Wal-Mart Plans to End Extra Pay for Sunday Shifts

so...who makes this decision?

what does a write off look like?

Call insanity a medical condition or whatever you want...this guy was never going to contribute to society and never going to take care of himself and there is no reason tax dollars should be spent caring for him in a hospital.

Who makes the decision? Simple, if you don't have insurance, the decision is made for you. As I said, I would be willing to have government provide some interim relief (much the way unemployment works - you can't collect unemployment your whole life) but not life-time relief. Plan and simple - some people just have to be written off.

what does write off mean?

why can't you say it?

What do you plan to do when those crazy peopel you write off start pushing people in front of trains? Either you pay to support them through medical care, or you pay to support them in prison.

But downtown, you;re making it sound like the only problem is slackers and homeless cases mooching off the system. Actually, even the long time employed with modest income can often not afford health insurance (and certainly can't afford out of pocket for anything major)...so what happens? Until we address costs , this system will remain a mess.

downtown, write people off and just see what happens to our crime rate (particularly if you manage to articulate the position). it's amazing how many people don't have health insurance in our oh so advanced country.

everyone should have medical insurance. your life or death shouldn't depend on lucky or unlucky circumstances.

I agree - costs must be addressed. There are a number ways to do that. One is tort reform. There are too many crazy judgments driving up costs. In addition to doctor's running unnecessary tests and procedures, malpractice insurance premiums are out of control. For example, there is, in my opinion, no reason a family of an infant who died at child birth should get millions of dollars (absent really gross negligence or willful misconduct). Call me heartless, but if the infant was alive for an hour/day/week, the damages should be minimal. Sometimes, bad things just happen and it isn't anybody's fault.

Another issue is end-of-life care. I'm not proposing where to draw the line, but at some point, people must be told no. An obvious example - an 80 year person with terminal lung cancer should not be given anything more than care to keep him/her comfortable and reduce the pain. Now, I recognize that are a lot of other cases that fall short of that and somebody will have to make a decision. We can all debate where to draw the line, but as medical science advances, it is easier and easier to keep somebody alive but with little quality of life.

One way to make healthcare more affordable is to offer insurance plans that covers things like emergencies and routine care but does not provide certain coverages. In such a situation the plan might say that if you get certain illness or disease that costs a lot to cure/fix and the chances of success are low or moderate, it isn't covered. Basically, if you want to pay for insurance that will allow you to demand every single experimental, high-cost treatment plan out there, that's fine. Many people won't be able to afford that will have to do without. Quite simply, medical science is providing more and more options and not everybody can or should be able to take advantage of all of it.

I also believe that obese people and smokers should pay more. Obesity and smoking are two ways to almost guaranty that your medical costs will be higher and insurance premiums need to reflect that.

blah blah blah.

who's going to decide who dies?

or, as you put it.

who's going to decide who gets written off?

Columbiacounty - Let me ask you the same question - who is going to pay for it? Are you saying that a homeless person should get the same quality of care as a Bill Gates? Unless the answer is no, you essentially agree with me - choices need to be made and those choices, unfortunately have consequences.

we are going to pay for it. as best we can. i am not prepared to make this decision. i am willing to pay for it.

apparently you are neither willing to pay for it nor willing to make the decision.

nor willing to talk in anything but euphemisms.

blah blah blah

"There are a number ways to do that. One is tort reform. There are too many crazy judgments driving up costs."

Nice try. Classic Republican talking point. Tort reform would only save 0.5%

http://washingtonindependent.com/63471/cbo-tort-reform-would-cut-health-spending-by-0-2

downtown, you have no clue. tort reform? the plaintiff's bar has largely been eviscerated for such claims.

the real issue is that insurance companies, now mostly subsidiaries of large banking companies such as citigroup, have been making an asston from health care insurance. back in the day, not so long ago, health care costs weren't so huge. just think about what has changed. has it become easier to recover in a tort lawsuit? no. have premiums gone through the f'ng roof? has your gp or im received an increase in pay in the last few years? probably not.

http://cbo.gov/ftpdocs/106xx/doc10641/10-09-Tort_Reform.pdf

What exactly is it about a homeless person that makes him eligible for a lower level of care than a Bill Gates? Should fundamental resources be allocated based on income, weight, wealth, height, looks, attire, what?

