A couple of additional thoughts on the “concierge model” of primary medical care, which I wrote about a few days ago.
My primary care doctor went to that model of practice about a year ago, and I left his care when he did so. It was not that I could not afford the fee,
I could actually, it was just that I didn’t wish to participate in that form of practice. If doctors are overworked, then that is a problem which needs to be addressed, but I am convinced that this idea is not the solution.
The greatest ill facing our health care delivery system today is the cost that we pay for it, and this process is akin to trying to put out a fire by pouring gasoline on it. While it may marginally improve health care for a few, it degrades the quality of health care for many, thereby damaging the system as a whole, and it adds enormously to the systematic cost.
The “concierge fee” is not really “money for doing nothing” as I suggested before, it is an “availability fee” that the patient pays to assure that the doctor will forgo seeing other patients to spend more time with the few. Still, no actual service is performed for that fee, since the doctor continues to charge the usual fee for services rendered. When an attorney charges a retainer, later services are deducted from that retainer. When he takes a contingency fee, he risks losing the case and getting nothing. With the concierge fee there is neither risk or deduction of later services, so I have
to see that fee as an “overhead” charge.
As such, being “overhead,” that fee certainly adds to the cost of health care in this nation. If the average fee is $2,000 as the San Diego Union-Tribune article says, and the average number of patients is 450 for each of 3,500 concierge doctors in the U.S., then $3.15 billion, that’s billion with a ‘b,’ is being added to the cost of health care annually by that fee. That’s added to a health care system that was already the world’s most costly.
If each of those doctors dropped 1,700 patients when he established his concierge practice, then 5.95 million new patients were dumped into a system which has 3,500 fewer primary care physicians, and there was already a shortage of them to begin with. How can that not damage the system when there is a large number, millions, of additional patients being shared by fewer doctors?
This “concierge medical practice” is a thoroughly pernicious scheme.
My father was a physician, one who tended not to send a bill to patients when he knew that they would be unable to pay it. He didn’t want to stress them out over their inability to pay and he would, of course, continue to treat them after not sending them the bill. I think he would be horrified by this process, and I know that I am.
Wednesday, May 18, 2011
MSNBC = Election Central
I’m now recording both Hardball and The Last Word so that when they start babbling about the 2012 Republican election I can fast forward past the nonsense. The election is still 18 months away, and it will consist of a breathless contest to see who will be defeated by Barack Obama. Why they are so fascinated by it is a complete mystery to me.
They are amazed that the Republicans have no sensible candidates, which merely proves how senseless they are. The Republicans are not going to waste a decent candidate in an election against a Democrat who they know they have zero chance of beating. They are saving their guns for 2016. Anyone with an IQ above room temp should be able to figure that out.
Both of them spent an enormous amount of time yesterday talking about Donald Trump, two days after he quit running for president. I wasn't sure it made sense to talk about him the day he quit, but to keep him as a subject of "discussion" for a full two days after he is no longer a candidate? Why do we listen to these idiots?
I know, I know. You don't, and you wonder why I do.
Not only is their focus on an election which is more than a year away, but they are not discussing its impact on the nation’s well being or policies. They are yammering about the tactics which might be used, about who will raise money and how they will raise it, and about who is making the most tactical errors in campaigning. The election is no more important to them than a football game.
Chris Matthews had Bill Maher on for his whole show yesterday. Maher is supposed to be brilliant and witty, but I found him to be stupid and dull. Matthews kept being the only one laughing at his own jokes, which was embarrassing, and Maher kept not knowing what Matthews was talking about and asking for explanations of the jokes, which was dull. and after about seven minutes I switched to watching some reruns of Judge Judy. She makes much more sense than Matthews, and is funnier than Maher.
They are amazed that the Republicans have no sensible candidates, which merely proves how senseless they are. The Republicans are not going to waste a decent candidate in an election against a Democrat who they know they have zero chance of beating. They are saving their guns for 2016. Anyone with an IQ above room temp should be able to figure that out.
Both of them spent an enormous amount of time yesterday talking about Donald Trump, two days after he quit running for president. I wasn't sure it made sense to talk about him the day he quit, but to keep him as a subject of "discussion" for a full two days after he is no longer a candidate? Why do we listen to these idiots?
I know, I know. You don't, and you wonder why I do.
Not only is their focus on an election which is more than a year away, but they are not discussing its impact on the nation’s well being or policies. They are yammering about the tactics which might be used, about who will raise money and how they will raise it, and about who is making the most tactical errors in campaigning. The election is no more important to them than a football game.
Chris Matthews had Bill Maher on for his whole show yesterday. Maher is supposed to be brilliant and witty, but I found him to be stupid and dull. Matthews kept being the only one laughing at his own jokes, which was embarrassing, and Maher kept not knowing what Matthews was talking about and asking for explanations of the jokes, which was dull. and after about seven minutes I switched to watching some reruns of Judge Judy. She makes much more sense than Matthews, and is funnier than Maher.
Tuesday, May 17, 2011
ROTFLMAO
In case you are unfamiliar with the abbreviation, it means "rolling on the floor laughing my ass off," which is pretty much what I was doing during the first segment of The Last Word last night.
Lawrence O'Donnell started by saying that he had spent all day trying to think of a graceful way to say, "I told you so," which was an obvious lie, since he proceeded to say "I told you so," as ungracefully and hilariously as was humanly possible. Every quote that he used, his own saying that Donald Trump was not going to run, and everyone else in political punditry saying that Trump was a serious candidate, was totally accurate.
