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.
Showing posts with label taxpayers. Show all posts
Showing posts with label taxpayers. Show all posts
Sunday, November 10, 2013
Wednesday, March 2, 2011
Rainy Day Wisconsin: Union Busting
Arnold Schwarzenegger, former actor and Governor of California, looks a lot better after a few months out of office. Partly that is because California does not look so bad, now that the problems of states like Texas, Wisconsin, and Illinois are more in the limelight. Mostly it is because the new fearless leader of California, and its same-old Democratic Party, Jerry Brown, is having to tell his party constituency pretty much the same thing Arnold did: there is no money. We have sucked the blood of the golden geese, the working taxpayers and productive businesses, to the point where we have to wait for a bit of recovery before we can throw more poly ticks into the mix
My heart bleeds for the public service workers of Wisconsin. Public service is a fine thing. I believe in the right of working people to form unions, too. But while Governor Scott Walker, is hell-bent on destroying every union, public and private (except ones that support the Republican Party, hint, hint), that does not mean I feel I need to defend every union, and every union action, no matter what the details.
If the United States, or the individual constituent states, were really based on democratic (rule by the people) principles, what would be the relationship of government to public employees? In a democracy should the public make decisions through its elected representatives, or should public employees be the real decision makers? Should public employees decide their own pay, working hours, and pensions?
What can be good in a private sector union can have negative consequences with public employee unions. Private sector unions provide a balance for ordinary workers against the power of corporations. That does not mean that corporations would always be wrong if they set pay scales without employee input; it does not mean that unions don't sometimes have their own problems, like internal corruption. But a union that asks too much of a business will destroy the business, and hence hurt its own members interests. Smart unions and smart corporations cooperate so that everyone is reasonably happy: stockholders, management, employees, and yes, even customers.
Public service unions can have some good effects. My own take (and I have served on a public school board, and have been observing these matters for decades now) is that some government employees are overpaid, and some underpaid, just like in private industry. Some are workhorses, and some are shirkers, just like in private industry.
The reason anti-union ideologues like Scott Walker make government worker unions the scapegoat for all unions, and for that matter all employees (seen by Walker as an inferior class of people who don't have the initiative to start a business or claw their way into management), is that our political system does sometimes allow particular unions of government employees to get out of control. The unions use campaign contributions and their ability to mobilize members to work on political campaigns to influence state legislatures. In return state budgets get distorted in two ways. Powerful unions (in California that would be police and prison guard unions) get a disproportionate share of the state budget allocated to them. And since each time a budget is done there is not enough money to go around (and that includes tax loopholes for the rich, and make work for well-connected corporations), the future gets mortgaged, usually in the form of promises of higher pensions.
What we need to fix the system is less ideology and more attention to detail. The every-man-for-himself Republican Party needs to stop acting as if every union (and every employee wanting a living wage) is bad and every government employee is an overpaid shirker. Liberal Democratic Party politicians need to stop acting as if every public employee demand for pay and benefit increases is legitimate. Some group of politicians needs to start working for the preservation of the bulk of employees whose only old-age pension is Social Security.
The job of a representative in a democracy is not just to pimp for powerful businessmen and powerful unions. The rest of us, the non-union workers and small business people, would like some representation too. We should all want good schools and good police and some sort of a safety net. None of us need a bloated military establishment or taxpayer subsidies to the rich or a pension system for highly-paid bureaucrats that no amount of taxation can sustain.
Public employee unions should retain their right to collective bargaining. Our elected officials, and the administrators who actually set salaries, need to be tough and fair negotiators. Unless you think the People they are stand-ins for are soft but unfair. Which might be right.
My heart bleeds for the public service workers of Wisconsin. Public service is a fine thing. I believe in the right of working people to form unions, too. But while Governor Scott Walker, is hell-bent on destroying every union, public and private (except ones that support the Republican Party, hint, hint), that does not mean I feel I need to defend every union, and every union action, no matter what the details.
If the United States, or the individual constituent states, were really based on democratic (rule by the people) principles, what would be the relationship of government to public employees? In a democracy should the public make decisions through its elected representatives, or should public employees be the real decision makers? Should public employees decide their own pay, working hours, and pensions?
