I'm reposting something I put in an older thread earlier today in reply to stinerman.  Wanted to see what those not in the medical field think about it.  Plus it was a lot of typing and I hate to think I did all that work without any angry replies in return :

I respect the opinion that specialist make too much.  Some things to consider --

-- Specialists have to spend more years in training earning nothing/negative or less than minimum wage.  I myself will have done 10 years after college before I will be able to take a job earning more than minimum wage.  A primary care doc is trained in 7 years while an ARNP or PA take less than half of that.

-- The pay for doctors is wildly distorted by the government.  The CMS reimbursement schedules are the baseline for most insurance carriers.  The CMS fee-for-service schedules are generally dictated by several panels, the granddaddy is the AMA's RVU update committee (RUC).  Most of the RUC is made up of specialists with primary care represented by a rotating member.

-- In comparison to fee-for-service, capitation is an alternative payment method where an organization is paid a flat fee per diagnosis/patient/etc... and the organization manages the costs themselves, keeping the difference between capitated payment and cost.  Accountable Care Organizations (ACOs) are the PPAC's version of HMOs which have the potential to be paid on a capitation schedule.  As of now, ACOs are paid fee-for-service but the ultimate goal, and a likely source of savings, is the move toward capitated payments to ACOs.  When this happens, expect specialist reimbursements to drop even more.

-- The job market for specialists is shrinking while it is expanding for primary care.  This is due to the depressed economy (which does drive medical care), rapidly falling reimbursements for specialist care, and expected changes due to PPAC as above.

So, there are several forces that drive specialist reimbursement.  In the past, their high pay was kind of built in thanks to the RUC committee and lobbying by the big specialty groups (cardiologists are the biggest and most notorious).  Their pay will continue to fall and primary care will increase.  That's ok with me though it will impact my future earnings.  My feeling is there is way too much waste in American medical care and some of it goes to specialists.  My goal is a functional and efficient medical system, that will rebuild the goodwill that physicians/providers have lost lately as well as make the country stronger. 

As I said elsewhere, a large amount of the waste comes from layers and layers of middle-men who extract money out of the system but provide little to no value.  These guys are in government, hospitals, and insurance companies, kept in business by an overly-complicated bureaucracy and fragmented insurance industry.  Unfortunately, these groups had buy-in with PPAC and so the waste will continue.  If I had my way, we'd have single payer for all and a simplified private insurance system for those who want a higher level of care.  Cut the waste, cut the middle-men.

Did I pass?

in 2016

Just wanted to note the prediction to see if it comes to fruition:

Zombie Liberal Bloggers Can Still Eat Brains
We all know that liberal blogs are dead. The obituary is written every election cycle. But we will still destroy Andrew Cuomo's candidacy in 2016.

Jessica Jung's infamous horrible 1st pitch earlier this year before a Korean league game.

ESPN didn't fact check and screwed up twice in a matter of seconds.

ESPN pronounces her surname like she's German and ESPN falsely reports that it was before a Japanese league game.  Mr FormerCornoverheiser also pronounced her surname wrong during Pardon the Interruption.

Even if an...  ummm...  inaccurate one: Thanks to the Southwest Louisiana Tea Party: a neat way to "un-elect" Barack Obama!

All it needs is a vigorous letter-writing campaign!!

No word, though, on whether an online poll would work just as well...

Cool link.

Mitt Romney's experience as a highly successful businessman gives him the acumen and know-how to turn this economy around. After all, he spent his entire career in the private sector turning failing businesses around, and what is the US of A if not a failing business? Mitt then put his Midas touch to work on the SLC Olympics, when the entire games were mired in scandal and incompetence. He also served a term as Governor of Massachussetts, and though he didn't really turn anything around there, that stint proves that he has the ability to work with Democrats to get Democrat dream legislation passed things done by working across the aisle. Obama has zero business experience, which shows why he can't turn this ailing economy around. Also, Obama has way less executive experience, unless you count four years of excellent work as President. For these reasons, Mitt Romney the business leader is far more qualified to run the country and Barack Obama the community organizer.

So why then was Mitt Romney's campaign run like an amateur-hour clusterfork? 

First example: TV ad buys. It appears that the Romney campaign routinely paid up to four times as much as the Obama campaign for the same :30 TV slots. Can anyone explain why? 

According to our source, Team Obama simply did the “due diligence to find where the lowest unit rate was,” a tedious process which “takes manpower.” Conversely, it appears Team Romney simply didn’t want bother with the hassle. So they threw money at the problem — and walked away.

Does that sound like CEO acumen to you? Does that sound like best practices by a team who knows how to make the best use of resources? Far more detailed reporting from Politico a month ago makes it sound even worse: that the Romney strategy focused on more expensive core, network programming whereas team Obama focused on cable buys to reach smaller audiences, but more focused segments of the electorate. And buy buying "preempted" slots at the 11th hour, Romney's team ensured they were paying far more per second of airtime than their rivals. In the end, it seems Obama managed to get around twice the airplay per dollar spent as the Romney team. That team, by the way, was essentially one guy running an in-house media buying operation. Obama had dozens of people doing this work -- media planning can be extremely tedious and labor intensive, but then again spending time & money on the plan tends to beat just spending lots of money on the actual buy. Ask anyone in advertising.

