Misplaced Priorities and Misguided Decisions

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Chris et al,
I hate to say this, but only a few hours before Tito was unfortunately delayed, I checked out of my hotel in SIngapore, walked across the street to the spotlessly clean, shiny and new MRT station, and took the subway right to the airline terminal. Everything worked flawlessly and was on time.

As I passed through Immigrations, the officer made an abrupt hand gesture and said "Please!". Having become accustomed to the gruff, brash demeanor of U.S. Immigrations and Customs officials, I assumed that I had violated some pedantic rule, and stepped back, trying to appease him. He looked up, baffled, and again gestured and said "Please!". I showed a confused look to convey that I didn’t understand what I did wrong. He reached over and physically moved the candy dish closer to me, and again said "Please!", which I finally interpreted correctly to mean "Please [help yourself to a piece of candy because we want you to feel welcome while I process your paperwork!]". I accepted the gesture of kindness and he gave me back my passport, visibly confused by my first reaction.

Next I flew (face mask and all) on Singapore Airlines to Hong Kong, where customs and immigrations officials were similarly polite. Directly from the baggage claim hall I boarded the "Airport Express" train to downtown Hong Kong. I’m not sure whether this was a "mag lift" train or not, but it was remarkably quiet, smooth, and fast. Digital displays kept me apprised of the progress of the journey, and 24 minutes later I disembarked at Central Station, Hong Kong Island.

From there I made an easy connection to Hong Kong’s state of the art MRT system, and rode the subway to a station only steps away from my hotel. Total cost of the journey from airport to hotel, about U.S. $11. Everything was modern, shiny and new, and in flawless working condition. All public transit payments were made with state of the art cash cards, eliminating the need for currency.

Oddly enough, the whole experience was extremely emotional and quite sad. I kept recalling my first trips to Europe in the early '80s, when I was dumbfounded by store clerks working up sales receipts by hand, perhaps with the aid of a calculator. What? No electronic cash register? How  antequated it all seemed. In those days, you couldn’t help but be proud of being American. We were the world’s top dogs, and it was obvious. The rest of the world was trying to keep up, but failing. We were the undisputed technological leaders, and everyone knew it. In those days, Americans had to remember not to boast too much about how advanced things were in our society, because it was considered rude to flaunt our obvious technological superiority.

Here in Asia, I am dumbfounded every day by how far behind we are. You can pay for just about everything with your cellphone or a high-tech electronic cash card here. There is little reason to even carry bank notes. The public transit systems work flawlessly, and the trains come every 2 to 3 minutes, even into the wee hours of the morning. Contrast with New York or San Francisco, where the train or bus comes when it comes, if it comes, if you’re lucky.

Everything here is shiny and new. Most elevators are finished in polished stainless steel, which is brought out to a full mirror finish. I haven’t seen that in the USA since the early 80’s. Most of the bright-finished stainless steel in the USA has been "roughed up" intentionally by maintenance crews, because scratched-up stainless steel isn’t as susceptible to vandalism as the brightly polished stuff.

I have to confess that this trip is really affecting me emotionally. 25 years ago, when I traveled internationally I knew I was from the best nation on earth, and I felt damned proud of that fact. I read this blog post from Chris just after arriving back at my hotel at 1am, after a flawless late-night journey on a very comfortable, very modern, very quiet and very reliable MTR train.

What the hell happened to America? I liked it better when we were the top dogs…

Erik :frowning:

 

42

 how many have left because there is no political solution?

43

 how many have left because there is no political solution?

44

Hi, Erik;

This is a great example of the everyday anecdotes that you zero in on as barometers of where we are and where we’re going.  I pay attention to this stuff myself, as it is unfiltered by the media, and I look forward to more of this kind of post from you.

45

As regards the health care system in the U.S., my wife and I have been Kaiser Permanente members for a number of years. I am pleased to report that the level of care is excellent. I have a primary MD who I see whenever I want (usually within days based on their schedule). If I need immediate care, and my MD is unavailable, I’m seen by another MD that same day.
I had a significant surgery, before I turned 65, that went flawlessly and the follow-up care was excellent. My co-pay was insignificant and Kaiser covered the rest (approx. $20,000+)

Mind you, our monthly premium was pretty stiff while my wife and I were both under 65. However, now that we’re enrolled in Medicare, the taxpayer is picking up most of the tab. We don’t even have co-pays anymore for doctors visits.

All this to say that the Kaiser system seems to work very well from what I’ve experienced. If this could be expanded nationwide, I see it as a much better option than National Health Care.

As for who picks up the tab, I think the taxpayer should do so as is done in other civilized countries around the world. It is unforgivable that any segment of our population should lack basic health care in this country.

