Saturday, April 03, 2010
By chance, the electronic version of Pediatrics also arrived yesterday. It includes a depressingly clarifying essay "Has leisure time become Medicaid's new competitor?" by Indiana professor Samuel S. Flint. Flint briefly describes the ways that states have induced the past generation of pediatricians to take Medicaid patients:
Historically, state Medicaid programs have counted on the immutable economics of private practice. The vast majority of practice overhead costs are fixed (e.g., nonphysician personnel, rent, malpractice insurance premiums), but the marginal cost of treating each child is minimal. Consequently, it makes economic sense for physicians to accept some patients with Medicaid, because Medicaid fees for an otherwise unused appointment exceed low marginal treatment costs.
The problem with this strategy is that it is predicated on the notion that leisure time has little value, and that is changing, particularly among young physicians.
That's standard fare, but what gets interesting is Flint's effort to put dollars-and-cents numbers behind the argument. He notes that 38% of pediatric residents sought (and 21% accepted) a part-time position as a first job. This proportion surprised me. At least partly, it reflects the striking gender mix across the medical profession. Almost 70 percent of pediatric residents are women. Many pediatricians are working mothers, whose job schedules must accommodate work-family balance concerns.
Anyway, Flint calculated that such part-time positions would shorten doctors' annual work output by 2,094 visits, while reducing income by about $34,000. Doing the long division, Flint finds that pediatricians willing to work part-time vote with their feet to forego about $18.50 per visit.
You can pretty much guess what comes next.
This value ($18.50) exceeds the Medicaid payment for a brief office visit (Current Procedural Terminology [CPT] code: 99212) in Indiana and subsequent newborn care (CPT 99433) in New York, Florida, and Pennsylvania. It is greater than the Medicaid reimbursement for an emergency visit (CPT code: 99282) in 5 states, a subsequent hospital visit (CPT code: 99231) in 7 states, performing a venipuncture for a child under the age of 3 (CPT code: 36400) in 21 states, performing an arterial puncture (CPT code: 36600) in 16 states, reading a chest radiograph (CPT code: 71010) in 20 states, and performing developmental testing (CPT code: 96110) in all but 9 states.
Although the phobic in me would happily skip that arterial puncture, this overall pattern isn't healthy. We want pediatricians to regard children on Medicaid as desirable, paying customers. Right now, these kids are often viewed as charity cases for whom a pittance will be paid--late—after a load of paperwork is done. Not surprisingly, health economists and clinical researchers document the large proportion of doctors who won't take Medicaid. More disturbing than the implicit tiering of American medical care is the evidence that Medicaid patients receive lower-quality care. Sandra Decker documented, for example, that doctors devote less time and attention to Medicaid patients. Low Medicaid reimbursement has also been linked with higher infant mortality.
I'm a conservative for the little guy. The guy who cannot outsource the additional burdens (expenses) in life.
Now it's fashionable for liberals to claim that the rich don't pay enough (although none will tell me what's fair for a guy making $250,000). But I would offer that the rich never have paid taxes and never will.
Why? Because they have resources to pass the costs onto to others that can't.
Let's use my business as an example. Let's say the feds placed a mega tax (call it health care) on computer software that costs my software providers millions in extra taxes. What do the software companies do?
1) They could reduce their cost of production. Given the additional costs across the industry more and more competitive pressure will be placed on companies to reduce costs. What better way to reduce costs than to send the programming off to an Indian company; thus costing hard working American programmers their jobs.
2) They could pass along the costs to their customers. Since all American companies will be in the same boat, no one wins a competitive advantage if, say, all the software companies do an across the board 10% increase.
3) They could eat the taxes and the owners will make less. That's hilarious. Why would you do that if you can do 1 or 2? By the way, when is the last time in recorded history someone voluntarily did more work for less money?
Let's assume they increase the costs of their software and Gordon's software costs go up $3,000 a year...... what will Gordon do?
Basically, Gordon has the same three choices above.
