It is very sad; my hubby would have jumped out the window this week if we didn't
live in a ranch house and he is already in rehab for an ACL injury....
Peace, Love, & Light,

Vidette Todaro-Franceschi RN, PhD.
Associate Professor & Specialization Coordinator
Adult Health Advanced Practice Graduate Program
Hunter-Bellevue School of Nursing
Hunter College, City University of New York
425 E 25th St
New York, NY 10010
vtodaro@...

*********************************
www.energy-enigma.com

"To see that everybody not merely depends on everybody, but actually everybody
is everybody in a deeper sense."
Bohm, On Creativity, 1998.




---- Original message ----
>Date: Sat, 20 Sep 2008 01:36:15 -0000
>From: "bear" <tc_spirit@...>
>Subject: [Martha_E_Rogers] Re: An interesting week on Wall Street and some
ursine reflections...
>To: Martha_E_Rogers@yahoogroups.com
>
> :-) Vidette
>
> With all due reverence and respect to my many
> friends and colleagues
> who put in long hours as editors and reviewers, the
> tedium of academic
> publishing is too great a burden for this poor
> ursine to 'bear'.
>
> Sadly, most journal editors are unable to
> distinguish between
> something seminal and original and something trivial
> and redundant.
> Fielding dozens of requests for clarification
> because someone doesn't
> quite 'get it', and worse still the inevitable
> revisions to correct
> grammar and put in references where none are
> necessary except for the
> fact that the reviewers have no idea what a "thought
> experiment" is
> and editorial policy is that articles should have
> references, are just
> too tedious to describe and certainly to suffer.
>
> I'd rather take a hot poker in my eye than go
> through the editorial
> review process. :-)
>
> But, I am always willing to partner with co-authors
> whose tolerance
> for the submission and review process is way, way
> higher than mine.
>
> You can be sure that for the next few months journal
> editors,
> newspapers, and TV news commentators will be
> recruiting dozens of
> experts to explain the market meltdown - but many of
> these experts
> were dying to get listened to years ago when the
> meltdown was just
> beginning and the most severe effects could have
> been prevented. None
> of these same people had any interest in the experts
> views until they
> were hit in the face with a baseball bat.
>
> sadly, what is abundantly obvious to me, and has
> been for three
> decades, will take a disaster similar in depth to
> the week's events to
> become clear for most who haven't already put it
> together...
>
> :-)
>
> bear
>
> --- In Martha_E_Rogers@yahoogroups.com, "Vidette
> Todaro-Franceschi,
> RN, PhD" <vtodaro@...> wrote:
> >
> > Bear, I do hope you are writing your thoughts up
> for pub somewhere;
> even short letters to the eds of various economic
> pubs.
> > Peace, Love, & Light,
> >
> > Vidette Todaro-Franceschi RN, PhD.
> > Associate Professor & Specialization Coordinator
> > Adult Health Advanced Practice Graduate Program
> > Hunter-Bellevue School of Nursing
> > Hunter College, City University of New York
> > 425 E 25th St
> > New York, NY 10010
> > vtodaro@...
> >
> > *********************************
> > www.energy-enigma.com
> >
> > "To see that everybody not merely depends on
> everybody, but actually
> everybody is everybody in a deeper sense."
> > Bohm, On Creativity, 1998.
> >
> >
> >
> >
> > ---- Original message ----
> > >Date: Sat, 20 Sep 2008 00:32:54 -0000
> > >From: "bear" <tc_spirit@...>
> > >Subject: [Martha_E_Rogers] An interesting week on
> Wall Street and
> some ursine reflections...
> > >To: Martha_E_Rogers@yahoogroups.com
> > >
> > > Not for the faint of heart...
> > >
> > > I think most everybody is now well aware that
> there
> > > has been a severe
> > > economic crisis brewing for the last few years.
> > >
> > > There are still some who would like to imagine
> that
> > > nobody could have
> > > ever anticipated the unfolding of the mortgage
> > > market and its impact
> > > on the nation's and the world's financial
> markets.