If the health care premiums paid by the average worker were a payroll tax instead of a payment directly to Kaiser, it would go a long way towards covering those who are unable to pay for their health care.

46

If the health care premiums paid by the average worker were a payroll tax instead of a payment directly to Kaiser, it would go a long way towards covering those who are unable to pay for their health care.
 

I’m new to posting and couldn’t figure out how to put the above quote by Sam in the nice little gray box??  Sorry…

Anyway, being owner of two family businesses, I don’t agree payroll taxes are the answer.  We have offered health insurance in both companies for years, with one company employing all part timers, and the employee does not want to pay the 50% of the premium’s we do not pay.  We offer health insurance as a benefit and most young people will not participate feeling it cost too much and things just won’t happen to them.  Other employees know they will get treatment for any condition whether they have health insurance or not, be it going to the emergency room for a cold, they will get treatment or surgery needed or participate in Medicaid   Had one employee who didn’t have insurance and "after" an emergency room visit wanted to participate thinking the visit would be covered.

I think we need to educate our citizens so they participate, ask questions about their care and make sure they are getting the best value for their money.  We are the customers here. 

If it is a payroll tax, this is yet another burden to small business to handle, even if it’s just paperwork.  Unless you are a business owner, you can’t imagine the time we spend on paperwork for employees and the government.  We have to pay and do forms for state unemployment, federal unemployment, payroll taxes, W-2’s, retirement plans, employee garnishments, employee child support and there’s so much more.

I am just very passionate about saving small businesses and with the current environment I have no idea why anyone would open one.  Teresa

 

 

 

 

 

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[quote=teresa]

If the health care premiums paid by the average worker were a payroll tax instead of a payment directly to Kaiser, it would go a long way towards covering those who are unable to pay for their health care.
I'm new to posting and couldn't figure out how to put the above quote by Sam in the nice little gray box??  Sorry.......
Just place your cursor somewhere in the middle of the sentence or paragraph you want to "quote" and click on the " icon.
Anyway, being owner of two family businesses, I don't agree payroll taxes are the answer.  We have offered health insurance in both companies for years, with one company employing all part timers, and the employee does not want to pay the 50% of the premium's we do not pay.  We offer health insurance as a benefit and most young people will not participate feeling it cost too much and things just won't happen to them.  Other employees know they will get treatment for any condition whether they have health insurance or not, be it going to the emergency room for a cold, they will get treatment or surgery needed or participate in Medicaid   Had one employee who didn't have insurance and "after" an emergency room visit wanted to participate thinking the visit would be covered.

I think we need to educate our citizens so they participate, ask questions about their care and make sure they are getting the best value for their money.  We are the customers here. 

If it is a payroll tax, this is yet another burden to small business to handle, even if it’s just paperwork.  Unless you are a business owner, you can’t imagine the time we spend on paperwork for employees and the government.  We have to pay and do forms for state unemployment, federal unemployment, payroll taxes, W-2’s, retirement plans, employee garnishments, employee child support and there’s so much more.

I am just very passionate about saving small businesses and with the current environment I have no idea why anyone would open one.  Teresa[/quote]

Teresa,

My mistake. I didn’t mean payroll tax, I meant if the premium I paid was instead paid as a direct deduction out of my paycheck. This way, the employer wouldn’t be affected at all. In fact, I would personally remove the employers responsibility for health care completely. That would improve the lot of the small business owner and maybe the employer could raise employees salaries at the same time!

48

Sam,
  With any type of payroll deduction the employer is responsible for its payment and then the weekly, monthly, quarterly and annual reports for that deduction.  For example, with payroll taxes the "minimum" paperwork burden for the employer is the payment we make for withholding it, quarterly and annual reports for the tax along with the W-2 to the employee.  If the employee has a garnishment the sheriffs department serves the employer with paperwork, it is the employer’s responsibility to determine the percentage that can be held each week based on the employees net pay, keep track of this total amount and then the employer must mail it to the court system before the court date.  Then comes child support and the list goes on…

  My point being, the employer continues to be burdened with the employee’s responsibilities because it’s the easiest thing to do for the government and the employee.  Why couldn’t the employee make the payment for health insurance to the government each month (this is just an example since I want to keep health insurance private with no government intervention)?  Why is it yet another burden for the employer to track and be responsible for? 

  My passion gets the best of me these days, Teresa

 

 

49

Kaiser Permanente
http://en.wikipedia.org/wiki/Kaiser_Permanente

National Health Service

http://en.wikipedia.org/wiki/National_Health_Service

Personally, I don’t think you could slide a piece of paper between the two, other than :-

Mandatory arbitration

In order to contain costs, Kaiser requires agreement by planholders to submit patient malpractice claims to arbitration rather than litigating through the court system. This has triggered some discussion and dissent. Some cases proceed to court and one argument is over whether the requirement to go through dispute resolution is enforceable[citation needed].