I can tell you that Gordon will increase his prices because he's not making less money to do the same thing and since he's not going to let his workers work harder for less he's not going to reduce their wages.
Now, let's assume that as a result of my costs increases, I increase my fees by $10 a tax return.
Does that $10.00 mean more to a single mom making $20,000 a year or a guy making $400,000 a year?
In addition, maybe the guy making $400,000 decides that my fee increase is too high and decides to do his return on the latest Tim Geithner's edition of Turbo Tax because he's smart enough to do it and he's a got a nice PC to do the work on; something the woman making $20,000 a year doesn't have at her disposal.
If you don't think this happens in real life; think again. I actually went through this exercise with an elderly client and showed her the costs incurred on a special form I had to download for her.
I am still mystified by the number of people foolish enough to believe in the "science" of global warming but somehow still dumbfounded by this concept.
Maybe I can't light a bulb out there.
That should make up for the other census we weren't counted in.
It appears the stories were seeded to various liberal blogs before the members actually went outside.
Read the story here.
Friday, April 02, 2010
Former New York Mayor Ed Koch expressed disappointment in President Obama on Thursday for his treatment of Israel after it announced it would continue construction in East Jerusalem – the section of the holy city claimed by the Palestinians.
"I have been a supporter of President Obama and went to Florida for him, urged Jews all over the country to vote for him saying that he would be just as good as John McCain on the security of Israel. I don't think it's true anymore," Koch told Fox News' Neil Cavuto.
Israeli Prime Minister Benjamin Netanyahu got a chilly reception at the White House last week after Israel announced plans to build 1,600 new apartments for Jews in East Jerusalem during a visit from Vice President Biden. The announcement drew sharp condemnations from Washington and calls to cancel the construction plans – requests that Netanyahu says he will not heed.
Koch said he believes Obama "orchestrated" what happened in Israel.
"What they did is they wanted to make Israel into a pariah," he said. "It's outrageous in my judgment. "
WOW! This guy must hang around with Tea Partiers sporting a Nazi arm band.
San Francisco attorney Jon Eisenberg thinks he's learned a thing or two about Barack Obama over the past 15 months. Eisenberg, who won a landmark decision against the government in Northern California's U.S. District Court Wednesday on a wiretapping case, says that when it comes to violating civil liberties in the name of national security, the present occupant of the White House is just as bad as -- or "even worse" than -- his predecessor.
"The Obama Administration stepped right into the shoes of the Bush Administration, on national security generally and on this case in particular," Eisenberg said, referring to the lawsuit brought by his clients, an Oregon branch of an Islamic charity and two American lawyers. The plaintiffs argued successfully before federal Judge Vaughn Walker that their conversations were illegally wiretapped under the Bush Administration's secret surveillance program.
Just as significant as the ruling, however, may be what the case demonstrates about the Obama Justice Department's approach to surveillance of suspected terrorists. Eisenberg told SF Weekly that government lawyers working for Obama had been "more strident" than those working for Bush, refusing to let him see important federal documents related to the case even after he was approved for a top-secret security clearance.
"Even though I have the security clearance, I don't have the 'need to know,' so I can't see anything," Eisenberg said. "This is Obama. Obama! Mr. Transparency! Mr. Change! It's exactly what Bush would have done."
Or are they?
Most of the indicted militia members accused of being anti-government extremists have active voting records, a check with area voter registration offices showed yesterday.More.....
One is a registered Democrat, and the party affiliations of the rest could not be determined.
Jacob J. Ward, 33, of Huron, Ohio, voted as a Democrat in the 2004 and 2008 primary elections, and in 10 other elections since 2000.
The average high for the month was 55.5 degrees vs. an historical high of 53.9
The average low was 35.6 versus an historical low of 33.8.
That breaks a three consecutive month cool streak and brings the score to
Thursday, April 01, 2010
Ace of Spades with details........
Then you have this little story about a Union boss indicted for corruption. His offense?