What do you think would happen to patentable product-oriented medical research if only the rich could afford the resulting products, rather than a broad base of consumers?

And who is your death panel?

"One way to make healthcare more affordable is to offer insurance plans that covers things like emergencies and routine care but does not provide certain coverages."

That's a great idea, just as long as you do not plan on getting any illness not covered by your policy.

"Another issue is end-of-life care. I'm not proposing where to draw the line, but at some point, people must be told no."

So you want death panels?

I don't believe that tort reform would save only 0.5%. Who do you think pays for those multi-million judgments?

And nobody has answered my question - who is going to pay for these treatments and how are you going to reduce costs?

I already said i am not willing to pay for it and have no problem telling some people "no" - you can't have medical care. Haven't you read what I'm saying - some people simply need to be denied care. What you are saying is that there should be an unlimited budget for sick people, even those who don't contribute to society.

Many states have already enacted tort reform and health care is no cheaper in those states than in states without it. Texas is one of the most notable states with tort reform. Yet Texas has the HIGHEST percentage of uninsured people than any other state.

i answered it.

we all are going to pay.

are you going to stand in the emergency room and decide who lives and who dies?

And to summarize the tort reform piece The_President linked, malpractice judgements amount to the tiniest little spit in the bucket of healthcare costs in this country ... approaching zero.

Your opinions are based on emotions/ideology and not on facts. And you seem oddly unable to see yourself in the position of needed basic care and not being able to afford it ... do you think that homeless man was always homeless?

Explain the quid pro quo of medical treatment and "contributing to society", as you phrase what amounts to blatant self-interest.

"I don't believe that tort reform would save only 0.5%. Who do you think pays for those multi-million judgments?"

So you know better than the Congressional Budget Office? Yeah, sure you do.

"how are you going to reduce costs?"

SINGLE PAYER

Just an FYI: I have 6 docotrs in my family. They admit to me they do BS tests all the time, but not because they are afraid of being sued. They do them because the more tests they do, the smarter they look in the eyes of the patient and, most importantly, more $$$ for them. Enact tort reform tomorrow and they would still do all of the same tests.

so you think the multi-million judgements have increased over the past 15 years? that's my point. they haven't. tort costs have decreased (percentage-wise), yet health care costs have skyrocketed. the amounts of money that have been given to investment banks for health care costs have skyrocketed.

who owns cigna? you don't have a clue.

I seriously doubt if that CBO number covers the effect of over-testing, over-cautious medicine which is the result of the litigation culture that has arisen. This is something that needs to be addressed, and tort reform is one part of the answer (not to mention that the whole thing is so sleazy so often that it's just morally wrong).

No one is claimiong that tort reform alone solves the problem, but it is clearly an important factor in health care costs in this country.

Over testing occurs because it means more money for doctors. NOt because of they are fearful of lawsuits.

Cigna? Dunno. But I know Senator Bill Frist & family own one of the largest chains of hospitals in the US.

Maybe THE largest.

Profiting greatly from Medicaid, Medicare, Big Insurance, etc.

If you want to know why healthc are costs are expensive, just ask Rick Soctt. He paid a $1.7 billion fine for Medicare fraud and he is currently serving 4 years.... as governor of Florida.

buyerbuyer, i think that there was a culture of acquiring too much in terms of machinery for many hospitals. they just overbought hugely. i think everyone should have reasonable access to certain equipment, but certainly not every hospital needed to purchase all the bells and whistles machinery.

it was a period of medical exuberance, kind of like our re exuberance. they thought they would have plenty of customers, and they didn't anticipate the additional level of cost insurance companies would add. i don't know if the excessive testing would have occurred without the need to keep the facilities alive because they had overspent on capital improvements. very circular thinking, but i think you get what i'm after.

and if you've spent way too much, you may be spending way too much to pay for it. but that's not all of the us, and probably not much of NYC at all.

http://en.wikipedia.org/wiki/Hospital_Corporation_of_America

buyerbuyer, i don't think you have any idea how much medical tort claims have been reduced. really.

it had zero to do with our increased med costs. tort costs have hugely decreased as a percentage of money over the past couple of decades. the amount of money your insurance company wants to make you pay, both for premiums and for other expenses, has probably increased more than 100-1000%. well more.