Kaiser established an Office of Independent Administrators (OIA) in 1999 to oversee the arbitration process. The degree to which this is independent has been questioned.

Wilfredo Engalla is a notable case. In 1991, Engalla died of lung cancer nearly five months after submitting a written demand for arbitration. The California Supreme Court found that Kaiser had a financial incentive to wait until after Engalla died; his spouse could recover $500,000 from Kaiser if the case was arbitrated while he was alive, but only $250,000 after he died. The Foundation for Taxpayer & Consumer Rights contends that Kaiser continues to oppose HMO arbitration reform.

Patients and consumer interest groups sporadically attempt to bring lawsuits against Kaiser Permanente. Recent lawsuits include Gary Rushford’s attempt to use proof of a physician lie to overturn an Arbitration decision.

Homeless patient treatment

Kaiser has settled three cases for alleged patient dumping since 2002. During that same period, the Office of the Inspector General settled 102 cases against US Hospitals which resulted in a monetary payment to the agency.[51][52][53]

On November 16, 2006, Los Angeles city officials filed civil and criminal legal action against Kaiser Permanente for "patient dumping"–the delivery of homeless hospitalized patients to other agencies or organizations in order to avoid expensive medical care[citation needed]as reported by National Public Radio’s All Things Considered.

The legal filings are intended to punish hospitals for releasing homeless hospital patients (often via taxis) on the sidewalk near relief shelters instead of accepting responsibility for releasing hospital patients into the care of a relative, or of a recognized agency.

The city’s decision to charge Kaiser Permanente reportedly was influenced by security camera footage, allegedly showing a 63-year-old patient, dressed in hospital gown and slippers, wandering toward a mission on Skid Row, as outlined in a 20-page complaint. City officials say that as many as 10 other area hospitals are under investigation for possible future action for this practice.

 Kidney transplant program

In 2004 Northern California Kaiser Permanente initiated an in-house program for kidney transplantation. Prior to opening the transplant center, Northern California Kaiser patients would generally receive transplants at medical centers associated with the University of California (UC San Francisco and UC Davis). Upon opening the transplant center, Kaiser required that members who are transplant candidates in Northern California obtain services through their transplant center.

On May 3, 2006, the Los Angeles Times published an investigative report which accused the transplant program of mismanagement which resulted in delays for patients awaiting kidneys. According to the report, Northern California Kaiser performed 56 transplants in 2005 and twice that many patients died waiting for a kidney. At other California transplant centers, more than twice as many people received kidneys than died during the same period.

On May 13, 2006, after less than two years of operation, Northern California Kaiser announced that it would discontinue the kidney transplant program. As before, Northern California Kaiser now pays for pre-transplant care and transplants at outside hospitals, as do all other Kaiser Permanente regions. This change affected approximately 2,000 patients.

Two patients have filed personal injury lawsuits against Kaiser and the widow of a patient who died has filed a wrongful death claim. According to the lawyer representing the three plaintiffs, more lawsuits are planned.

 See also

  • Sicko, a movie about, among others, Kaiser Permanente. (which you can also find in post#22 above...
  • ..............................................................................................................
The NHS took to checking by phone when patients who were due an operation when they were taking holidays. Using this information, it wasn't unknown for the 'patient' to be booked for the operation during their holiday period so that the operation would be logged as cancelled yet still maintaining favourable statistics.

‘Meet And Greet’ nurses have been used in the past for waiting emergency patients in what appeared as ‘finding out the severity of the case’. The reality was that the patients were then logged as ‘seen’ to show favourably low waiting times.

To counter the short supply of hospital beds, wheels were removed from trolley beds and placed into corridors and called wards to statistically lower waiting times…

Nothing like percentages are there…

My thoughts are that 50 million uninsured Americans should be seen as a national disgrace. If calculating the one-sixth of Americans against the English population of some 60 million, there would be both an estimated 10 million without medical support and a public outcry!!!

Call me bias…

Best,

Paul

50

Teresa wrote:

"My passion gets the best of me these days, Teresa"
 Super. Makes me wonder how things would be if we called them for what they really are and left political correctness off. 
51

[quote=teresa]  My point being, the employer continues to be burdened with the employee’s responsibilities because it’s the easiest thing to do for the government and the employee.  Why couldn’t the employee make the payment for health insurance to the government each month (this is just an example since I want to keep health insurance private with no government intervention)?  Why is it yet another burden for the employer to track and be responsible for? 
  My passion gets the best of me these days[/quote]

Forgive me for jumping into the middle of this, but guess is that, by making the employer responsible, the government is effectively cutting off the possibility of simultaneous employment and nonpayment.  It’s might be a way of making sure no one can opt out.

