Thursday, June 4, 2009

From Powerhouse To Funhouse

The Employment Situation report for May is scheduled for tomorrow. So, the subject is.. jobs.

Every first Friday of the month we look at the headline numbers from the Bureau of Labor Statistics: so many jobs were added or lost last month; thus, we deduce the economy to be growing or declining. But this is less than half of the story; we rarely- if ever- discuss what kind of jobs are involved. I believe this to be superficial analysis and highly misleading.

For example: a skilled auto worker making $30/hr is fired and gets a job tending bar at $7/hr plus tips. Are these two jobs equivalent? Of course not.

About two years ago ago I started looking at the wholesale disappearance of goods-producing jobs in the US versus the creation of lower-to-middle tier service sector jobs (leisure and hospitality, retail, healthcare and education).

I have now updated the chart presented in the original post; I think it speaks for itself (see below).

Data: BLS

Good, well-paid jobs involve the addition of high levels of value to their output; some because of the high amount of invested capital in plant and equipment and technology (e.g. jobs in manufacturing) and others because they are knowledge-based (e.g. software). What we did in the US, instead of safeguarding these precious jobs, was (and still is) trully moronic, considering we did it willingly and without any outside pressure.

From powerhouse to fun-house, from manufacturing cutting-edge products to consuming bread and circuses.

This is also the reason I am so upset with the continuing sole emphasis of the administration on financial-sector bailouts. The trillions involved are being wasted in keeping a terminal patient on life support, instead of supporting the radical transformation of our energy and resource sectors. And don't forget that these trillions are borrowed!

Sometimes I feel like our Pax Americana is ablaze and we are all gathered round, poking the fire with our marshmallow sticks and laughing, telling each other camp stories.

This insanity has got to stop NOW.

47 comments:

Anonymous said...

There also used to be well paying blue collar jobs until they went to China and illegal Mexicans under Bush 1, Clinton, and Bush 2.

The argument that illegal Mexicans do jobs Americans don't want, is because there are paid below minimum wage, get no health care, no rights, no pensions, ...

Raise the pay for honest work, with health care and pensions and there will be a line of American workers outside the door.

Both illegal immigration and offshore needs to be stopped.

It is has nothing to do with "socialism" either, that is corporate America trying to get you to vote against yourself.

yoski said...

Good article:
http://money.cnn.com/2009/06/04/news/economy/green_jobs/index.htm?postversion=2009060405

"Many of the entry-level jobs making green energy components start at $12 an hour, much less than the now extinct $28 an hour job that had allowed high school-educated workers in the auto sector to achieve middle class status.
...
But the company's president, John Winch, noted that in the long run, wages in the U.S. will probably come down as wages in the developing world come up - all part of the globalization process."
The US has some of the best resources, farmland, good universities, bunch of smart people but "we" don't have the political will to tun things around. Our health care is infested with parasites (insurance & lawyers) our financial system is run by organized crime (GS, AIG, etc) and let's not forget the miliatry indutrial complex (Haliburton, defense contractors). All those interest groups control our government (lobbyists) so there's little hope things will turn around. They're in it for themselves and for next quarter's profits.
In China there're no lobbyists. The Chinises government has a pretty clear vision of where they want to be 20 years from now. So far they're doing a reasonbly good job pursuing those long term goals. They will be laying claim to a much larger slice of the pie in terms of power and raw materials.
Long term there will be an equlibrium between $28/hr + benefits and a bowl of rice a day.

Anonymous said...

Anonymous,

Please go back to school. Learn proper grammar ("there" = "they") before you call someone an "illegal".

You realize the white race is the illegal race in this continent. Why don't YOU go back to Europe?

Thee Earl of Obvious said...

I may be wrong and I don't mean to nitpick but auto worker jobs that pay $30 are actually unskilled jobs. My understanding is this is the pay rate for production line workers who are classified in the union as unskilled.