It is a myth that huge tort awards are pervasive. What is pervasive is that malpractice insurers are trading on the "feeling" that there a lot of those awards. It allows them to jack up premium sky high. We need insurance company reform, not tort reform.

Can we not get on this tangent again?

As a Canadian/Brit-whatever, I have the hard task of assuring non-Americans that physicians here aren't being sued 24/7, and that my family is getting okay healthcare w/o being bankrupted.
As an American-whatever, I have the equally hard task of telling Americans that no, death panels don't really exist elsewhere in Western socialized systems, and that, yes, it's spectacularly pleasant not to have to worry about bankrupt caused by a broken leg.

"the real issue is that insurance companies, now mostly subsidiaries of large banking companies such as citigroup"

Wrong. Citi sold Travelers. BofA is selling (or has sold) Balboa. No major US bank owns an insurance company - there is very little in common between banks and insurance companies, except some insurance products (life insurance) do carry investments.

Malpractice is a problem, but most go nowhere. Try taking health insurance companies' antitrust exemptions away from them, and turn them back into mutuals, instead of for-profit companies. They started out as mutuals, but you'll note that as they have turned into for-profit ventures, rates have skyrocketed.

Socialized medicine works.

steve, they were owned by the banks during most of the period of hugely increasing premiums.

i used to have bc/bs before it was for-profit. sigh.

Having done a little quick internet research about, yes I see what you're saying about the reduction of tort claims, and no, I was not aware of that. I never thought tort reform alone is a huge element of health care reform, but I support it on its own merits (granted it is a very complex issue in terms of actual implementation). The scope of the secondary impact on defensive medicine may we be very large (I tend to think it is, but this is hard to measure).

Health care reform is a huge issue, way beyond the scope of this forum, but in my view until we address costs nothing is going to work very well. Before we go to single payer, I'd like to see legislation breaking the link to employer provided plans, and allowing more competition across state lines, with a federal minimum bare bones mandate...or something along those lines. Perhaps American ingenuity could make a market oriented system work -- but we haven't really tried yet. If it won't work, let's go to government clinics like many countries have, and let the rich pay for after hours services of the better doctors, if they wish. Somehow or other, we need coverage for everyone.

"allowing more competition across state lines"

Sounds nice, but it's a ploy & a race to the bottom: whichever state has the least regulation & allows for the lowest benefits wins. Insurance companies can currently compete across state lines - they don't want to because every state has 1 or 2 main providers, who can operate as virtual monopolies. Sort of like when they opened local phone service to competition: Bell South didn't invade Verizon territory because they didn't want the competition the other way around.

No market system works for health insurance: it's your life, so you're willing to have anyone else (the insurance company) spend all the money they can to save you. There are people in vegetative states on Medicare that Medicare continues to pay solely because the relatives don't want the person to die.

Well, if you've been in a coma for 25 years, the chances are....

steve...what do you mean insurance companies can compete now across state lines? i can't buy insurance at a company in maryland and live in nyc....also, i mentioned a federal minimum mandate for coverage?...

Tort reform would help reduce costs because it would reduce lots of costly defensive medical practices. aboutready never addresses that because her more limited view is better for her position. She changes facts to suit her theories rather than develop theories based on facts.