What can be good in a private sector union can have negative consequences with public employee unions. Private sector unions provide a balance for ordinary workers against the power of corporations. That does not mean that corporations would always be wrong if they set pay scales without employee input; it does not mean that unions don't sometimes have their own problems, like internal corruption. But a union that asks too much of a business will destroy the business, and hence hurt its own members interests. Smart unions and smart corporations cooperate so that everyone is reasonably happy: stockholders, management, employees, and yes, even customers.
Public service unions can have some good effects. My own take (and I have served on a public school board, and have been observing these matters for decades now) is that some government employees are overpaid, and some underpaid, just like in private industry. Some are workhorses, and some are shirkers, just like in private industry.
The reason anti-union ideologues like Scott Walker make government worker unions the scapegoat for all unions, and for that matter all employees (seen by Walker as an inferior class of people who don't have the initiative to start a business or claw their way into management), is that our political system does sometimes allow particular unions of government employees to get out of control. The unions use campaign contributions and their ability to mobilize members to work on political campaigns to influence state legislatures. In return state budgets get distorted in two ways. Powerful unions (in California that would be police and prison guard unions) get a disproportionate share of the state budget allocated to them. And since each time a budget is done there is not enough money to go around (and that includes tax loopholes for the rich, and make work for well-connected corporations), the future gets mortgaged, usually in the form of promises of higher pensions.
What we need to fix the system is less ideology and more attention to detail. The every-man-for-himself Republican Party needs to stop acting as if every union (and every employee wanting a living wage) is bad and every government employee is an overpaid shirker. Liberal Democratic Party politicians need to stop acting as if every public employee demand for pay and benefit increases is legitimate. Some group of politicians needs to start working for the preservation of the bulk of employees whose only old-age pension is Social Security.
The job of a representative in a democracy is not just to pimp for powerful businessmen and powerful unions. The rest of us, the non-union workers and small business people, would like some representation too. We should all want good schools and good police and some sort of a safety net. None of us need a bloated military establishment or taxpayer subsidies to the rich or a pension system for highly-paid bureaucrats that no amount of taxation can sustain.
Public employee unions should retain their right to collective bargaining. Our elected officials, and the administrators who actually set salaries, need to be tough and fair negotiators. Unless you think the People they are stand-ins for are soft but unfair. Which might be right.
Wednesday, November 12, 2008
Stop the General Motors Bailout
Some members of Congress appear to be getting ready to bailout General Motors, aka GM. This would be bad for America. Allowing GM to go out of business would be a very good thing. And it GM is to stay in business, the money should come from its shareholders, not the taxpayers.
The pimps in Congress who want money for GM, and the corporate press, will be careful not to remind you of all the dividends that were drained out of GM over the last century. If even the dividends paid out in the last ten years had been kept and used to create a cash reserve, or invested in producing small, energy-efficient cars, GM would be fine right now.
How about sucking the dividends back in? Have GM send to its stockholders notices saying that if they don't send back the dividends, GM will go under. See what happens.
Think of the enormous benefits America will see if GM goes under. Ford and Chrysler have plenty of capacity to supply U.S. consumers with cars. In addition, when GM goes under, everything it owns will go for sale under the bankruptcy court. Maybe a foreign car manufacturer, Tata or Toyota or Fiat, that has more competent management will buy the whole thing. Maybe some parts of it will go here, some parts there. Maybe GM will be broken up into four or five smaller American-owned companies that are better managed, nimbler, and capable of operating in the 21st century.
So why is the Democratic Party leadership so keen on giving your taxes to a bunch of old corporate capitalist types. They will say it is jobs. That is their sales pitch. But the same money could create a lot more jobs if put into any industry other than auto manufacturing.
To be efficient, robots have to be used to run modern automobile factories. So there are two choices for your taxpayer dollars: recreating an inefficient GM with human jobs, or creating an efficient, competitive GM with robots replacing workers.
Let us just face up to the fact that when push comes to shove, the Democratic Party uses taxpayer dollars to do its campaign donors bidding. Between the United Auto Workers, the GM bosses, and hedge fund managers, Barack Obama and other Democratic Party officials were flooded with money this campaign cycle. Those donors want to be repaid. Job creation is just one Democratic Party standard marketing tool. I am not against job creation, but I know when it is a sales pitch instead of the real deal.
GM purposefully made and promoted miles-per-gallon, expensive SUVs that they knew were killing the planet (see Global Warming) and impoverishing consumers. They were happy to make us dependent on foreign oil and lobbied for drilling for oil in ecologically sensitive areas of the United States.
