"Respect the earth, live in harmony with nature, spend time with your family, be good to your neighbor, and value the dedication, skill and care of the craftsman."
#1 daughter and I have mostly been working. I finished up the Computer Guy's jobs, we did a crash course in Analytics for #1, we worked on the accounting a little bit, and we talked a little about the possibility of her doing some graphics stuff.
We've also had conversation and restaurant meals, and we even went to T.J. Maxx and picked up a couple of things for Christmas stockings.
I hadn't been in a store since before Hallowe'en, so I hadn't realized that it's Christmas in retail. I used to work in retail, so I'd have known if I had thought about it. And, obviously, I wouldn't have gone on a Saturday. It was crowded and merchandise was all over the floor. People stood stupidly in the aisles looking as though their entire brains had gotten so fixated on whether to buy the pink one or the green one that they had simply shut down and were now unable to move. It was like that even at the impulse buy section at the cash wrap.
I'm so fortunate not to work in retail any more.
#1 daughter has been giving me lots of good advice.
This morning we're going out to the grist mill to get breakfast (restaurant meals sure add up, but #2 son and I have been planning this for a couple of weeks now and we're going to do it) and our Thanksgiving baking supplies. Then #1 daughter will head back south.
I'm still here with #1 daughter. #2 son came by suddenly last night for about three minutes on his way to an ultimate frisbee match, and that's about all I have time to write!
I skipped rehearsal last night because #1 daughter came in, and she is asleep right now in this room, so I'm not going to type any more.Great to have her.
I made it to the gym yesterday, and finished my physician owned hospital paper. It was quite eye-opening, I must say. Another of those cases in which it's easy to see one side of the story till you look at the rest of the data -- like the actual text of the law.
Here are some examples of POHs:
If you visit L.A.’s Chinatown, you might see the Pacific Alliance Medical Center – and you might wonder why there’s a statue of Joan of Arc, the patron saint of France, in front of a modern hospital in Chinatown. Built in 1868 to serve the city’s French immigrants, it became a Chinatown landmark in the 20th century. After 129 years of continuous service, the French Hospital was facing bankruptcy, and ready to close down. The move would have left the Chinatown neighborhood (a neighborhood of about a million people, many living in poverty) with no full-service hospital. In 1989, a group of forty Chinese doctors and businesspeople took a risk and raised enough money to save the hospital. Through the dedicated support of the people of the community and of the brave doctors who took that risk, PAMC is now a five star hospital.
Dunbar Memorial Hospital in Detroit was founded in 1918 by African-American doctors frustrated by the fact that so few Detroit hospitals allowed African-Americans. In the entire city, only one hospital accepted African-American patients, and that hospital had only 25 beds. African-Americans died at twice the rate of white residents of Detroit at that time, and the presence of Dunbar Memorial could spell the difference between life and death. Dunbar Memorial is now a museum.
St. Joseph’s Medical Center was Houston’s first hospital, built at the end of the 19th century. At the turn of this century, failing financially after 122 years in business, it was put up for sale. Analysts feared that the hospital, the main source of health care for the poor of Houston, would only be of interest to buyers who wanted downtown property on the cheap, and that its days of service as a hospital were over. St. Joseph’s was rescued by its doctors. The only downtown Houston hospital, St. Joseph’s covers everything from mental health care to cardiac surgery, and has delivered one third of all the babies born in Houston.
True, these are just a few examples, but there are only a couple hundred POHs in the country, and there are so many examples like these. Doctors have opened hospitals because they want to give good care and feel frustrated with the way the hospitals they work at are administered.
Doctor owners at POHs typically own about 3% of the hospital, and those hospitals often lose money. Sometimes they're profitable, though. The average is a 13% profit. In my field, a 25% profit is considered good. So we're not usually talking about people getting rich -- particularly since we're so often talking about surgeons. They're already rich. The difference to their incomes isn't significant, and those who've been asked have expressed how offended they are by the suggestion that they'd ignore the good of their patients for the sake of a few extra dollars.
The law itself is bizarre, too.This may be the result of its being the work of a committee.