If so, my point is that this wage is comparable to what a skilled worker makes (say an ER nurse with experience). Therefore these jobs are paying an inflated wage and the correction we are seeing while painful to those involved is necessary; no?

I hate playing the artificial card as it makes me wonder if the entire middle class was not just some post war phenomena that has now run its course.

Excuse me while I confer with a fellow MBA grad while we make the fries...

Edwardo said...

Oh how the mighty have fallen.

Yes, for the reasons you cite, the good ship U.S (S) lollipop is going down. Future generations will chortle at our epic collective stupidity.

The speed with which the U.S squandered its abundance and position will be the stuff of legend.

yoyomo said...

Hel,
Except for your characterization of "PAX" Americana, your post sounds identical to what Paul Craig Roberts has been loudly calling attention to for the past few years. Needless to say, he couldn't disagree with you more on the US being a source of PAX for the past 20 years. Is he someone you read?

Yoski,
"Our health care is infested with parasites (insurance & lawyers)"

Some doctors are also parasites. In 92' I had an MRI for a disc problem which I took to a second doctor for another opinion and he insisted on a new MRI saying the first one was fuzzy. Afterwards I found out he was part-owner of the radiology clinic he sent me to and every radiologist I showed both sets of MRI images to assured me that there was not the least bit of difference in the quality between the two. The first set cost me $800; the second $1,200.

The article Thai linked to about exploding health costs near El Paso pointed this out as a major problem in some areas.

yoyomo said...

"...some post war phenomena that has now run its course."

When the mass of the Proles wake up to the reality of just how temporary and fleeting (in the sweep of history) the "American way of life" will be, mass traumatic shock syndrome will sweep through the nation and then the potential for some real fireworks will start to materialize.

Joe said...

The insanity you speak of will stop when foreign investors call "no mas". Only to be replaced by a new form of insanity, utter panic and collapse.

Where, pray tell, can the Treasury come up with 900 Billion $ by September. Will not happen. We are now very close to the end of US Empire.

Joe M.

Thee Earl of Obvious said...

The Doctors will blame the lawyers for the need to do a 2nd MRI. Imagine being on a a jury if the question was asked.

Lawyer: "did you take an MRI"

Dr.: well, no, but

Lawyer: "just yes or no please"

Dr.: no

Judge: you may step down

Maybe the jury will and maybe they wont hear that an MRI was taken. So, cover your ass

Joe said...

yoyomo,

Just read your last comment and it appears we are thinking along the same line. To further your comment, the American experience will become to be known as a transient event.

However, in electrical terms, a large enough transient can cause catastrophic damage. Since 60% of the world's wealth is denominated in the USD this transient will be the one that took out world.

Joe M.

Debra said...

60 % of the world's wealth is denominated in USD ?
Remember what I said about our intuitions already belonging to millions of other people ?
Somebody on this blog has already mentioned that "people" in the world are quietly buying up Chinese currency...
Filthy lucre in dollars is on the verge of becoming filthy lucre in yen. (yuan, I don't remember, and I'm not particularly interested...)
Hell, I PROMISE that I will pull out that article on Vaucanson and his amazing mechanical duck that got Marie Antoinette all excited.
Just so that we can keep all of this in PERSPECTIVE, and see how far back it goes.
But you'll have to come read it on dink's show...

Anonymous said...

Anonymous #2: Anonymous #1 made good points, even if he did make a grammar mistake. Address what he wrote.

Whites built America. If they all went back to Europe, you'd be back living in the stone age like your people were before America was colonized (I'm assuming you're Mexican rather than a self-hating white).

-Anonymous #3

Joe said...

Anon #3,

He could very well be a native american indian, in which case he would be thrilled to be able to go back to his more self-sustainable lifestyle and not worry about the white eyes stealing his land and way of life.

Joe M.

Walter said...

yoski nailed it with the quote from the president of the ohio manufacturing company:

But the company's president, John Winch, noted that in the long run, wages in the U.S. will probably come down as wages in the developing world come up - all part of the globalization process.