> > > These are however
> > > the same people who could not imagine planes
> hitting
> > > buildings,
> > > hurricanes destroying major cities, and they
> are,
> > > unfortunately, also
> > > the people who will be blindsided when the
> > > disastrous situation we
> > > face with respect to health care finance
> mechanisms
> > > also unravels as
> > > it unfortunately will in the years (if not
> months)
> > > to come.
> > >
> > > The number of people who have really understood
> what
> > > I have been
> > > saying about capitation contracts, managed care,
> and
> > > the combining of
> > > health care providers and finance entities can,
> in
> > > all honesty, be
> > > counted on my fingers and toes. This may be the
> > > moment to help people
> > > understand what is coming in health care in the
> next
> > > few months/years.
> > >
> > > The mortgage situation developed because greedy
> and
> > > manipulative
> > > mortgage companies and brokers sold foolish
> people
> > > on the idea that
> > > with an income of $20,000 per year they could
> afford
> > > to live in a
> > > $600,000 house, drive a new car every year, have
> a
> > > second home, and go
> > > on vacations - all they needed to do was sign up
> for
> > > a 3 year ARM with
> > > no interest or principal payments and then in
> three
> > > years they could
> > > get another 3 year ARM based on the obvious
> future
> > > appreciation in the
> > > value of their houses.
> > >
> > > But it wasn't just really dumb people making
> $20,000
> > > who fell for this
> > > nonsense. Some of the dupes made very large
> > > salaries, had advanced
> > > degrees, but simply couldn't understand that the
> > > RVs, boats, and
> > > second and third homes they were buying with the
> > > equity in their
> > > overvalued houses simply could not have been
> > > sustained any longer than
> > > it has been. I won't begin to tell you how many
> > > colleagues I have
> > > urged not to avail themselves of ARMs in the
> last 5
> > > years. Eventually,
> > > when the only thing driving up prices is the
> next
> > > sucker standing in
> > > line willing to pay the price, markets
> inevitably
> > > collapse.
> > >
> > > As I have watched over the last couple of years
> the
> > > thought that has
> > > constantly run through my mind has been the
> > > ebullience that
> > > characterized the country just before The Great
> > > Depression.
> > >
> > > If the only people hurting were foolish people
> who
> > > signed such
> > > mortgages and the foolish people who bought
> > > supposedly high return
> > > mortgage derivatives, i could easily live with
> their
> > > pain. But the
> > > greed knew no limits, and in the end, it isn't
> these
> > > most foolish
> > > people who will shoulder the bulk of the burden
> of
> > > the bailouts, it is
> > > the ordinary, everyday people who live within
> their
> > > means and who
> > > avoided taking such risks who will ultimately
> pay
> > > the tens of
> > > thousands of dollars per person in deferred
> taxes
> > > that it will take
> > > us, our children, grandchildren, and
> > > great-grandchildren to pay off
> > > the massive debts being assumed by the federal
> > > government for its
> > > failures to stop the mortgage meltdown years
> ago.
> > >
> > > How does this relate to nursing and my work on
> > > Professional Caregiver
> > > Insurance Risk? Just as foolish people took the
> risk
> > > that they would
> > > not be able to secure refinancing on their
> > > overvalued properties,
> > > despite the fact that this risk was palpable to
> > > anyone paying
> > > attention, the sheep kept walking willingly to
> their
> > > future slaughter.
> > >
> > > But of concern to me is all the similar risks,
> in
> > > this case health
> > > insurance risks, that doctors, hospitals,
> nursing
> > > homes, and clinics
> > > have willingly accepted as they have signed on
> for
> > > managed care
> > > agreements, capitation contracts, and the
> worldwide
> > > use of Diagnosis
> > > Related Groups financial reimbursement formulae.