I also taught class, wrote blogs, and went to choir and bells. Today is an all writing day, with rehearsal this evening.
Yesterday began with a nice walk. Then I had a whole day -- nearly uninterrupted -- of writing. I really enjoyed it.
I had a couple of exciting moments. First, there was the website I was sent to edit which turned out to be entirely stolen. Yep, the client had snitched whole paragraphs of content from a variety of competitors. Fortunately it's agency work, so I don't have to deal with the client directly, but I'm making a mental note not to trust those guys with my money.
The question is unlikely to arise, I know. Right now, I'm waiting for payments to come in so I can pay #2 son's tuition. I don't expect to need a financial advisor any time soon.
The next bit of excitement was a contact through my website from a major educational product company. I had to restrain myself from gushing about how I used to sell their stuff! That exclamation point is to show how I would have gushed, not to emphasize my restraint. I totally can fix their web site, too, and I really hope they choose me.
I did also have a call from another agency yesterday, and we got as far as "How do we proceed now?" and "You'll be hearing from me soon." And then this morning I had a request to interview from a new agency that describes itself as "a disruptive force." I think I'd quite like to work for a disruptive force.
But perhaps the most exciting bit was one of the topics I wrote about. Really, I like all the topics I was writing about. I wrote someone a very nice website yesterday, and I love the process of coming up with ways to say what they want to say that really fit their goals, and the character of their business, and their target audience. It's a great pleasure. But I'm working right now on 2500 words about a political issue, something I don't get to do very often, and it turns out to be very interesting.
It's about physician-owned hospitals, or POHs. Some of the POHs have come about because inner-city hospitals were being torn down by cash-strapped cities, so the doctors who worked there banded together to save the hospital. You could make a movie out of that. Some have been built by doctors who were frustrated with the level of care they were able to give at corporate-owned hospitals, and making their own hospitals allowed them to provide the kind of health care they thought their patients deserved.
Some, no doubt, were built by groups of doctors who felt that they could make more money if they got not only their fees, but also some of the profits of the hospital itself. And it it this capitalist attitude that has -- perhaps -- led to a bill which is designed to run PHOs out of business.
There are two main arguments against PHOs. The first is that the level of care they provide is inadequate, that they are out to make a quick buck and therefore they push expensive procedures onto patients who don't need them, that they put profits first, etc.
Consumer Reports, an organization I trust, just brought out a report ranking hospitals throughout the U.S. In 19 states, the top-ranked hospital is a POH. In my state, the top two are PHOs, and four of the top seven are. Since there are only about 225 PHOs in the nation, this is not the kind of result you'd expect. The PHO in our capital city, which doesn't even have a million residents, is not just #1 in the state, but is ranked in the top 5% of the nation by Health Grades, an independent organization.
And, since much of this first argument is about for-profit vs. nonprofit hospitals, it's worth noting that relatively few hospitals nowadays are nonprofits. We have some charity hospitals in our state, run by religious organizations, but most belong to corporate chains. Even many of our city hospitals are managed by corporate chains on a for-profit basis. In Sacramento, a city which looked into this question, 95% of the hospital beds belong to six corporations. So the PHOs aren't in competition with government hospitals.
That, however, is the second concern. PHOs, the story goes, will cherry-pick (or skim the cream -- pick your favorite metaphor) the healthier, wealthier patients, leaving the charity cases and the Medicare patients for the public hospitals. This is of course the same argument we've heard for years about public vs. private schools.
The Congressional Budget Office, however, was quite frank about their thinking on this. In areas with PHOs, they noticed, it was more common for people to have orthopedic and cardiac surgery. By closing down PHOs, forbidding their expansion, or limiting their ability to accept Medicare, they hope to avoid paying for such expensive treatments for Medicare patients. That is the source of the savings they're predicting: Medicare patients won't get expensive procedures.
I don't see why they didn't just say that they'll no longer pay for cardiac and orthopedic surgery (it's a long list, actually, but those were the examples in the letter) for Medicare patients. Possibly they felt that such a law might make them look heartless.
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