"The wage scale will probably be more dependent on what the world's wage scale is," said Winch.

Basically our wages and standard of living will be falling until its in line with China, India, Africa, etc...

Globalization is about raising their standard of living, by lowering ours.

The sad part is trying to raise the worlds standard of living by putting on the back of the American people, is like trying to lift a Winnebago with a couple of child's helium balloons. The population differences pretty much assure that ours will be dropping a lot faster than theirs will be rising.

yoyomo said...

@Walter

"The population differences pretty much assure that ours will be dropping a lot faster than theirs will be rising."

This is a point I've harped on before but you're the first person on this blog to address it. My view has always been that the west, by exploiting the 3W for the past 250yrs(colonialism/imperialism), condemneed itself to eventual poverty when the now much more numerous 3W began to catch up.

If 110yrs ago the west had helped stabilize and develop (instead of undermine and destabilize) the territories under their control, now the world would have a much smaller population with a better balance of development as each country tried to maintain a quality standard of living.

Now that opportunity has been lost forever and the teeming masses are not going to stop struggling for any scrap of the pie they can grab and the high living western Proles will now be able to receive the total benefits of the full-fledged favela experience without ever leaving home; as has been said before - favela living, it's not just for Brazilians anymore.

yoyomo said...

Lawyer: Did you take an MRI?

Doctor: The patient brought a current, hi-resolution MRI with him. I based my diagnosis based on an examination of those images.

Earl: I think I've been watching too many TV legal melodramas.

Anonymous said...

I spent eight years, every month, calling George W Bush and dimwit US Labor Secretary Elaine Chao two of the biggest liars in US history. In the US, it takes the creation of 100K-130K new jobs created PER MONTH just to absorb new graduates into the workforce. These two Republican morons rarely, if ever, met that target, proof that Republican tax cuts do not work to creat jobs. The labor force in India and China is way too large. I'm sure the Chinese know this, so I'm puzzled by the talk of "Chinese students laff at Tim Geithner." The Chinese HAVE to know the baseline jobs creation number for the US, even if US people do not. Well, some do, because they were with me pointing out that no good jobs, no buying houses or automobiles.

I still say put your bills on Elaine Chao's desk by sending them THROUGH Mitch McConnell R-Ky. They wanted to be the Phil and Wendy Gramm of Washington, DC. Bury Mitch's desk. It's important for him to be an embarrassment for the amount of mail clogging the US Senate, especially when credit card legislation and health care legislation are up for votes.

Thai said...

@Earl of Obvious- Amen

You are absolutely correct (as is Yoyomo). In fact, the paradox is part of the self reinforcing reason we are in this health care bubble in the first place.
Indeed, this is the very reason Scandinavian countries moved to no fault medical malpractice insurance- it cuts the lawyers out of the med mal process... Understand the legal profession takes a 50% cut out of the whole med mal process and at some level it becomes a basic issue of "how do you want to spend your money", e.g. on patient compensation for bad outcomes AND and lower health care costs? Or do you want to spend it on lawyers.
Your choice.


@Hell, your bias in the physical sciences is coming through again and though you know I love you, on this again you are a little misleading and I am going to have to push back.

The average mid level provider (e.g. physician assistants and nurse practitioners) makes a VERY VERY good salary. And if they are efficient with their education, they can start earning this 4 years out of high school.

In fact, it is not uncommon to see surgical, EM or OB/GYN PAs making $140-160,000+/year (if you include benefits).

Indeed, they often make more than many physicians they work with (and with far less training to earn this income, meaning their educational ROI is FAR FAR greater than it is for MDs with a MUCH better lifestyle).

Indeed, MLP productivity improvements have not gone unnoticed by some state medical societies, who are ever eager to protect their turf.

