Monday, December 21, 2009

Online Doctor help

.... from Bangalore ?

Well, this technology, if eventually accepted, will quickly revert to using overseas physicians.

And this is the beginning of the end for American physicians just as using overseas workers was the beginning of the end for high tech jobs here.

Congress is now taking over the national health-care system and they are looking to slash high costs and wastes and programs like this claim to decrease costs. It will be embraced by the national health care provider.

Doctor's earning power will decrease significantly over time time and job openings dwindle just as it has for information technology workers.

How much of doctor visits concern mundane things like sniffles and fever? A great deal.

Add doctors to the list of professions you don't want your children to pursue.

Will anyone in the US profit from this? The large firms that provide this service will make a bundle.

Another indication that soon all jobs that can be done overseas WILL be done overseas.

December 21, 2009

The Virtual Visit May Expand Access to Doctors

SAN FRANCISCO — Americans could soon be able to see a doctor without getting out of bed, in a modern-day version of the house call that takes place over the Web.

OptumHealth, a division of UnitedHealth Group, the nation’s largest health insurer, plans to offer NowClinic, a service that connects patients and doctors using video chat, nationwide next year. It is introducing it state by state, starting with Texas, but not without resistance from state medical associations.

OptumHealth believes NowClinic will improve health care by ameliorating some of the stresses on the system today, like wasted time dealing with appointments and insurance claims, a shortage of primary care physicians and limited access to care for many patients.

But some doctors worry that the quality of care that patients receive will suffer if physicians neglect one of the most basic elements of health care: a physical exam.

“This is a pale imitation of a doctor visit,” said David Himmelstein, a primary care doctor and associate professor at Harvard Medical School. “It’s basically saying, ‘We’re going to give up any pretense of examining the patient and most of the nonverbal clues that doctors use.’ ”

Others, including Rashid Bashshur, director of telemedicine at the University of Michigan Health System, say online medicine is a less expensive way of providing routine care.

“The argument that you need the ‘laying on of hands’ to practice medicine is an old and tired argument that simply has no credibility,” he said. “There are two constants in medicine: change and resistance to change.”

Christopher Crow, a family physician in Plano, Tex., who used the system during its test period, said, “NowClinic gives you the ability to have that gut feel if something is wrong, in tone or facial expression or body language, that you have when you walk in the door with a patient.”

Many patients who do not have primary care physicians nearby use the emergency room for routine problems. Wait times for patients needing immediate attention have increased 40 percent, in part because of overcrowding, according to a study by Harvard Medical School and Cambridge Health Alliance.

In Texas, 180 counties do not have enough physicians, 70 percent of patients cannot obtain a same-day visit with their primary care doctor, and 79 percent of emergency room visits are for routine problems, according to OptumHealth.

“We are, through this technology, replenishing the pool of physicians and making them available to patients,” said Roy Schoenberg, chief executive of American Well, which created the system that OptumHealth is using.

For $45, anyone in Texas can use NowClinic, whether or not they are insured, by visiting Doctors hold 10-minute appointments and can file prescriptions, except for controlled substances. Eventually they will be able to view patients’ medical histories if they are available.

The introduction of NowClinic will be the first time that online care has been available nationwide, regardless of insurance coverage.

American Well’s service is also available to patients in Hawaii and Minnesota, through Blue Cross Blue Shield, and to some members of the military seeking mental health care, through TriWest Healthcare Alliance.

Some hospitals and technology companies provide similar services on a smaller scale, including Cisco, the networking equipment maker, which uses its videoconferencing technology to remotely connect employees with doctors. It is working with UnitedHealth Group to offer the service more broadly.

The service has encountered resistance in states where it is already available. Texas law requires that before doctors consult with patients or prescribe medicine online or over the phone, they form a relationship through means like a physical examination.

The Texas Medical Board, which regulates doctors in the state, is evaluating its telemedicine policies in light of new technologies. But Mari Robinson, executive director of the board, said that an online or telephone exam was inadequate if doctors and patients had not met in person and was “not allowed under our rules.”

After American Well’s service began in Hawaii last year, lawmakers passed legislation that allowed doctors and patients to establish a relationship online, though the Hawaii Medical Association opposed the bill.

“From our perspective, we still are a little bit concerned that a relationship can be established online with no prior relationship,” said April Troutman Donahue, the association’s executive director.

American Well and OptumHealth predict that health care professionals will adapt. “This is new technology, so you have a lot of code written that doesn’t take these medical technologies into account,” said Rob Webb, chief executive of OptumHealth Care Solutions.

Many patients seem ready to embrace the new technology. In a recent study, a Harvard research team at Beth Israel Deaconess Medical Center found that patients were comfortable with computers playing a central role in their health care and expected that the Web would substitute for face-to-face doctor visits for routine health problems.

Keeping Foreign Labor out

The open border USA?

Not quite.

How about India, one of the very countries that has exported labor to the US over the past 15 years, allowing it to become an 'economic miracle' :

Vietnam and India are among the nations that have moved to impose new labor rules for foreign companies and restrict the number of Chinese workers allowed to enter, straining relations with Beijing.

December 21, 2009
Uneasy Engagement

China’s Export of Labor Faces Scorn

TRUNG SON, Vietnam — It seemed as if this village in northern Vietnam had struck gold when a Chinese and a Japanese company arrived to jointly build a coal-fired power plant. Thousands of jobs would start flowing in, or so the residents hoped.

