Rural Hospitals Redux

The Takeaway yesterday had a good segment on rural hospitals, basically continuing to “cry wolf” about their affordability.

One of the participants in the discussion is, Dr John Waits, who with his colleagues and staff at Centreville Clinic Staff, are doing their best to help their community afford their healthcare.

Dr Waits struggles valiantly in the discussion to avoid using the terms profit and subsidy. This is a mistake in my opinion, while you can talk about healthcare efficiencies, people need to hear that large hospital groups are for profit, yes even the not-for-profit ones. People need to understand that rural hospitals are not affordable without subsidy. Equally, urban communities need to understand that without rural communities, we have an entirely different set of problems.

Save Our Hospital
Photo (c) Daily Yonder

Subsidy isn’t a bad word, nor is tax that ultimately is used to pay for it. You can either levy tax at a state level or at the federal level, preferably on big hospital groups and medical providers revenue(not profit). You can then use that tax money to subsidise rural healthcare. Or you can use general federal taxation, and use the additional money to fund a medicaid hospitals in rural community cities.

Struggling along with no real honesty, and without confronting the elephant in the room, will just mean more rural hospitals closing, leading the to further decline of rural communities and the increased pressure on cities.

Read my earlier post “Can America Afford It’s Rural Communities?

‘Facebook can’t be trusted’

New Zealand’s Privacy Commissioner John Edwards (@jce_pc), was interviewed this morning on NPR by Rachel Martin. Edwards criticized Facebook after last month’s attacks on two mosques in Christchurch were live-streamed on Facebook.

It was a refreshing interview with a politician who doesn’t have all the answers, and knows it’s not his job to come up with them. He is also not beholden to big tech financing, as a New Zealand politician. Equally Edwards was clear where the blame and responsibility lay. The whole interview is well worth listening to, but Edwards rightly pointed out

we have a platform that has displayed shocking lack of responsibility and accountability for the tools that it has enabled

He [Zuckerberg] kinda conflated that [bad actors], with the live streaming of the atrocity in New Zealand, but that person didn’t go to any lengths, there were no systems. If you are going to offer a service that is capable of such deep and profound harm, then it is incumbent on you to ensure it is safe.

In the USA you have product liability, if a manufacturer makes something, a product, which causes harm, they are liable for that. It’s time we started to look to the social media companies for that.

… the lack of responsibility the company has taken. They should be acting now. If they can’t assure us that the streaming service is safe, then it should be taken down.

I was quite disappointed when I heard Mr Zuckerberg equate the atrocities in Christchurch with childrens birthday parties. He said if you put a delay in the system it might have prevented the uploading that video, but that would have broken the experience of people who use it for childrens parties.

I don’t understand the mathematics there, how many childrens parties, Mr Zuckerberg, equals one murder, one live streamed suicide, one sexual assault live streamed? It’s really incumbent on the platform to take responsibility to make the product safe. Until they ca, to take it down.

Bravo sir, bravo. In many aspects of life we have too easily succumbed to technology allowing us to do things which are not necessary, it’s there just because it can be. Facebook isn’t alone in this, and it’s time that we take a step back.

Remember when conference calls had live moderators? When you couldn’t speak until the lines were open? That wasn’t there just so the speaking presenter/executive could just say “next slide please”, it was there to stop unwanted and unruly interruptions. No one is saying one to one video communication should be outlawed, but live streaming needs to be moderated and regulated.

If the live streaming platforms won’t do that, can’t make it profitable, then so be it, ban it.

You can’t broadcast naked bums, boobs and dicks on American broadcast TV, at any time of the day. Yet, we allow facebook, youtube, twitter and other live streaming platforms to broadcast anything to anyone, anytime. This isn’t a free speech issue, I’d prefer grown-up movies to be broadcast unedited on TV, like streaming services. At least in the UK they have the 9pm ‘watershed‘.

It’s hard to see how anything will change here, until we have more politicians like Mr. Edwards.

Stock buybacks rule – Tax breaks enable

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Photo: Roberto Machado Noa/LightRocket via Getty Images
As predicted, not by the tweeter in chief, but by almost anyone who understands big companies and executive, stock buybacks hit an all time high in 2018 and are likely to be higher again in 2019.