> > >
> > > Just as mortgage brokers preyed on the ignorance
> of
> > > borrowers,
> > > organizations that purport to be health insurers
> > > have effectively
> > > transferred the actual insurance risks involved
> in
> > > the legitimate
> > > practice of running an insurance company and
> > > transferred these risks
> > > to health care providers. Over the short run
> this
> > > worked out pretty
> > > well for a small number of greedy and predatory
> > > companies, executives,
> > > investors, and sales people. Individuals made
> > > hundreds of millions of
> > > dollars by limiting patient's choices and
> delaying
> > > diagnosis and
> > > treatment â€" the most fundamental
> cornerstones of
> > > "caring". After all,
> > > if you haven't figured out what sort of care
> your
> > > patient needs, how
> > > can you possibly provide that care?
> > >
> > > Who this massive transfer of insurance risks
> hasn't
> > > worked out too
> > > well for are the tens of millions of people who
> lost
> > > the benefit of
> > > separation between their health care provider's
> > > personal financial
> > > gain/loss and clinical and professional duties
> and
> > > responsibilities.
> > >
> > > If you walk into virtually any managed care or
> > > capitated group
> > > practice, you won't need a PhD and a research
> > > background to note that
> > > the offices are overcrowded, the staff are
> > > overworked, the waiting
> > > time is absurdly long, and the amount of time
> each
> > > patient spends with
> > > their physician or nurse practitioner is too
> short
> > > to provide
> > > comprehensive diagnosis, treatment, and "care".
> > > These providers are
> > > really good at giving low cost, immediate care,
> but
> > > they really
> > > perform badly when it comes to delivering care
> to
> > > people with complex
> > > needs â€" our best friends, the unitary human
> beings
> > > who have complex
> > > needs, require longer visits not shorter visits,
> and
> > > whose needs are
> > > not well addressed by a prescription pad and a
> pep
> > > talk...
> > >
> > > The consequence of this, of course, is that
> hundreds
> > > of millions of
> > > patients spend far too long waiting to be seen
> and
> > > even when they are
> > > seen, the "focused visit" supersedes clinical
> > > efficacy. If there was
> > > no financial gain or loss in this situation for
> > > providers we might
> > > just all rail about the declining quality of
> care
> > > and how overburdened
> > > practitioners are. But there is a financial
> benefit
> > > to providers in
> > > this situation.
> > >
> > > Providers (and obviously not all providers) who
> > > overbook themselves,
> > > their offices, and their staff in order to add
> more
> > > managed care
> > > patients to the office roster are doing so to
> > > maximize their revenues
> > > without regard to the declining quality of the
> care
> > > they provide. They
> > > chose to accept health insurance risks but they
> have
> > > not, by and
> > > large, stood up and accepted the inevitable
> costs,
> > > their needs for
> > > bigger offices, more equipment, and more staff.
> That
> > > is one side of
> > > the financial gain/loss picture, the other is
> > > nowhere near so pretty.
> > >
> > > The other way providers (Hospitals, nursing
> homes,
> > > group practices,
> > > integrated health care delivery systems)
> optimize
> > > their financial
> > > performance is by ignoring, even denying, the
> > > clinical needs of their
> > > patients. Over the last few decades more and
> more
> > > patients have not
> > > been diagnosed early and correctly. Even when
> their
> > > physicians and
> > > nurse practitioners have finally acknowledged
> their
> > > needs, they have
> > > often been denied the very treatments they so
> > > desperately needed as
> > > their providers tried to escape their
> obligations to
> > > cover these costs
> > > â€" precisely what they agreed to do when they
> > > signed up to assume
> > > health insurance risks. In the end, the very
> > > providers that patients
> > > need to be able to rely on unquestionably, have
> > > violated the trust of
> > > their patients, just as the people selling no
> > > interest/principal
> > > mortgages and mortgage based derivatives to
> unwary
> > > borrowers and
> > > investors, many health care providers have
> benefited
> > > financially in
> > > their actions by delaying and denying diagnosis
> and
> > > care â€" passing the
> > > risks on to their unknowing patients.