The best way to make health care more affordable and accessible sure is not Obamacare. The best way would be to end the employer-based tax credit and provide individual credits for purchasing insurance, tort reform, and more competition, with government subsidies for the very small percentage of the population that may be uninsurable.

wsj on across state lines issue:

"Competition" has become a watchword of Team Obama's push for its health-care bill. Specifically, the Administration has defended its public insurance option as a necessary competitive goad to the private health insurance industry.

Health and Human Services Secretary Kathleen Sebelius routinely calls for more choice and competition in health care. In his weekly address this past weekend, President Obama raised the issue directly: "The source of a lot of these fears about government-run health care is confusion over what's called the public option. This is one idea among many to provide more competition and choice, especially in the many places around the country where just one insurer thoroughly dominates the marketplace." We take it this refers to a state in which one insurer holds most of the business.

It is no secret that this page is all for competition in the marketplace. If indeed that's the goal, allow us to suggest a path to it that will be a lot easier than erecting the impossible dream of a public option: Let insurance companies sell health-care policies across state lines.

This excellent idea has been before Congress since at least 2005, when Rep. John Shadegg of Arizona proposed it. It came up again recently in an exchange between Chris Wallace of Fox News Sunday and John Rother, executive vice president of AARP.

Mr. Wallace: "If you really want competition why not remove the restriction which now says that if I live in Washington, D.C. I've got to buy a D.C. health plan, and instead create a national market for health insurance, so that if there's a cheaper plan in Pennsylvania, I could buy in Pennsylvania?"

Mr. Rother: "There are states and localities where health care is much less expensive than others, and if we allow people to buy all their insurance from those places, it will raise the rates there. And it's called risk selection. It's a real problem, given the fact that health care costs can vary substantially from one place to another. So I think while the idea sounds appealing, the consequence would be it would make health care more expensive for those people who live in those low-cost areas."

How did Mr. Rother arrive at this conclusion?

His claim assumes that what makes insurance expensive in places like New Jersey—where the annual cost of an individual plan for a 25-year-old male in 2006 was $5,880—is merely the higher cost of medical services in the Garden State. He sounds an alarm in the rest of the country by suggesting that an individual living in, say, Kentucky—where an annual plan for a 25-year-old male cost less than $1,000 in 2006—would be asked to subsidize plan members living in high-priced states.

That's not how interstate insurance would work. Devon Herrick, a senior fellow with the National Center for Policy Analysis who has written extensively on this subject, notes that insurance companies operating nationally would compete nationally. The reason a Kentucky plan written for an individual from New Jersey would save the New Jerseyan money is that New Jersey is highly regulated, with costly mandated benefits and guaranteed access to insurance.

Affordability would improve if consumers could escape states where each policy is loaded with mandates. "If consumers do not want expensive 'Cadillac' health plans that pay for acupuncture, fertility treatments or hairpieces, they could buy from insurers in a state that does not mandate such benefits," Mr. Herrick has written.

A 2008 publication "Consumer Response to a National Marketplace in Individual Insurance," (Parente et al., University of Minnesota) estimated that if individuals in New Jersey could buy health insurance in a national market, 49% more New Jerseyans in the individual and small-group market would have coverage. Competition among states would produce a more rational regulatory environment in all states.

This doesn't mean sick people who have kept up their coverage but are more difficult to insure would be left out. Congressman Shadegg advocates government funding for high-risk pools, noting that their numbers are tiny. The big benefit would come from a market supply of affordable insurance.

Mr. Rother also said "risk selection" is a problem. But the coverage mandates cause that. As more healthy people opt out of health insurance because it is too expensive relative to what they consume, the pool transforms into a group of older, sicker people. Prices go higher still and more healthy people flee. High-mandate states are in what experts call an "adverse selection death spiral."

Interstate competition made the U.S. one of the world's most efficient, consumer driven markets. But health insurance is a glaring exception. When the competition caucus in Team Obama has to look for Plan B, this is it.

LICcomm: "it would reduce lots of costly defensive medical practices" ... PROVE IT.

You've already heard, second hand, from doctors saying that they overtest for reasons other than tort liability. Do you think, then, that they perform unnecessary procedures for tort liability reasons? Do you think at all?