They have made major attempts to stop businesses like Minute Clinic from growing in several major markets ($45/visit, you can't beat it- I have used it for my kids many times)

Again, these state societies try to stop these clinics even though there is NO evidence MLPs provide inferior care (vs. physicians) in a low acuity primary care settings yet do so at a far lower cost to society.

In fact, MLPs (a uniquely American profession by the way) are one of the biggest reasons it is hard to make cross national comparisons with physician incomes when you compare American physicians vs. other countries specifically as they do farm out a far larger percentage of the lower skill work to lower cost labor under their "higher skill" supervision.

In fact, many European countries are now talking about instituting MLP programs to lower their own cost structures further but interestingly are beginning to run into their own physician union opposition- which is course I think immoral, but gain, I am not in the pro union camp for reasons like this.

We are seeing some "pro union" physician groups in the US try to organize physicians to prevent the growing use of MLPs in America, EVEN though they clearly improve health care delivery productivity dramatically (again, where utilized appropriately).


In fact, physicians hate to admit it but MLPs actually have MUCH lower med mal rates than physicians do in the US.

... But this is VERY misleading as MLPs see much lower acuity patients than physicians and the biggest risk factor for a med mal incident is acuity (i.e. how sick you are)- sicker people tend to have much worse outcomes and people (and families) don't like bad outcomes for obvious reasons.

Health care jobs are not all bad. Again it gets to who you spend your money on and how much you are spending.

You do have a physical sciences bias that does come out at times.

Anonymous said...

My father used to work 40hrs per week in a blue collar job and supported a family a five, 2 cars, health care for all, pensions, vacations, and a mortgage.

Now you often need both parents working to obtain the equivalent standard of living.

My conslusion, is that the American middle class standard of living has declined by over 50%.

I agree with the other posters that it is a combination offshoring jobs and turning a blind eye to illegl immigration.

I also think congress serves corporate America (capital) and no longer service American people (labor).

marcus said...

This sounds like a James Kunstler post.

Pax Americana burned to the ground during the tortured Cheney Administration, and there ain't no rebuilding until the crimes are studied, listed, and processed. And if you don't think they are connected the financial mess look up "The Shock Doctrine". Crisis are only seen as opportunities to these craven characters and the more the better.

The insanity has to go on until a majority of people in this country get it. We been hoodwinked, robbed, and left as refuse on the highway to nowhere, and until a hell lot more Hells in society educate people to this reality the shell game will continue.

There is a chance Obama will learn and move on it but he's kind of busy with other burning issues like proliferation.

yoyomo said...

Thai,
In this instance, we (Earl) both can't be right. Either a new MRI was needed or it wasn't. All the radiologists I showed both sets to said they were of identical quality and extremely clear; I was still as a cadaver when the machine came on. The doctors at the hospital who knew this guy all thought very little of him and weren't the least surprised that he would be hustling business for his radiology clinic. The article about the Texas county with higher medical costs you linked to cited the same exact problem, doctors as businessmen trying to maxamize ROI on their investments.

WRT MLP, doctors have to recieve higher reimbursement rates if they are restricted to seeing only the most complicated cases; that is where the conflict comes in. Doctors need to compensate for the extra care they give really sick patients with the fees they get from routine visits.

yoyomo said...

Marcus,
What makes you think proliferation is a burning issue for anyone but the major corporations that want to exploit small countries at will. I don't care about proliferation, it has no effect on 99% of the population like me; unless I misunderstood you and you were employing a little sarcasm.

marcus said...

Yo Yoyomo, Just a small example of the prez's busy sched.

And did 9-11 affect your world and 99% of the rest of the world?
Now view that experience through the variable of a radiation bomb. I'd say its something to be concerned about, maybe not for a few years but its a serious long term issue.

Thai said...

Yo, if your story is both as you say AND occurred for the reasons you say, the physician is obviously a sleaze ball and he/she should be reported.


Remaining focused on broader economic issues (as per Hell's request).