> > >
> > > That individuals, even very large aggregations
> of
> > > health care
> > > providers cannot effectively manage health
> insurance
> > > risks is sort of
> > > a no-brainer for anyone familiar with elementary
> > > sampling theory, the
> > > core of my work on professional caregiver
> insurance
> > > risk. Large
> > > insurers manage risk by knowing their business,
> > > aggregating millions,
> > > even tens of millions, of policyholders, thereby
> > > reducing the
> > > variation in their insurance operating costs.
> > >
> > > But when companies that act like, talk like, and
> > > walk like health
> > > insurers transfer their health insurance risks
> to
> > > various health care
> > > providers, the risk aggregation is undone.
> Mortgage
> > > companies evaded
> > > the small amount of risks of non-payment due to
> poor
> > > underwriting, by
> > > transferring the risks of future non-payment to
> home
> > > buyers by selling
> > > them mortgages they couldn't afford and for
> short
> > > terms that virtually
> > > guaranteed defaults. What the mortgage companies
> > > failed to recognize
> > > is that eventually the houses they would be
> > > repossessing wouldn't be
> > > worth anything.
> > >
> > > Similarly, year after year of mismanaged care
> has
> > > led to a situation
> > > where millions of patients needs have been
> ignored,
> > > tens of millions
> > > are completely uninsured (Though i would argue
> that
> > > we can probably
> > > count the number of Americans with real health
> > > insurance with a very
> > > small number of beads).
> > >
> > > When large "health insurers" transfer insurance
> > > risks to health care
> > > providers, they KNOW that the health care
> providers
> > > cannot manage
> > > these insurance risks as efficiently as insurers
> > > can. The consequence
> > > of this is that health care providers do the
> only
> > > thing they really
> > > can to cut costs â€" remember, if health care
> > > providers were making
> > > their operations more efficient we would already
> > > have electronic
> > > medical records, and your waiting time for an
> > > appointment would be
> > > moments not hours.
> > >
> > > Capitated providers clearly cannot operate their
> > > practices efficiently
> > > and this is the area of their presumed
> expertise.
> > > Insurance
> > > operations, a field considerably older and far
> more
> > > developed than
> > > modern medicine and nursing, is way out of the
> > > domain of expertise of
> > > health care providers. So what do health care
> > > providers do to manage
> > > the financial risks they face? They reduce the
> level
> > > of services they
> > > provide.
> > >
> > > It takes longer to get appointments. Even when
> you
> > > get to the
> > > office/hospital, they don't want to take care of
> all
> > > your needs, they
> > > want to take care of the easiest needs you have
> and
> > > have you come back
> > > some time in the future when you can wait too
> long
> > > for too little care
> > > again. Delaying costs is a common insurer
> practice.
> > > Obviously delaying
> > > costs for one policyholder doesn't mean much.
> But
> > > delaying payments to
> > > millions of policyholders, precisely what
> happened
> > > after Katrina and
> > > which will happen with Gustav and Ike,
> dramatically
> > > affects the bottom
> > > line, for a while anyway.
> > >
> > > It is, in my humble opinion, long past time for
> > > nursing to champion a
> > > restructuring of our failing health care finance
> > > system and way past
> > > the time when nurses should be talking about
> working
> > > with managed care
> > > systems. The consequence? If you own stock in a
> > > managed care company â€"
> > > bail out while you can!
> > >
> > > I know it is one of my long rants, but I would
> feel
> > > remiss if I didn't
> > > point out that one of the next big ripples in
> our
> > > financial services
> > > sector is our 'about to collapse' system of
> health
> > > care finance and,
> > > by extension, our wildly dysfunctional health
> care
> > > system.
> > >
> > > Health care providers, like mortgage derivative
> > > investors, signed up
> > > for risks that are simply unmanageable. It is
> time
> > > to stop a system
> > > that hasn't worked for providers or consumers.
> > >
> > > Selfishly, I don't want anyone on this
> listserver to
> > > ever say that
> > > nobody could have possibly anticipated what is
> so
> > > clearly coming...
> > >
> > > Bear
> > >
> > >
> >
>
>