Yesterday, after I pointed out Yglesias' no-harm no-foul attitude towards the n-word, a few of his readers, having not commented upon the inappropriateness of the word all day, finally got angry about it... accusing conservatives of planting the slur on the site.
Odd that they didn't seem bothered by the word at all until the finally came up with a conspiracy theory by which to blame it on conservatives.
And they go on to prove their racial tolerance bona fides by reprinting the comment on our site. It's not been Tollbusted to something else, but yeah, originally it was a reprint of the Yglesias bon mot.
And how do I know it was an Yglesias reader? Well, I know it wasn't one of mine: a search for the unique hashmark used to differentiate all commenters' IPs demonstrates that the hash in question has never before appeared on the site. Since I haven't noticed the dispute being picked up by any other big sites, I'm wondering where else this new unwelcome commenter may have come from.
Stay classy, Matthew Yglesias and Matthew Yglesias' racist readers.
BTW: This from a post about Michael Steele, posted late yesterday even as one of his commenters had first-posted the n-word about Steele and it remained up all day long:I mean, I love accusing conservatives of being motivated by racism...
Emphasis in original.
Oh, My: This Yglesias reader also posted this in the top headlines thread:162 Michael Steele is a house nig! What's the difference between Sarah Palin's mouth and Sarah Palin's c**t? Retarded shit only came out of her c**t once.
Posted by: Paulie Carbone at April 01, 2010 10:51 AM (KK69A)
I redacted the c-word. Paulie Carbone didn't.
A union official is accused of selling out his own members - getting a corrupt contractor to build his Manhattan bar by letting him hire nonunion workers on other jobs.
Brian Hayes, a business agent for Local 608 of the carpenters union, allegedly took thousands in cash, free labor and materials to build McGarry's on Ninth Ave. in Manhattan, prosecutors and union sources said.
In exchange, Hayes let the contractor pay employees at his work sites below minimum wage and off the books, and run a Bronx job without a union shop steward, officials charged.
"He's a hardworking guy who's been unjustly accused," said Hayes' lawyer James Froccaro, who declined to elaborate.
A state liquor license lists Hayes as the vice president of a bar at the address of McGarry's. Workers at the popular Irish pub declined to comment.
Hayes is one of nine union big shots, including carpenters union boss Michael Forde, indicted last summer on bribery and racketeering charges.
1) The LA Coliseum
2) The shower in our spare bathroom
3) The Hocking River
4) Gary Indiana
6) Topeka Kansas
We'll let you know when they clear a place that actually has oil.
Case in point. Remember H1N1? Just last summer we were being warned of flu deaths rivaling the 1918 flu.
What happened? Little to nothing.
But Gordon, that's because of the government's response to the risk and all the immunizations given to the public.
I've never heard of a vaccine that it killed off a strain of flu when it wasn't even administered like the 130 million doses that went unused...........
Despite months of dire warnings and millions in taxpayer dollars, less than half of the 229 million doses of H1N1 vaccine the government bought to fight the pandemic have been administered -- leaving an estimated 71.5 million doses that must be discarded if they are not used before they expire.
Between 81 million and 91 million doses of swine flu vaccine were injected into peoples' arms or squirted up their noses through the end of February, according to federal officials, leaving about 138 million doses unused. An estimated 60 million of those will be donated to poor countries or saved for possible future use. But doses already in vials and syringes will be thrown away if not used before their expiration dates pass.
The prospect of millions of doses of the once-precious vaccine being discarded is the latest twist in the $1.6 billion program -- the most ambitious immunization campaign in U.S. history. The government-led effort produced a vaccine in record time, but unexpected production problems delayed delivery of the bulk of supplies until after the second wave of infections had peaked, leaving millions anxious and frustrated as they scrambled for the shots and nasal sprays.
Wednesday, March 31, 2010
Tuesday, March 30, 2010
Second, one of their followers (and campaign contributors) takes them up on it and attempts to kill a republican congressman.
Third, they offer to give their little terrorist's campaign contributions to charity....