Re: "if they are restricted to seeing only the most complicated cases; that is where the conflict comes in. Doctors need to compensate for the extra care they give really sick patients with the fees they get from routine visits."

You are continuing to confusing separate issues.

If care is provided, people are getting compensated- period.

All those doctors and nurses are not working for free; this is true whether they work for themselves, Kaiser or the government.


The conflict of interest on caring for "sick and complex" vs. "not sick and otherwise healthy" is a conflict of interest for society, not physicians. As long as we have decided to do it, the conflict is for society to deal with.

Having decided to to do it, the issue becomes how efficiently you can delivery care and what the quality of that care should be.

If you provide the care more efficiently, whether or not the doctor takes home more, less or the same amount of money, the system is more efficient- period.

This frees money up for other purposes.

Whether that money is in the pocket of a patient who will now pay less money, or an insurer who can earn more profit, or a physician who will make a small margin supervising the midlevel, or the government, there is still more money in the system and it will end up being used by whoever has it as they so chose.

You are really getting more into issues of who pockets money when they save the system money. But that is different than delivering care more efficiently which is different than the existence of conflicts of interest around any delivery of care.

Conflicts exist in all systems and with all models. It is what it is.



In fact, this whole MLP issue is really much more complex than even this long comment thread suggests, for there are a great many instances when MLPs have been clearly shown to INCREASE costs (forgetting any quality differences for a moment, though the same statements apply)


In the medical finance world, we refer to ordering tests/procedures (such as your MRI) as "utilization".

MLP utilization is frequently abysmal vs. physicians and ANY savings in salary differentials between the two as a result of lower training costs CAN BE very much lost in over utilization.

AND MLPs have none of the financial conflict of interest issues that seem to push your buttons so much.


Indeed, there is a VAST difference in utilization within MLPs themselves just as there is a VAST differential in utilization of physicians.

So you need to be careful in generalizations as an very efficient MLP will clearly have a better utilization profile than an inefficient physician, etc...


Remember, health care spending is fractal

Greenie said...

"My conslusion, is that the American middle class standard of living has declined by over 50%.

I agree with the other posters that it is a combination offshoring jobs and turning a blind eye to illegl immigration."

You are wrong. Primary cause of fall in standard of living is inflation. Inflation makes all people to adjust life so that the other bad things take place. Why? Because people tend to look at the nominal price, not real price.

As an example, inflation drove the prices of houses up. People still wanted to buy houses just like previous generations did. Result - both parents went to work instead of one.

Who is responsible for inflation? The thugs at the Fed.

Thai said...

Anon and Greenie, don't you tend to see it as one of those "all of the above issues"?

For instance:


1. Larger % of Americans do not work today vs. the past.

2. Larger % of the country is retired

3. A larger % of one's lifetime is now spent in retirement

4. A larger % of earnings goes to support the probability people will actually survive from birth all the way to age 75- health care, safety, etc...

5. Increases in the % lifetime earnings which go to support spending on people who will no longer be economically productive.


6. Change in the mix of national origin of recent US immigrants with a VERY real effect on America's national education skill mix

7. Effect on the economy of changes in the birth rates of various socioeconomic groups in America.

8. Changes in the % of life earnings going to education.

9. Changes in the definition of what is considered a "normal" home or normal car or normal vacation (e.g. the size and amenities of the average American home and car have grown faster than income or America productivity)

10. Change in the % of the economy controlled by the government (government is a much larger % of the economy today than years past with some exceptions)

11. Changes in the mix of economic skills required vs. economic talents Americans actually have when compared to what the world economy actually requires today.

bb said...

add healthcare, not the inovative side of it, but extending the lives of 80-somethings for a few more months as another issue. this is a heavy burden as well through the health insurance scam.

Anonymous said...