This is a big deal, companies that buyback their stock, are reducing the number of shares available on the market. That generally means the share price goes up. Share prices are often one of the main ways executives are measured, their bonuses are usually dependant on the share price. Also, because the price of each share goes up, it makes it harder for lower and middle class people to get in on the action.

buying your own shares is like eating your own young, a glorified share manipulation gamble

The other reason share buybacks are import to watch, is they effectively use the companies cash to “eat themselves”. That cash is then no longer available for Capital investment, new building, equipment and other necessary expansion expenditure. Citigroup reports that companies buying back their own stock, spent more money doing that, than at any time since 2008.

Home Depot announced a $15-billion buyback in February, as a way to artificially hedge their share price, after they announced they’d miss expectation on revenue. Cynical share price manipulation. I have no idea if they used repatriated tax money, but if they miss earnings again this year, the share price will drop. Of course the executives and board will be ok, they’ll have sold their shares at the newly inflated share price, which is down on it’s 2018 high(212.39), but not nearly as low as it would have been if they’d not bought their own shares.

Next time a big business closes an office near you, and jobs are lost, don’t take their reason at face value. When did they last do a stock buyback, and how much cash was repatriated under the Trump/GOP tax break for 2018?

Opinion | How Much Will Americans Sacrifice for Good Health Care? – The New York Times

Sadly, this New York Times Editorial op-ed is factually wrong in a material way that I had to write a letter. I also ripped into Dan Gorenstein on twitter(1) for linking to the article and “guessing” he didn’t think Americans would tolerate #MedicareForAll.

Here is the text I sent to the Times, who knows if they will publish it. My track record of getting corrections to editorial op-eds published is close to zero. It’s like they don’t want to be wrong.

The editorial board seems both confused, and factually inaccurate when it comes to how insurance works in government funded, single payer healthcare systems. It is common place in such systems to have an option of top-up insurance. I was lucky to have had such insurance when I needed serious surgery in the UK, in 1992. It was employer provided insurance.

One of the constraints in the many government single payer systems is the supply of buildings and doctors to treat a patient “on demand”. Urgent cases are as always seen as soon as they can be. Non-urgent cases, not so much. But then, medically, they are non-urgent. Top-up insurance allows patients to schedule both dates and locations, specialists for non-urgent treatment. The single payer system, pays an agreed amount for the treatment or surgery, much like Americas current insurance based system.

The difference is, that in America today there is massive over supply of both facilities and staff, specialists etc. That over supply is costing every one, both the insured and the uninsured, money for nothing. Yes, it’s great if you can walk into your local Dr’s today and get a referral to a specialist this afternoon for that annoying toe bunion that has bothered you for the past 6-months. Should our healthcare system be based on the costs of carrying that burden? Absolutely not.

While single payer systems are not perfect, nor is the current US Insurance based model. Almost everyone of the people that are involved in charging, finance, billing, negotiating, handling disputes, etc. is overhead. That overhead has to get paid for. So called “death panels” are more common in the US based insurance system than they are in single payer systems. In a single payer system there is no out of network, drug prices are controlled, and there is much more transparency. For everything else there is top-up insurance.

The editorial board overlooking this important fact, does a major dis-service to it’s readers and to Americans who continue to pay too much for healthcare.

Source: Opinion | How Much Will Americans Sacrifice for Good Health Care? – The New York Times

British Concentration Camps: A Response to Jacob Rees-Mogg | The Gladstone Diaries

On a BBC politics, current affairs program, Question time last week had another of it’s heavily #brexit based episodes. This one featured UK Government and Conservative prig, William Rees-Mogg. Mogg is infamous for his lowkey, I’m holier than thou, silver spoon accent. He makes statements with such supposed authority you’d be hard pressed to doubt there were 12 commandments.

This time in a pseudo-educated way, he prognosticated over William Churchill and took other members of the panel to task, “from the comfort of 2019”. “You’ve got to understand the history”. Turns out, as often, Moggs dictats were, as they frequently are, a mix of details and claims pulled literally out of thin air.

