for war crimes and, instead of being hung by their necks like the Nuremburg criminals, spend the rest of their lives in prison. To some extent the American people are to blame for allowing the crimes. But our lack of power to change the system is really no different than the situation of those living under the Islamic State. Hopefully the governments of Syria and Iraq will be able to defeat the Islamic State, but will respect the lives of civilians. And spare the lives of any soldiers that surrender, as per international law of prisoners of war.
Showing posts with label hospitals. Show all posts
Showing posts with label hospitals. Show all posts
Sunday, November 22, 2015
Sunday, November 10, 2013
Doctors Who Refuse Medicare or Medicaid Should Lose Licenses
There is a simple and fair solution to the increasingly common problem of doctors refusing to accept Medicare and Medicaid patients.
What point is there to giving seniors, the disabled and the insolvent Medicare and Medicaid if many doctors refuse to accept them as payment?
What kind of person refuses to accept Medicare and Medicaid? An anti-social person. A person who entered the medical profession driven by greed, not by the desire to help people. A person who does not even care about other doctors, whose own incomes are hurt when they have to take too high of a ratio of Medicare patients to make up for sociopath doctor behavior. In short, a criminal, but a white collar criminal who can do far more harm to people through negligence than an ordinary street criminal can do through theft.
Before going further, let me say that, on the whole, Medicare and Medicaid pay scales are fair. When a doctor or hospital says they are losing money when they accept Medicare or Medicaid, in truth they are saying they cannot ream these patients, and the taxpayers, the way the ream private insurance companies and the poor saps who come in without any bargaining power over the price of services. Medicare payments are enough to cover costs and provide an upper middle-class standard of living for doctors and fair wages to other health workers. If some payments for some services need to be raise a bit to be fair, I have no problem supporting that.
What happens when a doctor refuses Medicare patients? A senior will likely end up on a long waiting list, their health deteriorating while they wait. In some cases there may be no similarly qualified specialist in their area. Turning away a sick person because Medicare will pay for their treatment is a form of malpractice.
The solution is obvious. Any doctor who refuses Medicare/Medicaid patients should lose their license and pay a hefty fine. There should be a regular system to check for these abusers of our system.
In writing legislation to include good social behavior as a licensing requirement, there does need to be care taken to be fair. For instance, the Medicare load differs by location and specialty. It would not work to set a specific percentage of Medicare patients all doctor must see in order to keep their licenses. An individual doctor might reject a new patient because they are truly already fully booked, perhaps even mostly with Medicare patients.
The current Medicare bureaucracy should be sufficient to monitor physician compliance and take into account variations in locality and specialty. Some parts of America have a high percentage of seniors, others low percentages. That should not be hard to take into account with a formula that would flag potential bad eggs. Area doctors can be surveyed. If, of ten in the same specialty, nine complains that 70% to 90% of patients are on Medicare or Medicaid, while the tenth is near 0%, it should be clear what is going on.
Of course the first thing the bad doctors will do is stop saying why they are refusing patients. They might also try seeing patients, charging Medicare, but not actually treating patients, something that already happens all too much.
We all (or almost all) pay into Medicare throughout our working lives. To be denied care in our old age by a doctor is a crime. We should be able to call an authority to report such criminal behavior, and they should be happy to end up with only a suspended license, not behind bars with the other criminals, where they really belong.
It is difficult to get a slot in medical school, and so the number of doctors is limited. With a license to practice comes the responsibility to practice fairly, including taking a fair load of Medicare and Medicaid patients.
What point is there to giving seniors, the disabled and the insolvent Medicare and Medicaid if many doctors refuse to accept them as payment?
What kind of person refuses to accept Medicare and Medicaid? An anti-social person. A person who entered the medical profession driven by greed, not by the desire to help people. A person who does not even care about other doctors, whose own incomes are hurt when they have to take too high of a ratio of Medicare patients to make up for sociopath doctor behavior. In short, a criminal, but a white collar criminal who can do far more harm to people through negligence than an ordinary street criminal can do through theft.
Before going further, let me say that, on the whole, Medicare and Medicaid pay scales are fair. When a doctor or hospital says they are losing money when they accept Medicare or Medicaid, in truth they are saying they cannot ream these patients, and the taxpayers, the way the ream private insurance companies and the poor saps who come in without any bargaining power over the price of services. Medicare payments are enough to cover costs and provide an upper middle-class standard of living for doctors and fair wages to other health workers. If some payments for some services need to be raise a bit to be fair, I have no problem supporting that.
What happens when a doctor refuses Medicare patients? A senior will likely end up on a long waiting list, their health deteriorating while they wait. In some cases there may be no similarly qualified specialist in their area. Turning away a sick person because Medicare will pay for their treatment is a form of malpractice.
The solution is obvious. Any doctor who refuses Medicare/Medicaid patients should lose their license and pay a hefty fine. There should be a regular system to check for these abusers of our system.
In writing legislation to include good social behavior as a licensing requirement, there does need to be care taken to be fair. For instance, the Medicare load differs by location and specialty. It would not work to set a specific percentage of Medicare patients all doctor must see in order to keep their licenses. An individual doctor might reject a new patient because they are truly already fully booked, perhaps even mostly with Medicare patients.
The current Medicare bureaucracy should be sufficient to monitor physician compliance and take into account variations in locality and specialty. Some parts of America have a high percentage of seniors, others low percentages. That should not be hard to take into account with a formula that would flag potential bad eggs. Area doctors can be surveyed. If, of ten in the same specialty, nine complains that 70% to 90% of patients are on Medicare or Medicaid, while the tenth is near 0%, it should be clear what is going on.
Of course the first thing the bad doctors will do is stop saying why they are refusing patients. They might also try seeing patients, charging Medicare, but not actually treating patients, something that already happens all too much.
We all (or almost all) pay into Medicare throughout our working lives. To be denied care in our old age by a doctor is a crime. We should be able to call an authority to report such criminal behavior, and they should be happy to end up with only a suspended license, not behind bars with the other criminals, where they really belong.
It is difficult to get a slot in medical school, and so the number of doctors is limited. With a license to practice comes the responsibility to practice fairly, including taking a fair load of Medicare and Medicaid patients.
Subscribe to:
Posts (Atom)