Anyway, prove all of what you're postulating, or concede that it's ideological cart-before-horse nonsense.

"with government subsidies for the very small percentage of the population that may be uninsurable"

Which is anybody who's sick. Why should we subsidize insurance companies? Just get rid of them. In healthcare, they provide no value-added. It's a broken model that never worked to begin with.

i simply don't get it.

tell me who goes to a doctor and says, hey i've got (blank) pain. examine me and if you can't figure out what's going on, lets call it a day because i don't want any tests that might be unnecessary.

i'll be back in two months if the (blank) persists and hopefully won't discover that its something horrible.

the tort smokescreen has been debunked over and over--the cost of malpractice is nuttin in the big picture--and nuttin compared to what gets siphoned off to the insurance companies, who only impede good efficient care

that there has been any benefit to anyone from our private health insurance system, other than those in the insurance company executive suites and owners, is one of the best run con jobs in history---kudos to the insurers, their lobbyists, pr people and their bought politicians

Defensive medicine is a fact -- the debate is about whether it is significant, or whether tort reform would decrease it if it is significant (to some extent, it has become a cultural issue in the way we do health care). Alan, of course no one can exactly identify it, but using anecdotal evidence as if that proves tests are generated by the avarice of doctors, is not "proof" either.

So then if "no one can exactly identify it", how is defensive medicine "a fact"?

Alan -- it's just silly to say "there is no defensive medicine because you can't quantify it." Come on.

I think there are legitimate issues on both sides of this health care debate -- something is very very wrong with the current system -- but disingenuous grossly overstating a case, or declaring everything else nonsense is not a debate.

"Defensive medicine" is not "a fact": what is a fact is that doctors get paid for each procedure and test they perform, so they perform a lot. That is the part of the model that's broken.

For instance, I get paid by the number of words I type. Ergo, do you think I type "don't" or "do not"?

I get 12 cents for the first one, and 24 for the second.

The country's distribution of Walmart stores:

http://www.nytimes.com/interactive/2010/12/10/opinion/20101210_Disunion_SlaveryMap.html

Enlightening.

http://www.thesmokinggun.com/documents/walmart-employee-cookie-bust-784512

FEBRUARY 21--Walmart is pressing a felony charge against a 63-year-old worker who has been accused of stealing a bag of Oreo cookies from the Indiana store where she worked on the maintenance crew.

Penny Winters was arrested this week after Walmart launched an internal investigation upon the discovery of an empty cookie wrapper. A subsequent review of surveillance footage showed “Ms. Winters select the package of cookies, open it, and proceed to consume multiple cookies during her work shift,” according to a Portage Police Department report.

Cops did not estimate the value of the “multiple cookies” consumed by Winters, who has been fired from her $11.40 position with the retail giant.

When confronted by a Walmart “asset protection manager,” Winters admitted taking the Oreos, adding that she had also helped herself to other snacks during her seven-month tenure at the store (Winters had previously worked for several years at a Walmart in Arizona).

Winters, seen in the above mug shot, told the Walmart investigator that she “simply did not have the monies to legitimately purchase the food items."

When cops asked her about the Oreos, Winters claimed she found an open package of the cookies near a cash register and assumed that they had been provided for free by management.

Winters was arrested Monday and charged with felony theft for pinching the Oreos (and other unspecified junk food). Winters was released from the Porter County jail Tuesday after posting bond. (2 pages)

Oh yes, Porter County, Indiana, I was looking at one of the new developments there but I decided to rent instead for the next year.

i thought felony theft would have to be over a certain amount? shouldn't it be a misdemeanor?

And this is why I believe in the death penalty.

>And this is why I believe in the death penalty.

Agree, there needs to be some repurcussion for posting about an Oreo theft in Indiana on a New York real estate board, or else we will encourage more of this.

His posting does shed some light on the poor quality of life in the Riverside Boulevard New Territories and Indiana and places similar to those, so in this case Riversider should be allowed to live.