Actual historian, Robert Saunders, took Moggs claims to task.

First, some figures. From 1899 to 1902, roughly 48,000 people died in British concentration camps in South Africa. Of the 28,000 white deaths, 22,000 were children under the age of 16. More than 4,000 were women. The 20,000 Black deaths were less clearly recorded – a mark of official indifference – but most estimates suggest that about 80% were children.

Source: British Concentration Camps: A Response to Jacob Rees-Mogg | The Gladstone Diaries

The Boer War makes a useful addition to my 2016, Making Britain Great Again post.

State of the Union: Whither Afghanistan?

Tonight the President will address the nation in his second state of the nation. It’s unclear if he’ll say anything about Afghanistan, he’d be wise not to. Equally, given the President is prone to tackling sacred cows, maybe he should.

President Trump sent more troops and in his words America would stay until the “war is won”.  While not as notorious as Vietnam, Afghanistan is Americas longest war, all Presidents from Roosevelt are complicit. America had been involved  in/with Afghanistan from 1946 until the late 1970’s, as the Americans left, the Soviets arrived.

We are now negotiating with the Taliban, essentially the same deal to end the American involvement in Afghanistan, that Donald Rumsfeld turned down in 2001. Since then there has been 17-years of bloody war, costing America more than a trillion dollars, and taken the lives of more than 4,000 Americans.

Afghanistan is a country that is at the center of the world, almost exactly 10,000 miles from either coast of America. Long before the War on Terror, long before the Russians invaded Afghanistan, the Americans were there. Buoyed by their success in WWII and in an effort to counter the Soviet Union threats of expansion, in 1946 American Engineers, their wives and families started to arrive in Helmand province in unprecedented numbers, they lived in a campus that became known as “Little America“.

M-K Completes Dam Projects in AfghanistanThey worked for the worlds biggest construction company at the time, Morrison Knutson. The King of Afghanistan had bought them in to replicate what had been done in Nevada, roads, dams, canals and even a new model city. The Kings plan had been to harness the power of the giant Helmand River and turn Afghanistan into a modern society like the west. Thats when everything started to go wrong.

In an era that is long forgotten and projects that were ultimately doomed to fail, it was the first, and possibly the best example of “too big to fail”. It did, we are still paying that price today, even before the Russians invaded, America had sunk $80-million into Afghanistan.

It’s the forever war, will President Trump actually succeed, no.

REFERENCE MATERIAL

The New York Times “The Daily” covered Afghanistan yesterday(Feb 4th), disappointingly they never included anything about the whole “Little America” project. It is still one of the best summaries of what happened since the Russians invaded.

BBC NEWS has a great infographic style documentary on Helmands Golden Age from 2014 by Monica Whitlock. It is a good read and contains many pictures from Morrison Knutson engineer Glenn Fosters films. It also includes many clips of his color films, sadly they are geo-locked and not available in the US. You can though find much of the same material on Youtube. As an accompanying piece, Monica Whitlock also recorded an episode of the BBC World Service “The Documentary Podcast“, also from 2014. In an episode called “Damming Afghanistan: Lost Stories from Helmand” you can download and hear it here.

NPR has a 2012 interview with author Rajiv Chandrasekaran about his then new book, Little America – The War Within the War for Afghanistan. Entitled “A Cautionary Tale About Transforming Afghanistan”, by Greg Myre, it is online here and can be downloaded here. It includes an amazing slideshow.

The US Agency for International Development, bureaus for Program and Policy Coordination, Bureau for the Near East, have a great detail report on Afghanistan, it can be read here, in its original 1983 form.

America and Syria – the backstory

President Trump has decided, unilaterally apparently, to pull all America troops out of Syria, both surprising his Chiefs of Staff and allies.

The American story with Syria is intertwined with almost everything the west has done in the Middle East since the end of the 2nd World War.  American was the prime enabler of the Assad family rise to to power, and as everything post war seemed to be, all about fighting the rise of Communism and installing “democracy”.

Syria gained its independence in 1946 and in 1948 engaged in the Arab-Israeli war. Later in 1949, the Americans were party, or if you believe many, responsible via the emergent CIA, for the coup d’état that replaced the Syrian democracy with Husni al-Za’im, who was executed later the same year.