If GM's management deserve anything from the government, it is the gallows.
More data:
General Motors
The pimps in Congress who want money for GM, and the corporate press, will be careful not to remind you of all the dividends that were drained out of GM over the last century. If even the dividends paid out in the last ten years had been kept and used to create a cash reserve, or invested in producing small, energy-efficient cars, GM would be fine right now.
How about sucking the dividends back in? Have GM send to its stockholders notices saying that if they don't send back the dividends, GM will go under. See what happens.
Think of the enormous benefits America will see if GM goes under. Ford and Chrysler have plenty of capacity to supply U.S. consumers with cars. In addition, when GM goes under, everything it owns will go for sale under the bankruptcy court. Maybe a foreign car manufacturer, Tata or Toyota or Fiat, that has more competent management will buy the whole thing. Maybe some parts of it will go here, some parts there. Maybe GM will be broken up into four or five smaller American-owned companies that are better managed, nimbler, and capable of operating in the 21st century.
So why is the Democratic Party leadership so keen on giving your taxes to a bunch of old corporate capitalist types. They will say it is jobs. That is their sales pitch. But the same money could create a lot more jobs if put into any industry other than auto manufacturing.
To be efficient, robots have to be used to run modern automobile factories. So there are two choices for your taxpayer dollars: recreating an inefficient GM with human jobs, or creating an efficient, competitive GM with robots replacing workers.
Let us just face up to the fact that when push comes to shove, the Democratic Party uses taxpayer dollars to do its campaign donors bidding. Between the United Auto Workers, the GM bosses, and hedge fund managers, Barack Obama and other Democratic Party officials were flooded with money this campaign cycle. Those donors want to be repaid. Job creation is just one Democratic Party standard marketing tool. I am not against job creation, but I know when it is a sales pitch instead of the real deal.
GM purposefully made and promoted miles-per-gallon, expensive SUVs that they knew were killing the planet (see Global Warming) and impoverishing consumers. They were happy to make us dependent on foreign oil and lobbied for drilling for oil in ecologically sensitive areas of the United States.
If GM's management deserve anything from the government, it is the gallows.
More data:
General Motors
Sunday, September 28, 2008
Saving Wall Street, Pros and Cons
Readers of this column know that I don't much approve of how this nations' government or economy are run. But you know I like to illuminate the stuff in the box by gazing at it from outside the box. Right now the stuff in the box is a bail out for some of America's biggest investment banks, which in turn will bail out some of their biggest clients, who are holding mortgage-related investments. In all cases, we are talking about obscenely rich people who could care less about ordinary people and have repeatedly shown that with their actions.
Yet joining the criticism of the strange coalition of left-of-center Democrats and right-wind House Republicans who "opposed" the Treasury plan mainly to make political hay just seems like jumping on a pile of big guys who have already caused permanent injury to a quarterback who had a million dollar arm just a few moments earlier. The House Republicans say they don't want ordinary taxpayers to bail out Wall Street. That is a laugh, except that some of their constituents are so brain dead they probably swallowed that poll-driven excrement without a thought.
,
I agree with progressives that a bottom-up rescue plan would be better. But we are stuck with the decision makers that the American voters chose, and the way things work is most incumbents will be re-elected to Congress in November. I have never drunk the free-markets always work kool-aid, but I also know that a credit freeze will almost certainly throw this country into an economic depression, and quickly. It would be very hard to dig our way out of such a Depression. In 1929 when the last Depression began the national treasury was almost debt-free. That is not the case today. The government won't be able to spend its way out of a Depression because no one will be willing to finance that level of spending. The only alternative is the kind of inflation that destroyed Germany in the 1920's, or enduring the pain until the business cycle eventually gets back on track by itself. The possibility of the complete collapse of civilization as we know it is no longer totally improbable in the short run.
So I am for the $700 billion (probably more like $1 trillion, by the time it is over) bail out of Wall Street. In effect taxpayers are buying assets that may increase or decrease in value. Congress did insist on some good changes to the original plan. It could be much worse.
It is not the first bailout in American history, and it is not always Wall Street that gets bailed out. Remember that IRS "refund" check you got a few months ago? That, aside from being a shameless election year ploy, was a bailout for us all. And some bailouts are so institutionalized we don't think twice about them, like receiving unemployment insurance or Social Security disability payments, or food stamps.