The Democratic National Committee (DNC) said Monday that it will donate money it had received from a man charged with threatening to kill a top Republican.
A DNC official said it was researching contributions made by Norman Leboon, a Philadelphia man charged Monday with threatening to kill House Minority Whip Eric Cantor (R-Va.), and donate any money he had donated to charity.
"We are researching the matter, and any donations made to the DNC or the Obama campaign by Mr. Leboon will be donated to charity," a DNC official said.
Federal Election Commission (FEC) filings show that Leboon had made two, separate donations to then-Sen. Barack Obama's (D-Ill.) presidential campaign. The two donations, made in June of 2008, total $505. These are the only federal contributions on record for Leboon.
Funny how this story would be a whole lot different if, say, a republican were responsible.
An association representing 300 large corporations urged President Obama and Congress on Monday to repeal a provision of the health care overhaul that prompted AT&T, Caterpillar and other companies to announce substantial charges for the current quarter.More....
The association, the American Benefits Council, said the provision — which reduces the tax deductions for companies with drug coverage for their retired employees — would deal a significant blow to corporate profits and would discourage companies from hiring more workers.
Henry Waxman is peeved. He expects corporate America to swallow health-care reform without a peep of protest -- and, apparently, without revealing new costs to shareholders or the Securities and Exchange Commission.
Last week, AT&T announced it will take an immediate $1 billion write-down thanks to a new tax in the health bill that will cause Caterpillar ($100 million) and Deere & Co. ($150 million), among other large employers, to do the same. The benefits consultancy Towers Watson estimates that the change may reduce corporate profits by as much as $14 billion over time.That's real money. For comparison: It's enough to bribe Sen. Ben Nelson of the Cornhusker Kickback 140 times over; it's three times the amount Democrats poured into a (failing) weatherization program that once was a highlight of the stimulus bill; it represents 10 percent of the supposed deficit reduction of health-care reform over 10 years.
Just out of curiosity, is there anyone out there interested in my sexual conquests, preferences and kinky turn ons? When will Ross Perot come out to tell us he loves being spanked while wearing a ball gag? Or maybe Elton John can tell us whether he's a pitcher or a catcher? How about Tiger? Maybe he can inform us how much he loved his wife while he was riding one of skanks in the reverse cowgirl position?
That's what I thought.
Maybe it's just me getting older but I have about as much interest in Ricky Martin's sex life as he is in mine.
Liberals are all about "keeping out of my bedroom!" but how about "keeping your junk in your bedroom so I don't have to listen to it". Even though I'm a libertarian, I'm starting to think that "Don't ask, don't tell" the law of the land punishable by excessive tickling with a boa.
Sorry, all this sex talk had me wanting to express one of my fantasies.
Monday, March 29, 2010
Maybe it’s a sore subject.
IRS Commissioner Doug Shulman practically ran away when The Daily Caller asked him whether he prepares his own taxes. Millions of Americans struggling through complicated IRS forms in the weeks leading up to tax day — April 15 — might like to know.
“I don’t have time for this … If you want an interview, you can call my office,” he said, speed-walking down an ornate hallway in the Longworth House Office Building. Shulman had just testified to the top tax committee in the House about steps he was taking to make it easier for people to file their taxes.
Shulman’s spokesman later said he employs an accountant to prepare his tax filings, as does about 60 percent of the country who shell out hundreds or even thousands of dollars each for such services.
Rep. Xavier Becerra, a top Democrat on the Ways & Means Committee that was holding the hearing, is keeping a watchful eye on those tax preparer services, who he says sometimes fleece unwitting customers. “Americans who could fill out a simple [tax forms] are being charged hundreds of dollars to do what they” could on their own, he said.
So does Becerra prepare his own taxes?
“No. I have a tax preparer back home who’s been doing it for me for many years,” he told The Daily Caller. Becerra explains that his finances are more complex — and his tax filings fall under far greater scrutiny — than ordinary Americans who could figure out the forms if they tried.