The Syrian story since the 2nd World War is complicated, wars, Hamas, Iran, Hezbollah. Assad senior played key roles in much of the 1980’s terrorism, before the US and especially the UK decided that their actual target in the Middle East was Gaddafi, and that they needed Assad’s Syria as an ally their upcoming war.

So, you can be surprised by President Trump’s actions, you can blame it on his trying to appease Russian leader Putin, or you can just believe that this is yet another of President Trump’s rollbacks of President Obama’s actions. Whatever you do though, don’t think American involvement in Syria is just about the defeat of ISIS.

serveimageA great read is Wilfords 2013 America’s Great Game. You can purchase the book from Amazon, you can read a book review on the Boston Globe, or this review, “Playing Both Sides” on the New York Times. better still, you can watch/listen to Wilford, here on C-Span.

Protect Colorado – Give me a break! (Yes on 112)

When we ride our bikes north and east of Boulder you can see the gas and oil pipelines an extraction points at regular intervals. But it’s nothing like Texas. Very, Very few oil derricks, certainly in and around Erie, CO there are a number of fracking pad sites, you can see them clearly from Colorado State Highway 52, in places.

But there is nothing like the density I expected given the prominence of the Oil and Gas industry in the state politics. Even when you drive out through north east Colorado, wells yes, but still surrounded by massive areas of open farmland.

So when you see TV ads and claims like this, you have to wonder.

from the Protect Colorado PAC web site.

“extreme out-of-state groups” > “thousands of jobs” > “devastate Colorado’s economy for years to come” – All pretty extreme. I wondered.

But I wonder no more. As always the great folks over at CPR News covered this is much detail, there are lots of in-depth articles on their website. I found the Colorado Wonders segment on the radio by Energy and Environment reporter Grace Hood and presented with Journalist and Presenter Ryan Warner.

You can hear them discuss it in full here. It’s the first 12-minutes or so. To save time, and as a form of notepad, here are my notes.

  • The two main political action committees involved are Protect Colorado(Oil and Gas PAC) and Colorado Rising(Environmental PAC) 
  • Protect Colorado is outspending Colorado Rising by 32-1.
  • Depending on how you look at the land affected it could put 85% off limits if Prop.112 passes, or it could put only 54% off limits due to increased setbacks.
  • The 85% number comes from looking at surface land available for well pads. Except, as anyone who has watched the fracking industry for the last 10-years knows. Drillers can now drill underground and then go horizontal for upto 3-miles. Yep, so your fracking site can be setback 2500 feet from schools, hospitals etc. but they can still drill upto 3-miles underground. Stunning.

So thats who is involved and some numbers to get you started More interesting though are the claims for the impact on the Colorado economy. Here again Grace and Ryan have you covered.

Oil and Gas Industry Impact in Colorado Overall

  • 2014, the peak of the oil and gas boom, Oil and Gas accounted for only 7% of Colorado’s Gross Domestic Product (GDP).
  • 2016, a low for oil and gas, Oil and Gas contributed just 3% of GDP.
  • 2018 looks to be about 5% of GDP, and is the average over 10-years.

This sort of contribution doesn’t even put the Oil and Gas Industries in the top-10 list in Colorado. So much for the devastating impact.

But I hear you say. Oil and Gas contributes so much more. What about taxes?

  • Severance taxes(what Oil and Gas pays) from 2012-2017 were between $4-million and $265-million. Sounds a lot, but is less than 1% of the State budget.
  • Compared to other States, like Alaska, where the severance taxes make up more than 50% of the State budget.

Why the variation and swing in both GDP and Taxes from Oil and Gas? Because it’s all dependant on the price of crude oil and gas. While the oil price has been slowly rising, it’s nowhere near the 2013 peak.

Grace Hood makes the point in her answers that the numbers don’t include oil and gas service workers and service industries. One of which would be the truck drivers who truck water out to fracking sites. Then there are the people directly employed by the Oil and Gas Industry, that must be big?

  • Employment State-wide is circa 29,000 or just 1% of the workforce in Colorado.

Who Wins?