The problem with bailouts evenly distributed among the citizens or taxpayers is that they just don't work in the kind of situation we have right now. Quite a few people may have caught up on a single mortgage payment with the tax refund, but they are in trouble precisely because they habitually spend more than they make, so most of them were probably in trouble again the next month. They need their life styles to be cut back. If they did that it might be worth the government doing something about refinancing their mortgage payments.
When Wall Street was raking in profits 3 years ago, it was because they concentrated the profits from millions of relatively small transactions. In this crisis we see the concentration of millions of small losses (small here might mean up to $1 million dollars per mortgage). To deal with the crisis quickly, the fire must be put out where it is burning, not where we would like to fight fires in the future.
What is sad is that once the crisis goes away, no fundamental reform is likely. There were a few fundamental reforms in the Great Depression partly because the crisis was not averted early on, in 1930. Some radicals might argue, (and I'm tempted) that therefore it would be best to let Wall Street and the entire free-market Capitalist religion fall. The problem is that good cultural, political and economic systems don't automatically spring up after bad systems have crashed. In the last Great Depression many nations ended up with Fascist governments (See my fascism pages): Italy, Germany, and Spain of course, but also France, Austria, Slovakia, Poland and others. Even the New Deal had many fascist-type elements, most notably the death-grip on power held by President-for-life Roosevelt.
Yet joining the criticism of the strange coalition of left-of-center Democrats and right-wind House Republicans who "opposed" the Treasury plan mainly to make political hay just seems like jumping on a pile of big guys who have already caused permanent injury to a quarterback who had a million dollar arm just a few moments earlier. The House Republicans say they don't want ordinary taxpayers to bail out Wall Street. That is a laugh, except that some of their constituents are so brain dead they probably swallowed that poll-driven excrement without a thought.
,
I agree with progressives that a bottom-up rescue plan would be better. But we are stuck with the decision makers that the American voters chose, and the way things work is most incumbents will be re-elected to Congress in November. I have never drunk the free-markets always work kool-aid, but I also know that a credit freeze will almost certainly throw this country into an economic depression, and quickly. It would be very hard to dig our way out of such a Depression. In 1929 when the last Depression began the national treasury was almost debt-free. That is not the case today. The government won't be able to spend its way out of a Depression because no one will be willing to finance that level of spending. The only alternative is the kind of inflation that destroyed Germany in the 1920's, or enduring the pain until the business cycle eventually gets back on track by itself. The possibility of the complete collapse of civilization as we know it is no longer totally improbable in the short run.
So I am for the $700 billion (probably more like $1 trillion, by the time it is over) bail out of Wall Street. In effect taxpayers are buying assets that may increase or decrease in value. Congress did insist on some good changes to the original plan. It could be much worse.
It is not the first bailout in American history, and it is not always Wall Street that gets bailed out. Remember that IRS "refund" check you got a few months ago? That, aside from being a shameless election year ploy, was a bailout for us all. And some bailouts are so institutionalized we don't think twice about them, like receiving unemployment insurance or Social Security disability payments, or food stamps.
The problem with bailouts evenly distributed among the citizens or taxpayers is that they just don't work in the kind of situation we have right now. Quite a few people may have caught up on a single mortgage payment with the tax refund, but they are in trouble precisely because they habitually spend more than they make, so most of them were probably in trouble again the next month. They need their life styles to be cut back. If they did that it might be worth the government doing something about refinancing their mortgage payments.
When Wall Street was raking in profits 3 years ago, it was because they concentrated the profits from millions of relatively small transactions. In this crisis we see the concentration of millions of small losses (small here might mean up to $1 million dollars per mortgage). To deal with the crisis quickly, the fire must be put out where it is burning, not where we would like to fight fires in the future.
What is sad is that once the crisis goes away, no fundamental reform is likely. There were a few fundamental reforms in the Great Depression partly because the crisis was not averted early on, in 1930. Some radicals might argue, (and I'm tempted) that therefore it would be best to let Wall Street and the entire free-market Capitalist religion fall. The problem is that good cultural, political and economic systems don't automatically spring up after bad systems have crashed. In the last Great Depression many nations ended up with Fascist governments (See my fascism pages): Italy, Germany, and Spain of course, but also France, Austria, Slovakia, Poland and others. Even the New Deal had many fascist-type elements, most notably the death-grip on power held by President-for-life Roosevelt.
Subscribe to:
Posts (Atom)