How about the chairman of Ways & Means oversight subcommittee that asked for Shulman to testify Thursday?
“Oh no, no, no, no, no. I have an accountant that I’ve been using for years,” Rep. John Lewis said. He said he needs to head home this weekend to fill out paperwork for his accountant.
Given that no one actually read the monstrosity, I'm going to say no...........
"Most of these people [in the Administration] have never had a real job in their lives. They don't understand a thing about business, and that includes the President," says a senior lobbyist for one of the companies that announced the charge. "My CEO sat with the President over lunch with two other CEOs, and each of them tried to explain to the President what this bill would do to our companies and the economy in general. First the President didn't understand what they were talking about. Then he basically told my boss he was lying. Frankly my boss was embarrassed for him; he clearly had not been briefed and didn't know what was in the bill."
It isn't just the President who didn't understand his own proposal. Late Friday, House Energy and Commerce Committee Chairman Henry Waxman and Rep. Bart Stupak, chairman of the Oversight and Investigations panel, announced that they would hold hearings in late April to investigate "claims by Caterpillar, Verizon, and Deere that provisions in the new health care reform law could adversely affect their company's ability to provide health insurance to their employees."
Neither Waxman or Stupak -- who betrayed the pro-life community by negotiating for more than a week with the White House to ensure his vote on the health care bill -- had anything more than a cursory understanding of how the many sections of the bill would impact business or even individual citizens before they voted on the bill, says House Energy Democrat staff. "We had memos on these issues, but none of our people, we think, looked at them," says a staffer. "When they saw the stories last week about the charges some of the companies were taking, they were genuinely surprised and assumed that the companies were just doing this to embarrass them. They really believed this bill would immediately lower costs. They just didn't understand what they were voting on."
Read the rest
Sunday, March 28, 2010
Treasuries fell, pushing 10-year note yields up the most since December, as lower-than-average demand at $118 billion in note auctions raised concern that investor interest is waning as the deficit climbs to a record.
U.S. interest-rate swap spreads plunged to the lowest levels in more than two decades as investor focus shifted from the plight of financial institutions to the ability of nations to finance rising fiscal deficits. Bill Gross, manager of the world’s biggest bond fund, said the almost three-decade bond rally may be ending. Two-year notes dropped for a fourth week in the longest stretch of decreases since August before next week’s March payrolls report.
“Supply and the realization that there is more to come is starting to weigh on Treasuries,” said Larry Milstein, managing director of government and agency debt trading in New York at R.W. Pressprich & Co., a fixed-income broker and dealer for institutional investors. “Swap spreads turning negative forced investors to cover shorts and dump Treasuries going into the auction, exacerbating the weakness.” A short is a bet that a security will decrease.
The 10-year note’s yield rose 15 basis points, or 0.15 percentage point, to 3.85 percent, according to BGCantor Market Data. The price of the 3.625 percent note due in February 2020 decreased 1 7/32, or $12.19 per $1,000 face amount, to 98 5/32. (more....)
So what do we make of this information? Let's ask Alan Greenspan.....
Former Federal Reserve Chairman Alan Greenspan said the recent rise in Treasury yields represents a “canary in the mine” that may signal further gains in interest rates.Hey we'll just print more money.
Higher yields reflect investor concerns over “this huge overhang of federal debt which we have never seen before,” Greenspan said in an interview today on Bloomberg Television’s “Political Capital With Al Hunt.”
“I’m very much concerned about the fiscal situation,” said Greenspan, 84, who headed the central bank from 1987 to 2006. An increase in long-term interest rates “will make the housing recovery very difficult to implement and put a dampening on capital investment as well.”
The yield on 10-year Treasury notes was 3.85 percent at 3:08 p.m. in New York, down three basis points from late yesterday and up from 3.69 percent at the end of last week.
U.S. interest-rate swap spreads declined to the lowest levels on record this week, reflecting investor concerns about the ability of nations to finance rising fiscal deficits.