The last note I took while listening to the CPR News item was the biggest impact would be felt in Weld County. You can take the link to find out a bit more about Weld County, but here are some notes I looked up from Wikipedia.

  • Weld County has an estimated population as of 2017 of 305,000.
  • Weld County is the richest agricultural county in the United States east of the Rocky Mountains, and the fourth richest overall nationally.
  • For a relatively rich county, the median family income is just $49,569. So the money is going where?
  • There are just 76 people per square mile in Weld County, compared to some 450 people per square mile in Boulder County and even more dense in urban areas and cities.

So while it’s easy to see that Weld County, if as populace as Boulder County, would suffer real financial hardship, given the population density and size of Weld County, it’s hard to image that the setbacks will be a real inhibitor there. Unless of course they are all out of sites and places to drill already. 

It’s easy to come to the conclusion that you should VOTE YES on Prop.112. I can’t vote as a non-citizen. The TV Commercials by “Protect Colorado” are pure unadulterated fear mongering. Sure, families and workers will be impacted if 112 pases, but hey, they’ll be impacted if the oil prices head south again. The boom and bust of the Oil Industry has been going on for decades, the setbacks won’t change that.

Protect Colorado doesn’t have a leg to stand-on with their extreme claims. I know most people who live near me would be horrified to find that a well pad 2-3 miles away was drilling underneath them. The setbacks are well deserved for safety in urban and more populous areas than Weld County and the like.

Amazon’s $15 Minimum Wage Won’t Change How Americans See Work – Bloomberg

n 2017, the real median household income in the U.S. was $61,372, which is roughly what two earners with full-time jobs making $15 an hour would make.

I remain totally confused about class as a term to classify people in America. This article is a prime example. While overall this is good news, if $15-per hour helps the middle class, how little do you have to earn to be working class? And why is that term never used?

As far as I’m aware the amazon deal doesn’t include health insurance, which effectively means before taxes, you’ll have to work for nearly 1-week in 4 just to pay for an individual plan, for a family plan, you’ll be working for just over two weeks every month just to pay your health insurance premiums. Then there’s food, rent, transportation etc. and so who knows where you are going to find the average $4,533 deductibles if you do get sick. Rather than working class, you are the working poor.

If two people have to work for a couple to survive they are working class. Telling them they are “Middle class” if they earn more than $22 is just a great example of gaslighting. To be middle class,  surely it means when one of you can chose not to work.

Source: Amazon’s $15 Minimum Wage Will Won’t Change How Americans See Work – Bloomberg

Maternity medical crisis

As we approach this year’s open enrollment period for health insurance, I continue to be shocked and disappointed about almost everything I learn about the US Healthcare system. Before I return to notes about my own experiences and my own health, maternity care is another healthcare topic that doesn’t often get discussed, as the average American prepares to pay more than $10,348, per person, per year on healthcare.

While many argue about the definition of single payer, and if it would lead to socialism (and what that is?), the inefficiency, mistakes, cost and just outright expense of what should be routine treatment, continues to make me despair.

America has healthcare snobs, millions of them, they just don’t realize that while they might have great access to medical facilities and Doctors, that doesn’t mean it’s always good, or that the system acts in their best interest. However, any suggested change is met with claims of death panels, socialism and more. Oft heard is also they ‘don’t want the Government in the healthcare.’

Even I was left speechless as I watched a recent CBS Sunday Morning segment on maternal healthcare. Among the points made were:

  • U.S. “most dangerous” place to give birth in developed world
  • The United States is ranked 46th when it comes to maternal mortality. That’s behind countries like Saudi Arabia and Kazakhstan.
  • “Sixty percent of the deaths in the United States are preventable,”
  • At least two women are dying every day

And it’s not about access to healthcare; it’s not about the poor without insurance; yes, there is a racial element, but it’s not what you’d think. Here is the entire segment, well worth watching before you enroll this year.

| Edit: The embedded video doesn’t apparently load in some browsers, so here is a direct link to the CBS This Morning web page. https://www.cbsnews.com/news/maternal-mortality-an-american-crisis/

Can it be true that women giving birth in America are more at risk than women in dozens of other countries?