Back in the bad old days when I was still living in the mother country, I noticed just how much time, energy, and filthy lucre was being spent on keeping up with the Joneses.
Keeping up with the Joneses was almost a full time occupation for my Dad. It is an unfortunate product of our junkie take on consumption.
Who says the seniors can't be "economically productive ?" Who says that our kids can't be economically productive either ?
All of these are BIG CHOICES that WE are making.
And the fact that we can't manage to see that these are choices doesn't make them any less so...

Joe said...

Greenie at 3:40PM hit the nail on the head. The FED IS the problem and we are now at the FED/fiat-USD end game.

I said a while back this whole crisis is a USD crisis and this is why we are very close to the end of US Empire as we know it.

Joe M.

Thai said...

Greenie and Joe, if you are correct, then there should be a exact correlation between the drop in American productivity and the onset of inflation in America which has remained ever since.

Do you have data supporting your thesis?

marcus said...

In general comment to Hell's post: This country has always been about entertaining and working ourselves to death, the real stupidity comes in trying to do what we are not adept at--empire.

As for the Fed and fiat currency. What would you suggest? Our esteemed members of Congress controlling the currency? Sorry, I don't trust the majority in Congress to serve the Constitution any more.

Or, a gold standard? Didn't we already try this with bad results AKA The Great Depression?

Nothing wrong with the Fed or the fiat regime. What is needed is effective regulation and law enforcement.

If all the ratings agencies didn't rate this crap AAA would we be in half the trouble we are now? And should they not pay for this mis/malfeasance so the bad actors don't repeat these mistakes.

Thai said...

re: regulation

My only problem with this issue is that the law of the conservation of energy means the same thing as the law of the conservation of risk.

If you do not believe it possible to build a "perpetual motion machine", you should also not believe it is possible to build a "perpetual risk reduction machine". For if you could build one, you could create energy out of nothing.

I know this sound esoteric but I really don't think it is.

Thai said...

And I absolutely agree with Marcus re: "should they not pay for this mis/malfeasance so the bad actors don't repeat these mistakes."

Thai said...

Marcus, right after I wrote those last two comments, oddly enough I ran into the following article and had to smile.

Flaws in all our mental heuristics regarding ideas of risk- in particular that we can reduce personal risk by swapping it for systemic risk- are not inconsequential as (sadly) these kids learned the hard way.


I have a question for you and or for any other readers...

Have you ever been asked the answer the Monty Hall question as a way of seeing how well you understand certain issues around risk?

The problem is incredibly relevant to physicians who have to give patients advice on different treatment options when they have different amounts of information. Misunderstanding the Monty Hall question can lead to many errors of advice to the detriment of a patient.


When I was first asked the question, I got it completely wrong.

Indeed I disagreed with the answer for months until I finally came to understand it.

Anyway, if you already know the question, please forgive my asking it, but if you (or others) do not, it is kind of fun and it goes something like this:


You are a contestant on Monty Hall. Behind one of three curtains is $1 million dollars and you are asked to chose which curtain the money is behind.

You chose curtain #2.

Monty Hall then opens curtain #1.

There is nothing behind it.

Monty Hall then asks you: "do you want to change your decision and chose curtain #3 instead of curtain #2?"


What should you do?


Anyway, regards

yoyomo said...

"You are continuing to confusing separate issues."

No I'm not; it's called cost shifting. If you have lots of simple cases, you can charge each one just a little more so you can give your few really sick patients a bit of a break on how much you charge them.

If all your patients are complex, time consuming consuming cases, you will not be able to see as many patients and will have to charge each one more.

It's not that complicated, really.

"...AND occurred for the reasons you say..."

How the hell do I know his reasons (I'm not a mind reader), all I know are:

#1 other doctors who looked at both sets said both were good and their was no difference between them

#2 he was part owner of the radiology clinic, his name was on the invoice form

"...issues that seem to push your buttons so much."

I would think being lied to would push your buttons too, if only on principle but more so if it cost$1,200.

marcus said...

"re: regulation

Thai: "My only problem with this issue is that the law of the conservation of energy means the same thing as the law of the conservation of risk."

