Contempo Magazine Blog

The administration had a 10.6 % physician fee cut that would have taken effect on July 1st but now is in question. The House of Representatives passed a bill that would hold off on the physician pay cuts for 1 and 1/2 years by taking money from funds used to pay private insurers for those Medicare recipients who go with a privately run plan instead of regular Medicare. Apparently other types of providers like physical therapists will still see cuts. Congress recessed for the July 4th holiday with the Senate in turmoil about what to do. The Bush Administration has threatened a veto because of the private option cuts but is giving doctors a 10 day freeze on Medicare rates to see if a compromise can be carried out according to Paul Kane at the Washington Post.

Budget deficits, expensive technology, the “graying” of America, the shrinking workforce and increasing retirement population all play a role in our evolving health care crisis. It was reported in 2005 by National Public Radio that the fastest growing age group in our country was people over age 85. The reality is that we can not continue to spend the same amount of money per person that we are now and things must change. The Board of Trustees for Medicare and Social Security reported in The New York Times that Medicare would go broke by 2019. They recommended that the FICA or payroll tax be doubled from 2.9% to 6.4% just for the plan to survive in addition to the combined premiums paid by enrollees averaging over $500 per month.

There is been some concern in the press that doctors will stop seeing Medicare patients due to the cuts. Most doctors who treat Medicare patients do not really have an option since their specialties really depend upon elderly patients. This will however create more pressure on them to spend less time with patients and avoid complicated cases.

Fifteen to twenty years ago overhead costs were not really important to doctors but not so today. Office rent, employee salary, malpractice insurance, equipment (both medical and office) have all been going up steadily while reimbursement per patient contact has consistently declined. The depth of experience and sophisticated training required of many doctor’s office employees demands that they be paid high salaries that would surprise the general public.

The majority of employees in the doctor’s office deal not with patient care but with records and billing. Medicare requires keeping detailed exacting records and following meticulous extensive processes to get paid. Doctors and their employees must regularly attend courses on the government’s coding systems and employ expensive computer systems to send in their billing. Despite the so-called clarity that should occur by using universal coding language and speedy electronic submission, it still happens that claim after claim must be resubmitted time after time till it eventually gets paid. The government continues to believe that fraud and “bad billing” occurs in the billions of dollars so it keeps the pressure on providers to prove necessity and document treatment. Off the record, an acquaintance familiar with FBI practice told me that the FBI got involved in Medicare billing fraud cases because they get $2 dollars back for every dollar they spend in investigation.

The system is clearly broken and needs to be scraped. The economic model of individual practitioners having separate practices will no longer work. I have to admit this was predicted by Dr. Arnold Relman, Professor at Harvard Medical School and Editor for the New England Journal of Medicine, when I was a student there so many years ago. Each doctor paying for his own staff, waiting room, billing equipment and the government overseeing hundreds of thousands of individual practices is wasting valuable resources on administration costs rather that patient care. But this will also mean that individual care will likely become more of team concept; that having “Marcus Welby, M.D.” always ready to drop whatever he is doing and personally attend to his patients will become just a television memory.

To make medicine more economically efficient there will need to ultimately be large scale consolidation of medical practices. Organized medicine in all specialties has made great strides in moving towards guidelines of treatment which help in health care quality and planning assessment.

The huge beast of private insurer inquisition which functions not only for its own benefit but also secondarily draws enormous administrative funds out of Medicare needs to be tamed. Health care CEO’s are reporting bonuses in the millions of dollars as are their health insurance companies which are “running” private Medicare programs.

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The venerable wind mill which ran a water pump from a well to feed cattle was a common sight in Texas for over a hundred years. Today there are wind farms in mostly the western part of the state. Concerns about potential damage to flocks of rare migratory birds like the Whooping Crane have lead to environmental objections to wind farms in central and eastern Texas. At least one commercial enterprise, H.E.B., has plans to build a wind power generator in Weslaco, Texas.
Most of the technological and commercial development of wind power has centered on building farms of wind power generators with sometimes hundreds of turrets. On the other hand the development of home wind power is less developed.To power a typical household of 10,000 kwH generally requires two blades with a 20 foot diameter on a tower approaching 100 feet in height with an average wind speed of 12 miles per hour. Most systems will have a battery storage system as a backup for when there are winds below energy producing velocities.

At this point the cost of building a single wind power generator at home is still relatively expensive. Our research indicates costs would be around $16,ooo at least. The conversion of wind power to electricity in small home versions is not nearly as effective as the larger commercial units found on wind farms.

To effectively capture the winds energy, the blades are best placed on towers which can be as high as 500 feet off the ground. Wind turbines low to the ground or on roof tops may not get enough wind to function properly. Most cities require fallways for towers which means the tower might have to be a larger lot then most residences.
In addition, the tower might not be allowed due to proximity of an airport. Most wind towers if allowed would require constant flashing lights. So most single towers for home use are usually found in rural settings.

Wind farms have been criticized by some as being noisy. The American Wind Energy Association reports that they generate about 35 to 45 decibels of sound. Unfortunately, because home turbines are smaller and rotate at higher speeds than their commercial counterparts they can actually generate more noise.

Future developments in technology may might make urban home wind energy harnessment more feasible.

As July 4^th approaches many folks in the Rio Grande Valley will once again be out celebrating with fireworks. Unfortunately all across the country emergency care centers will be standing by for the inevitable fun night out that turns into a potential tragedy. In fact, it is likely that someone reading this article will be affected.

According to the Centers for Disease Control almost 10,000 people a year are treated for fire-work related injuries and another ten or more will die. One third of all injuries occur to children less than 15 years of age. About ½ of the injured are males under the age of twenty.

Injuries occur most commonly to the hands, eyes, face, and ears. Blindness, third degree burns, and scarring may occur even with treatment.

Firecrackers and bottle-rockets account for the majority of injuries except in small children where sparklers are the offender. Illegally obtained large professional firecrackers were responsible for 1/3 of deaths.

The best way to prevent fireworks injuries is to leave it to the professionals. It is much better to attend a professional fireworks show which is usually more spectacular than risk losing your life or that of a loved one at home.

Using fireworks at home is dangerous. Small children and fireworks are a bad combination. Curiosity may draw their face too close to the firework causing a facial burn or igniting their clothing. Bottle rockets may fly in unexpected directions causing permanent eye injuries or worse. Home made fireworks are unpredictable and are a leading cause of injury.

Remember that a bottle rocket that goes astray into a vehicle or home causing a fire can be considered a criminal act. More than $21 million dollars damage was done in this manner in 2004. Parents of minors can be held legally liable for the acts of their children in causing property damage or injury from fireworks.

Contempo recommends you check with your local city for the time and place of a professional fireworks display rather risking your family’s health.

In the video below you can see how dangerous illegal fireworks can be. Go to Contempo Magazine Home Page