The rate to exchange floating- for fixed-interest payments for 10 years fell below the comparable-maturity Treasury yield for the first time on March 23. The swap spread reached as low as negative 10.19 basis points yesterday before reaching negative 7.63 basis points.
The U.S. budget deficit reached a record $1.4 trillion for the fiscal year that ended Sept. 30 amid falling tax revenue from the recession, a bailout of the banking and auto industries, and the $787 billion economic stimulus package.
“I don’t like American politics and what’s happening,” Greenspan said.
Historically, there has been “a large buffer between the level of our federal debt and our capacity to borrow,” he said. “That’s narrowing. And I’m finding it very difficult to look into the future and not worry about that.”
What - My 6th annual April 15th end of tax season beer fest.
When - April 15th approximately 6:00 pm
Where - Cindy's Friendly Tavern, Loveland OH
Why - Because we could all use a free beer or two or three before we get our health care tab.........
Fast-forward to the dawn of the Obamacare utopia. In one of a bazillion little clauses in a 2,000-page bill your legislators didn't bother reading (because, as Rep. John Conyers explained, he wouldn't understand it even if he did), Congress voted to subject the 28 percent tax benefit to the regular good ol' American-as-apple-pie corporate tax rate of 35 percent. For the purposes of comparison, Sweden's corporate tax rate is 26.3 percent, and Ireland's is 12.5 percent. But just because America already has the highest corporate tax in the Organization for Economic Co-operation and Development is no reason why we can't keep going until it's double Sweden's and quadruple Ireland's. I refer you to the decision last year by the donut chain Tim Hortons, a Delaware corporation, to reorganize itself as a Canadian corporation "in order to take advantage of Canadian tax rates." Hold that thought: "in order to take advantage of Canadian tax rates" - a phrase hitherto unknown to American English outside the most fantastical futuristic science fiction.
Ask yourself this: If you impose a sudden 35 percent tax on something, are you likely to get as much of it? Go on, take a wild guess. On the day President Obama signed Obamacare into law, Verizon sent an e-mail to all its employees warning that the company's costs "will increase in the short term." And in the medium term? Well, U.S. corporations that are able to do so will get out of their prescription drug plans and toss their retirees onto the Medicare pile. So far, just three companies - John Deere & Co., Caterpillar and Valero Energy Corp. - have calculated that the loss of the deduction will add a combined $265 million to their costs. An additional 3,500 businesses presently claim the break. The cost to taxpayers of that 28 percent benefit is about $665 per person. The cost to taxpayers of equivalent Medicare coverage is about $1,200 per person. So we're roughly doubling the cost of covering an estimated 5 million retirees.
This single component of "health" "care" "reform" neatly encompasses all the broader trends about where we're headed - not just in terms of increased costs and worse care, but also in the remorseless governmentalization of American life and the disincentivization of the private sector. As we see, even the very modest attempts made by Congress to constrain the 2003 prescription drug plan prove unable to prevent its expansion and metastasization. The one thing that can be said for certain is that, whatever claims are made for Obamacare, it will lead to more people depending on government for their health arrangements. Those 5 million retirees are only the advance guard. And, if you're one of those optimistic souls whose confidence in the Congressional Budget Office (CBO) is unbounded, let's meet up in three years' time and see who was correct - the bureaucrats passing out the federal happy juice or the real businesses already making real business decisions about Obamacare.Can we afford this? No. Even on the official numbers, we're projected to add to the existing $8 trillion in debt another $12 trillion over the next decade. What could we do? Tax those big, bad corporations a bit more? Medtronic has just announced that the new Obamacare taxes on its products could force it to lay off 1,000 workers. What do those guys do? Well, they develop products such as the recently approved pacemaker that's safe for MRI scans and the InterStim bladder-control device. So that's 1,000 fewer people who'll be working on new stuff. Well, so what? The public won't miss what it never knew it had. So again, the effect is one of disincentivization - in this case, of innovation.
Read the whole thing......