Then you go on to talk about a "perpetual motion machine."
So I think you are talking about efficiencies in systems, correct?

Does less regulation mean more efficiency? Let's look at the Robber Barron era. Do predatory business practices and monopolies breed efficiency? Do they contradict this founding concept: "...in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare...?

With the current crises: there were ethical people working for the rating companies (to cite one enormous failure)that tried to warn the authorities, they didn't listen. Why? My contention is we had a strict ideological Administration which believed in the principles of unfettered capitalism (efficiency) and because of this blindness caused the greatest financial disaster in history.

If your argument is that we should have let the banking system fail, let them pay the price, while taking care of the "general welfare" mentioned above, then we might be in agreement for that type of efficiency.

yoyomo said...

Marcus,

"Now view that experience through the variable of a radiation bomb."

Despite the govt hype, nuclear materials are not something that terrorist orgs can develop on their own and no govt would trust a bunch of uncontrollable free agents with that kind of power; it might be turned back on them.

North Korea and Iran are no threat to anybody unless you're planning on attacking them; simplest solution - leave them the f@#k alone.

Scare stories about Kim and Ahmedinajad being crazy are bull, they're not but even if they were, every functional govt has back-up systems and you don't maintain the same regime for 64 and 30 years while surviving 5 and 8 year wars if you're not functional.

You can go to sleep tonight without having any nightmares about mushroom clouds, just C_ntaleeza Rice.

Thai said...

Re: "If all your patients are complex... will have to charge each one more."

"Yes", that is exactly what physicians do.

FYI, the entire system is based on RVUs where (say) an ankle sprain is assigned less RVUs that a gunshot wound to the chest. As RVUs go up, charges and payment goes up.


If patients don't want to pay more for more complex care, they don't have to, but SOMEONE better pay or the majority of complex care will cease instantly.

... I guess a few will work for free (I periodically give some time to a local free clinic) but I seriously doubt you can run a national policy on this.

Certainly no country in the world has ever been able to do so as far as I am aware.

In fact, the issue of inadequate payment for greater complexity is why many primary care physicians have stopped seeing new Medicare patients.
Medicare pays OK per patient, but not if you convert it to $/RVU and Medicare patients are older and sicker, i.e. higher RVU/patient so they are becoming more and more difficult to care for financially.

Imo, it is the hallmark of physician integrity that instead of doing something sleazy like testing more and artificially increasing RVUs per patient, most doctors have simply said "I won't work for this".

They are not required to work for wages they do not want to accept.

AND, fwiw, Maggie Mahar, whose article you liked re: fraud in McAllen Texas, is a MAJOR proponent of increasing payments to physicians per RVU as part of a program of eliminating fraudulent billing.

Additionally, this is why congress overrode Bush and reinstated the 10% cut in provider medicare fees last year. They knew what it meant to their voters.


And FYI, lest you think all this applies to me personally, understand EM physicians DO NOT have the ability to refuse seeing Medicare patients- EMTALA laws make this impossible.

Although I am aware of hospitals/EM physicians performing "medical screening exams" on people who want care for non-emergent issues and then telling them they will not receive care if they can't (or won't pay). The practice is quite common in states that boarder Mexico as the influx of uninsured illegal immigrants is overwhelming the finances of the system.

... AND lest you think it means people will work in EDs for free, remember that people vote with their feet and right now there is a massive shortage of EM physicians (and I mean massive) in all but the most desirable areas of the country. AND the shortage is getting worse as the population gets older and sicker.

So in order to solve this issue AND provide care people want/demand, the reality is most ED physicians work under a partially subsidized arrangement. The money to pay them just comes from somewhere else ( now you know why aspirin costs $150/pill).



I tend to look at issues in medicine as the unstoppable force hitting the immovable object.

But none of these issues are conflicts of interest for physicians, unless the physicians let them become that way. These are conflicts of interest for society.

It is society that must decide how they want to spend their money in the end.


