It’s my understanding the incentives the MDs receive, in part, come from the Insurance companies they affiliate with and the hospital systems they are working through.
I notice that in the small towns in Rural north and South Carolina the doc in a box type places are investing big time. The same is true of the franchise and branded dentist offices. We went from non to 5 in a year on the doc in a box places and two dental places. A couple of counties over where my daughter lives has seen a similar change. I noticed several such places in a rapidly growing small city near Spartanburg SC recently when on a Sunday drive in my gas hog.
I wonder what this franchise model will me to Physician autonomy. Me things not good.
I used to always license my dogs, but honestly- I don’t anymore. I have a fenced yard and my dogs neither get out nor are they allowed to roam. I’ve never seen our town do any compliance checks with regards to licensing. Cat’s aren’t required to be licensed and therefore no one checks to see if they are vaccinated. Call it my small rebellion against the system. I am tired of government overreach. Ironic considering I am in law enforcement.
Here in CT our vet’s do not report vaccination status to the towns. Technically I am supposed to license my dog in town yearly, but I don’t. I have 4 dogs of varying sizes/ages/breeds. They don’t leave my fenced yard. They rarely get sick.
My youngest dog is now 15 months old. When he got his initial rabies vaxx around 6 months old his blood pressure tanked and they had to put him on some IV fluids…turns out he had an allergic reaction. Needless to say I will NOT be getting him any future vaccines.
I certainly do not advertise to my neighbors that I do not keep up my animals vaccines. But if I ever encounter a problem, I will cross that bridge then.
Allowing the Israeli official to leave the country is an unforgivable act. He should have been charged, denied bail, and given a fair trial. He is/was a flight risk and should not have been allowed out of jail until the completion of his trail.
Some experts or people giving opinions on US before election, said Trump is “soft Hitler” or soft authoritarian, not really, but paving the way, especially if nothing changes, people will vote harsher leaders in power and economic problems will double down on that pressure. Midwest/appalachian people have had long time hard life already, but could be some wealthy city like NYC starts to suffer and we will start see shift. We already see silicon valley downsizing, right? I dont see it comes back to 90s heyday hiring left and right. Also many previously silicon valley companies are born in eg midwest, as small company can live way longer than 1year there with risk money by simple living costs difference. Andrew Yang or folks he knows already started working on this aspect for years. To grow talent pool in midsize and smaller cities.
How about 4th turning (economic means) could flip backwards if democrats would get back in power 2026? They would likely introduce all 2021 policies driving things bad. So time could progress “backwards” in this sense, stalling deeper in crisis.
George Rockall made private equity themed dystopian video. Evidensia (global vet franchise) was mentioned in that. We now have international medical corporations too. All of those are what you’d think, colonizer raping max profit. Some docs and vets even work like doordash drivers, not employed directly, bearing max responsibilities but avoiding benefits that company saves from skirting these. People are cogs in machine. No human can function 100% sleep deprived and mind full of other nonsense from that system while trying to do job and be present.
Why are they expanding to those tiniest towns? Usually many franchises either avoid completely (Microcenter) or take their decades to finally arrive when every other corner is dominated(Walmart).
People are fleeing large cities, especially Blue ones and moving to small quickly expanding cities in the Southeast, or going to large ones in Texas and Florida. Part of what drives moving to these areas are the easy building codes that make building a new house a bargain compared to building on the West Coast and in the North East. Overall lower taxes and cost of living factor in as well.
The small cities in the South East are becoming surrounded by Urban sprawl. People can sell a home in a run down large city that has overburdened broken down infrastructure and burdensome taxes and buy a brand new or nearly new home or rent a new apartment and shop in brand new stores and eat a new chain restaurant while paying fewer taxes and lower utility bills. For others living a tad further it brings the opportunity to own land and acres and to garden and have large animals, and outbuildings etc.
By over building in these areas the corporate doc in a box places get a hold on the market while the places await the golf courses and private schools that would otherwise attract doctors.
One difference between the Midwest and Appalachia is that the Mid West is flat and has some of the best farming soil on earth.
The Midwesterners are supported by farm subsidies that in turn fund Monsanto and ADM. Appalachians receive more direct support that in turn funds Walmart which sells products manufactured by Global Food which buy their inputs from Monsanto and ADM contracted and government subsidized farmers.
It’s all about moving vast amounts of money around so the rich can skim off the top.
Most people in the midwest, at least here in iowa, don’t farm or work in industries that support farming. Maybe some states like Kansas, Nebraska and Oklahoma could have a higher percentage but its around 20% of people here in iowa. Its like 22% of the state economy but that includes livestock as well as crops.
The smaller farmers I know don’t get direct large cash payments as much as they get reduced premiums from crop insurance as well as enrolling some fallow fields in the CRP. Conservation Reserve Program (CRP) | Farm Service Agency
So its a bit more complicated than one might think. Not saying there isn’t crooked shit going on just saying not as straight forward.
My mother and I observed the public data base for her county and those surrounding. She was in NW Illinois. We were astonished as the amount of subsidies and how much they added up to in terms of per capata for those small towns.
Those farmers are sometimes being paid by the tax payers not those who buy their crops. It’s a round about subsidization of BIG FOOD.
On a tangential topic, the Payroll loan amounts were publicly available. Those numbers were pretty amazing. Who knew there were so many people working for some of those companies and churches and non profs.
