Reversing A. C. A. Outcome Incentive programs in favor of fee for service approach.

In the fee for service  ( FFS ) approach to medical billing, your physician, hereafter known as HE,  dings you everytime he turns his wrist or nods his head.    And he nods his head and or prescribes treatments just to build out the bill.

He gets paid whether you live or die or whether you improve in health or not. He takes no responsibility for the outcome. 

Isn't that just like a man.  Women never do things like that.

O'Bama Kare sought to encourage physicians to invest themselves in the outcome  of their treatments.  It also sought to steer physicians away from the practice of prescribing just to fluff up the bill.  

In the past few days, the trumpets in the IHS have set about to shut down the O'Bama trial and return to FFS.  I mean, after al, how is one to pay off the load on the jag.   Isn't that the real part that the sick person has to play in all of this?

I heard all of this in passing on NPR.   That report did not include the number of physicians who work under clinic contracts and hence reeive a salary instead of deriving thier income by way of a billing process. 

I work with a clinic type group.  Emory Hospital Systems may run a clinic system here in Atlanta. .  So, how many physicians  remain who run their own practice?

Upon reading Man On A Donkey

Most of us have an idea of God.   If we have any ense at all, we accept that this idea has limitations.  We get into trouble and or give up when god as we limit god fails to perform as demanded. 

We give lip service to that phrase of Paul's  " see through a glass darkly "  found in I Corinthians 13: 12.  We do so until the crunch comes:  Then we break the glass.  We function mostly like small children. 

In writing all this, I confess that I have faced little of the slings and arrows which Shakespeare says speaks of in Hamlet. 

For me, God holds us together even in the midst of  all that looks not like goodness. 

Lumen de Lumine that shines in darkness which compreheneth it not.  That also provides another point of consideration.  The believer always resorts to the caveat that human cognition lacks the capacity being a thing created to comprehend the thing creating.  D. T. Suzuki in his book Zen suggests the cauldron of naming  or using techniques approriate from inside the created order to describe that which exists outside the created order.  One  thinks of imaginary numbers.  But, history does not show an instance in which a mathematician has gone to the stake for taking exception to the use of imaginary numbers. 

We, in our various delusions and mental illness make god a monster.

liberte egalite fraternite meaning www.lawlessfrench.com Liberté égalité fraternité

Many of us who support
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equality of outcome
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do so in the belief that the rest of you cheat.  You may do this out of ignorance, or sheer conscious prejudice, but you cheat .   

You label and pre-judge persons based on a set of irrational prejudices.   How do we know this?  Because we do it ourselves.  It comes from human nature.  But, we recognize it and choose to circumvent it.   And, if we come accross and holier than thou, well

tough shit

We will risk that.  We will encure the danger of self-righteousness  and sanctimoniousness.   We can work around that.  We can apologize for that.  
What we can't tolerate in ourselves is 
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bigotry.
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we leave that to you.

New Operational Definitions Of Clinical Terms

Clinical Term:  Bat Shit Crazy
Appears in Southern editions only of the DSM IV.l 

The condition has a number of prominent features. 
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One such is a preference for throwing a caniption  fit when a hissy fit would do just as well. 
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A second feature involves telling anyone who will listen that "...they have always depended on the kindness of strangers."
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A third feature consists of fantasies dealing with gentleman callers . 
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A fourth feature invovles halucinations of robust young men resembling Paul Newman or Marlin Brando standing outside their house at night hollering Stella.

Men? Dong What?

In some part, I find myself shocked.  Another part counsels calm.  Since the Sixties, large parts of society gave themselves over to the notion that if we ounly shouted loud enough and proved sincere enough the edifice of privileged of and the rest of those endless list of evils would crumble as Marx, Leniin, and Mao promised. 

Alas dear friends none of those guys knew shit.   Their main suppositiions have proven wrong.  Society does not function like a mon olith.  It only appears to. 

So, in the realm of Feminist theory and practice and Male sexist backlash we struggle to find authenticity.  We search for a teory and practice that will work. 

We ain't there yet boobie.   And, no matter how hard you huff and puff and try to make yourself believe we are!  No.  We ain't. 

We have a few tools from ages past:  Ten of them in one set or Tweleve of them in another, if you like.  Takes lots of individual work.  

Keep on trucking.  

Again and again ...

The employeer goes into the market place and offers employmebnt.  The employee can take it or leave it.  Forget negotiation.  

Employers negotiate all other expenses such as but not limited to raw materials,  the cost of prostitutes, and the amount of bribes.  But, for some reason in the schizophrenia of the owners and management,  employees don't count.  Unlike Princess Camilla and horses, they can't paw the ground with their front feet to count.

But, O M G when employees organize to negotiate for wages and benefits the stuff has hit the fan.  The unions are foreign, subversive, and unhholy.   Like the song says
"... I've been slandered.  I've been  libeled.  I've heard words I've never heard in the bible..."

So when I suggest that labor  unions represent a stratagy by which people gain power in the market place, senile old men grab their golf clubs and come a hobbling dragging their  care givers  -- usually underpaid and black -- with them.    

Surthermore, when I suggest that failure to pay a fair wage and continue to tolerate slum landlords amounts to wealth transfer from the lowest segment of society to the wealthiest, the same group of the senile try and shout through their asthema, emphasis, and  COPD.  They lack the strength to pick up their portable oxygen tanks and throw them at me.  
    

Institutions And What?

I like reading historical novels.  In such, plot and such take precedence over history and accuracy.   

In one novel set in the Civil Ware, the author puts words in the mouth of John WIles Booth.    Allegedly Booth complained that Lincoln had destroyed Southern institutions.  

What institutions, other than slavery, cried  I,  as I let from my relaxed position.    I could not imagine institutions other than slavery.

So, I asked a most scholarly and thoughtful friend of  mine to fill in the blanks.  I did so while we lunched.  No, it was not Ms. Otis.   

The friend replied, though not in song,  that the conflict had brought an end to the exclusive agrarian nature of southern culture and economy.  Land ownership ceased to serve as the cheif and only element b y which a person secured their status in society. That owenership also served as the basis for an aristoracy which had also ceased.  

The land needed folk to work it.  If slaves did not do that work, who would?  Without that work, who would wrest  the agricultural wealth from the land? 

In the new South, moeny and invesments either took the place of land or stood along side of land as sources of wealth.  And, with wealth came social status.   

All through reconstruction the North controled the flow of money.  Land redistribution, or attempts at it, broke up the holdings of the old southern familys.  

As late as 1935, a repost ordered by FDR showed that more that sevety five percent ( 75% ) of financial matters and industrial wealth belonged to northern owners. 

Before the War, folk generally identified themselves as coming from V ermont or Virginia.  After, folk called themselves Americans.  Before, the phrase was These United States.  But, after folk said as today The Unived Sates.