The CEO President made other decisions that look a lot like sloppy, amateur mistakes. Directing millions of dollars to cronies connected with his staffers, for one. 

Mitt Romney's campaign has directed $134.2 million to political firms with business ties to his senior staff, spotlighting the tightknit nature of his second presidential bid and the staggering sums being spent in this election....Ryan Williams, a Romney spokesman, said payments to firms with connections to staff members were not only for consulting, but also were used to purchase a variety of services, including "polling, video production, political mail, get-out-the-vote phones, online advertising, website development, and budget and compliance management, among other things."

For another, building a massive GOTV data engine that turned out not to work at all. Romney's staffers even bragged to the press about how awesome their evidence-based GOTV operation was going to be. Come election day, around 30,000 staffers nationwide couldn't even get the thing to work.

"The Obama campaign likes to brag about their ground operation," [Romney communications director] Gitcho said, "but it's nothing compared to this."

Truer words, etc.

Finally, of course, there's the considerable evidence that the Romney campaign was relying on "unskewed" polls for their in-house decision-making; polls that dramatically understated Democratic turnout on election day. 

Is that the kind of judgment you'd expect to see from a highly successful businessman?

to combat sea level rise.

has a GDP of about 1 trillion:

Read all about it at BarackOFraudo.com

spent a lot of time on the question of whether Obama's decisive victory in both the electoral college and the national popular vote actually gives him a mandate from the people.

The US liberal media has spent zero time on the question of whether House Republicans, who decisively lost the popular vote by more than a 1/2 million votes, and are only in power b/c the Republican party massively gerrymandered their districts, have a mandate from the people to pursue their agenda.

#stillnotliberal

http://money.cnn.com/2012/10/10/news/economy/farmers-cows-candy-feed/ind...

NEW YORK (CNNMoney) -- Cattle farmers struggling with record corn prices are feeding their cows candy instead.
That's right, candy. Cows are being fed chocolate bars, gummy worms, ice cream sprinkles, marshmallows, bits of hard candy and even powdered hot chocolate mix, according to cattle farmers, bovine nutritionists and commodities dealers.

---

Thrifty and resourceful farmers are tapping into the obscure market for cast-off food ingredients. Cut-rate byproducts of dubious value for human consumption seem to make fine fodder for cows. While corn goes for about $315 a ton, ice-cream sprinkles can be had for as little as $160 a ton.
Related: Feds offer help to drought-stricken farmers
"As the price of corn has climbed, farmers either sold off their pigs and cattle, or they found alternative feeds," said Mike Yoder, a dairy farmer in Middlebury, Ind. He feeds his 400 cows bits of candy, hot chocolate mix, crumbled cookies, breakfast cereal, trail mix, dried cranberries, orange peelings and ice cream sprinkles, which are blended into more traditional forms of feed, like hay.

NEW YORK, Nov 21 (Reuters) - New Jersey Governor Chris Christie's approval rating has leaped 19 percentage points since superstorm Sandy slammed the state, as voters by a wide margin applaud his response to the crisis, a Rutgers-Eagleton poll said on Wednesday.

The Republican governor, who will face re-election in 2013 and is considered a contender for the U.S. presidency in 2016, has a 67 percent favorability rating among registered voters in the state, up from 48 percent in October.

The boost is notable because Christie's ratings have stayed steady between 44 and 50 percent for his nearly three years in office, according to David Redlawsk, director of the Rutgers-Eagleton Poll.

"Throughout the governor's term, we've had little movement in his ratings. This just blows that out of the water," he said.

Christie, a Republican star, angered some within his party by offering strong praise for Democratic President Barack Obama's storm response in the days after Sandy and just before Election Day. Critics say Christie's praise may have helped Obama's re-election.

The poll is the second survey in as many days to show that voters had an overwhelmingly positive response to Christie's response to the storm, which devastated the New Jersey shoreline and left large swaths of the region without power.

**

Some politicians are just damned smart regardless of what other people might say...you've gotta laugh.

Best Wishes, Traveller

Don't drink anything I wouldn't drink.

Explanation here.

No, really:

"... [Thelonious Monk] is departing from convention in such a sophisticated, controlled and artistic manner ... he is threading the needle between standards and the abstract seamlessly. This is the way we should live our lives."

I'm Gobsmacked. It was in response to this fantastic album:

Nice story about it in Minneapolis's local paper.

For fans of the movie Fargo, by the way, the story takes place in the town that has a giant Paul Bunyan statue, which figured prominently in the movie's snowy drives.

The story here. "Richard Windsor" here.

I had no idea the name Operation Geronimo needed to be apologised for.  How wrong I was.  It is good that the Indian Country is fighting on this issue.