@Marcus- "yes", we should let the banking system fail.

AND my point is also that ideologues are always part of the risk of a regulated system.

yoyomo said...

God Lord Thai,
You and (SS) make erroneous (fraudulent) assumptions about what I said and then go one to tell me why I'm wrong (evil). I'm not accusing doctors of taking advantage of anyone or saying they should work for free.

You mentioned Walgreen's pharmacy clinics as a low cost alternative to a doctor's visit and said that some doctors' groups were against these clinics. I proposed a reason for that opposition; private (not hospital) doctors ususally charge a standard fee for office visits and use the time savings from the simple cases so they can spend more time with the sicker patients without charging them more.

If the pharmacy clinics siphon off all the minor cases, the doctors will be left with only the more difficult cases and be forced to charge more to the people who already have the highest medical expenses. I wasn't saying this was good or bad, simply giving a possible reason why doctors' groups were opposed to the pharmacy clinics.

You're confusing my specific complaint of one doctor (don't worry, he wasn't Jewish) who took advantage of me with a blanket condemnation of doctors.

Thai said...

My humble apologies, I misunderstood your point.

Your inference as to why some physicians might indeed complain is correct. There are always those who don't mind profiting from the misery of others.

Please understand, I could care less what these physicians feel.

More cost effective care is more cost effective care- period.

Trust me, in the event that illness and disease are one day ended and I have to hand in my stethoscope, no one will celebrate this more than I.

I will just have to go back to school to learn another craft and dance a sad jig all the while I learn... Sad that some of those I loved most on this planet could not share in the miracle.

Regards

Anonymous said...

Inflation is NOT the problem. It is the assets are inflating FAsTER than wages.

If we did not have illegal Mexicans then there would be WAGE INFLATION to keep up with asset pricing.

illegal Mexicans and offshoring keeps wages down for ALL AMERICANS while asset prices and food and oil constantly inflation.

Hence we all get poorer except the few that control the assets.

Anonymous said...

Good post. In the 50s - 70s there was inflation but American wagers grew FASTER than prices so Americans were able to buy for each hr worked.

Since the 70s wages are growing SLOWER than prices because of illegal Mexicans and so we get poorer each year we allow more of this slave labor into America

Anonymous said...

Chagas kills more latinos then any other disease.

It comes fron not spending the $5 needed to install a simple p-join in Mexican plumbing stopping the sewage gases from coming back up into the home.

Problem is Mexicans must like the smell of sh&t and/or they are incompentent retards.

Anonymous said...

From Wikipedia - attributes of Fascism:

1. Obessive nationalism and patriotism - we vs. them, we Americans are better then them, we are the world's moral authority, ..

GOP? Check!

2. Extreme military culture, massive spending on building military power. Belief in military might as a solution.

GOP? Check!

3. Hatred towards both communism (anti-freedom) and liberalism (pro-freedom) and against the "educated elite class"

GOP? Check!

4. Use of angry, aggressive rants (think Hitler and Rush Limbaugh) and other media propaganda fear tactics to Indoctrinate depressed population into fasicst group think.

GOP? Check!

5. Corportism - a few huge firms working with government to control the economy.

GOP? Check!

Conclusion - looks like a duck, walk likes a duck, ...

Anonymous said...

Kids burned in Mexican day-care because Mexicans are so ignorant to build a day care in a fire hazard are now being treated in California with American taxpayers dollars.

Mexicans cannot even provide basic services to take care of themselves?

Why am I am paying taxes to constantly take care of a retard latino culture that cannot even care for themselves?

alphadebt said...

Interesting article, just shows what a mess our current financial situation really is.

Nancy Harris said...

Very interesting article. With various health care reform bills floating around both the House and the Senate, President Barack Obama is pulling out all the stops to get the votes that the bill needs, which is good news for the public option. President Obama continues to rally behind health care reform. I am really concerned that the fiasco of this reform may make Obama a one-term president.