52

[quote=teresa]
Sam,

  With any type of payroll deduction the employer is responsible for its payment and then the weekly, monthly, quarterly and annual reports for that deduction.  For example, with payroll taxes the "minimum" paperwork burden for the employer is the payment we make for withholding it, quarterly and annual reports for the tax along with the W-2 to the employee.  If the employee has a garnishment the sheriffs department serves the employer with paperwork, it is the employer’s responsibility to determine the percentage that can be held each week based on the employees net pay, keep track of this total amount and then the employer must mail it to the court system before the court date.  Then comes child support and the list goes on…

  My point being, the employer continues to be burdened with the employee’s responsibilities because it’s the easiest thing to do for the government and the employee.  Why couldn’t the employee make the payment for health insurance to the government each month (this is just an example since I want to keep health insurance private with no government intervention)?  Why is it yet another burden for the employer to track and be responsible for? 

  My passion gets the best of me these days, Teresa[/quote]

Teresa,

I am sympathetic to your burden. However, my suggestion was meant to minimize that burden. Since, when I was working, the employer had to calculate & deduct my health premium anyway, it seemed to make sense to just continue the process. Except instead of sending the money to the health provider, you would send it to a government address instead. So, from your perspective, nothing would change except the address.

53

Trains that won’t run on time?  Old tracks and no money to fix them?  Soak those rich industrialists.   They have the money, but are too greedy to understand that the common good and public welfare are more important than their yachts and sports cars.  Me?  How am I supposed to know how to fix things?  That’s for those smart guys in Washington to figure out.  That’s for the thinkers and producers to figure out.  It’s not my fault for the state this nattion is in, you can’t blame me.  Aw, what’s the use?  Who is John Gault?
 

It’s funny, I have heard rumors about making "Atlas Shrugged" into a movie.  Why?  We’re living it.

54

Well,
In everyone’s posts on healthcare, no one "followed the dollar".

"Private insurance" exists for the shareholders NOT the insured. If you think otherwise, you have listened well to the commercials.

Those who control the money, DO NOT want national healthcare and lob out fear reporting whenever the idea seems to get traction. National healthcare would actually DECREASE the burden on small business and make them MORE competitive. (Again, follow the dollar) Why do folks work for "large" companies? Benefits. If small companies would be on a level playing field, I would suggest there would be a "brain drain" in major corporations. I would much rather prefer to work for a small company where my ideas would be listened to and everyone wouldn’t be trying to scratch each others eyes out to get the, "corner cubicle."

 

Back to travel, I had a similar experience as Erik only in reverse. I was on assignment in Europe a couple years ago and rode the trains. They were smooth, clean and the stations were clean and well lit. Signnage was in at least two languages and if someone didn’t speak English, they took me by  the hand over to someone who did if I asked a question!  Recently, My family took a trip to Philadelphia from Hartford, CT. via the train… OH MY!

First, at the Union Station in Hartford, when I went to collect my family, I asked where arrivals from Philly were and the rude attendant looked at me like I had three heads and pointed toward a set of stairs across the room. "Upstairs." she barked. I made my way up the smelly, dirty stairwell to the "platform" where there was only ONE working track! And, it was in poor repair. the track on the opposite side of the platform was ripped up and looked like a scene from "Slum Dog Millionaire!" Now, this track wasn’t being repaired, it was missing and there was no intent to replace it. There was a rusted stretch of chainlink fence that kept you from stepping off the platform and falling into the hole. The fence was improperly erected and looked as if you pushed hard enough on it, you could knock the entire thing into the abyss! This station mind you is in a state capital!

When the train arrived (20 minutes late) my son embraced me as said, "Dad, don’t ever make me ride the train again, please?"   

I was shocked by everything I was seeing and experiencing. "MY god," I thought to myself, "Chris et. al. were right, we are becoming a third world country."

For those of you who think air travel is any better, think again. I fly frequently for work, and if you think the trains are the only ones with issues… Fear and anger is what I encounter at the airport. No one complains about shoddy service and when there are frequent delays or cancellations, the attitude is, "tough. We will tell you what you get to do or not do." So, the anger is from the airline employees and the fear is from the passengers who fear of being "detained" by police for being a "unruly passenger."

So, lets take stock. Trains, broke. Air travel, almost broke. What’s left? Buses - no need to go there is there? What’s left? Travel by car. Isn’t that the most energy inefficient? But, at this point, that’s all that is left.

My, my, my.

 

FWIW - C.