Point, set and match to Lawrence O'Donnell, and I am still chuckling this morning over his dismantling of the rest of the media idiotacracy last night.
Lawrence O'Donnell started by saying that he had spent all day trying to think of a graceful way to say, "I told you so," which was an obvious lie, since he proceeded to say "I told you so," as ungracefully and hilariously as was humanly possible. Every quote that he used, his own saying that Donald Trump was not going to run, and everyone else in political punditry saying that Trump was a serious candidate, was totally accurate.
Point, set and match to Lawrence O'Donnell, and I am still chuckling this morning over his dismantling of the rest of the media idiotacracy last night.
Well, This Is Just Silly
The people walking their dogs are all bundled up and are wearing rain hats, because it's raining! It does not rain here in May, and for damn sure it does not snow in our furshluginner mountains in May. To make things even sillier, this is forecast again for the weekend.
Monday, May 16, 2011
Fukushima Update
After waxing breathless for a couple of weeks about a cloud of radioactivity which was going to come across the Pacific and kill us all, the American media has forgotten all about the Fukushima reactor problem, but that problem has not gone away. Tepco now says that the fuel rods at Number One reactor melted completely and are believed to have formed a puddle at the bottom of the reactor containment vessel. They even show a neat little picture of the situation as they believe it exists.
My training as a reactor technician in the Navy does not make me an expert on nuclear reactors, but it does lead me to believe that we are not getting the full story here. From what I know about reactors, if all the fuel melted into one big puddle, the one thing it absolutely would not do is lay there quietly at the bottom of the reactor vessel and cool down to a nice safe room temperature.
The fuel load could not possibly come together into one solid mass without restarting the fission reaction and creating one whole hell of a lot of heat.
They are saying that the melted fuel created holes in the containment vessel that allowed water to leak out of the reactor. Right. Water would pour out of the vessel, but melted fuel would not leak out. Of course, if the melted fuel ran out of the vessel and went God knows where, that would account for the reactor being cooled down. They admit that they are merely assuming that the fuel is in a cooled down puddle at the bottom of the vessel. I am rather assuming that it is not.
There was also a story at the same link yesterday about crews shoring up Building #4 because it was leaning and appeared to be in danger of falling over, which would scatter the spent fuel which is stored on the upper level of it. That has not been refuted, but the story has been removed from the website, which is a little bit unnerving.
Another story which has disappeared from the same website is one that discussed the concerns about Reactor #3, which appeared to have suffered a complete meltdown also and was, at this point, still at a temperature significantly higher than its normal operating temperature when generating electricity. Like the Building #4 issue, this has not been refuted, merely removed from the website.
My training as a reactor technician in the Navy does not make me an expert on nuclear reactors, but it does lead me to believe that we are not getting the full story here. From what I know about reactors, if all the fuel melted into one big puddle, the one thing it absolutely would not do is lay there quietly at the bottom of the reactor vessel and cool down to a nice safe room temperature.
The fuel load could not possibly come together into one solid mass without restarting the fission reaction and creating one whole hell of a lot of heat.
They are saying that the melted fuel created holes in the containment vessel that allowed water to leak out of the reactor. Right. Water would pour out of the vessel, but melted fuel would not leak out. Of course, if the melted fuel ran out of the vessel and went God knows where, that would account for the reactor being cooled down. They admit that they are merely assuming that the fuel is in a cooled down puddle at the bottom of the vessel. I am rather assuming that it is not.
There was also a story at the same link yesterday about crews shoring up Building #4 because it was leaning and appeared to be in danger of falling over, which would scatter the spent fuel which is stored on the upper level of it. That has not been refuted, but the story has been removed from the website, which is a little bit unnerving.
Another story which has disappeared from the same website is one that discussed the concerns about Reactor #3, which appeared to have suffered a complete meltdown also and was, at this point, still at a temperature significantly higher than its normal operating temperature when generating electricity. Like the Building #4 issue, this has not been refuted, merely removed from the website.
Astonishment Reigns
As we hear that Donald Trump is not going to run for President, but is going to continue on NBC with his Celebrity Apprentice show. The breathless anticipation is over, we are no longer hanging by our fingernails to learn the fate of the free world.
Light Box
I saw this light box at ??? who the heck knows, I just spent the last hour trying to figure that out with no luck. I liked it so much I decided to make one of my own. Just a helpful hint before you get started, make sure you have somewhere to store a very large and very fragile box, if you breath on the thing it breaks. Just a fore warning. Moving on, mine works like a charm. It's not very hard to put together and is cheap to make. If you are like me who has a bright "wash out every picture" flash on your camera this will really help.
It looks like a worthless cardboard box, however this thing is pretty handy.
Take a large cardboard box and cut wholes in both sides of the box. Then cut off the entire top of the box. Next line the sides and the top with tissue paper. Be super careful not to rip the tissue because you do not want any cracks or rips that the sun light can shine through. Last line the bottom of the box with a white poster board, I did not even tape mine in I just set it inside. Now you are set to take awesome pictures.
I put my light box in direct sun light and here are the shots that I got. You can also use a lamp if you are going to be taking indoor pictures.
I made these headbands for my daughter's Easter dresses. I will have to make a tutorial on them soon because they turned out super cute.
I hope this is helpful to all you picture takers. Good luck.
Subscribe to:
Posts (Atom)