Four years later, the Haiphong Thermal Power Plant is nearing completion. But only a few hundred Vietnamese ever got jobs. Most of the workers were Chinese, about 1,500 at the peak. Hundreds of them are still here, toiling by day on the dusty construction site and cloistered at night in dingy dormitories.

“The Chinese workers overwhelm the Vietnamese workers here,” said Nguyen Thai Bang, 29, a Vietnamese electrician.

China, famous for its export of cheap goods, is increasingly known for shipping out cheap labor. These global migrants often work in factories or on Chinese-run construction and engineering projects, though the range of jobs is astonishing: from planting flowers in the Netherlands to doing secretarial tasks in Singapore to herding cows in Mongolia — even delivering newspapers in the Middle East.

But a backlash against them has grown. Across Asia and Africa, episodes of protest and violence against Chinese workers have flared. Vietnam and India are among the nations that have moved to impose new labor rules for foreign companies and restrict the number of Chinese workers allowed to enter, straining relations with Beijing.

In Vietnam, dissidents and intellectuals are using the issue of Chinese labor to challenge the ruling Communist Party. A lawyer sued Prime Minister Nguyen Tan Dung over his approval of a Chinese bauxite mining project, and the National Assembly is questioning top officials over Chinese contracts, unusual moves in this authoritarian state.

Chinese workers continue to follow China’s state-owned construction companies as they win bids abroad to build power plants, factories, railroads, highways, subway lines and stadiums. From January to October 2009, Chinese companies completed $58 billion of projects, a 33 percent increase over the same period in 2008, according to the Chinese Ministry of Commerce.

From Angola to Uzbekistan, Iran to Indonesia, some 740,000 Chinese workers were abroad at the end of 2008, with 58 percent sent out last year alone, the Commerce Ministry said. The number going abroad this year is on track to roughly match that rate. The workers are hired in China, either directly by Chinese enterprises or by Chinese labor agencies that place the workers; there are 500 operational licensed agencies and many illegal ones.

Chinese executives say that Chinese workers are not always less expensive, but that they tend to be more skilled and easier to manage than local workers. “Whether you’re talking about the social benefits or economic benefits to the countries receiving the workers, the countries have had very good things to say about the Chinese workers and their skills,” said Diao Chunhe, director of the China International Contractors Association, a government organization in Beijing.

But in some countries, local residents accuse the Chinese of stealing jobs, staying on illegally and isolating themselves by building bubble worlds that replicate life in China.

“There are entire Chinese villages now,” said Pham Chi Lan, former executive vice president of the Vietnam Chamber of Commerce and Industry. “We’ve never seen such a practice on projects done by companies from other countries.”

At this construction site northeast of the port city of Haiphong, an entire Chinese world has sprung up: four walled dormitory compounds, restaurants with Chinese signs advertising dumplings and fried rice, currency exchanges, so-called massage parlors — even a sign on the site itself that says “Guangxi Road,” referring to the province that most of the workers call home.

One night, eight workers in blue uniforms sat in a cramped restaurant that had been opened by a man from Guangxi at the request of the project’s main subcontractor, Guangxi Power Construction Company. Their faces were flushed from drinking Chinese rice wine. “I was sent here, and I’m fulfilling my patriotic duty,” said Lin Dengji, 52.

Such scenes can set off anxieties in Vietnam, which prides itself on resisting Chinese domination, starting with its break from Chinese rule in the 10th century. The countries fought a border war in 1979 and are still engaged in a sovereignty dispute in the South China Sea.

Vietnamese are all too aware of the economic juggernaut to their north. Vietnam had a $10 billion trade deficit with China last year. In July, a senior official in Vietnam’s Ministry of Public Security said that 35,000 Chinese workers were in Vietnam, according to Tuoi Tre, a progressive newspaper. The announcement shocked many Vietnamese.

“The Chinese economic presence in Vietnam is deeper, more far-reaching and progressing faster than people realize,” said Le Dang Doanh, an economist in Hanoi who advised the preceding prime minister.

Conflict has broken out between Vietnamese and Chinese laborers. In Thanh Hoa Province in June, a drunk Chinese worker from a cement plant traded blows with the husband of a Vietnamese shopkeeper. The Chinese man then returned with 200 co-workers, igniting a brawl, according to Vietnamese news reports.

One reason for the tensions, economists say, is that there are plenty of unemployed or underemployed people in this country of 87 million. Vietnam itself exports cheap labor; a half-million Vietnamese are working abroad, according to a newspaper published by the Vietnam General Confederation of Labor.

Populist anger erupted this year over a contract given by the Vietnamese government to the Aluminum Corporation of China to mine bauxite, one of Vietnam’s most valuable natural resources, using Chinese workers. Dissidents, intellectuals and environmental advocates protested. Gen. Vo Nguyen Giap, the 98-year-old retired military leader, wrote three open letters criticizing the Chinese presence to Vietnamese party leaders.

No other government in the world so closely resembles that of China as Vietnam’s, from the structure of the Communist Party to economic policies and media controls. Vietnamese leaders make great efforts to ensure that China-Vietnam relations appear smooth. So over the summer, the central government shut down critical blogs, detained dissidents and ordered Vietnamese newspapers to cease reporting on Chinese labor and the bauxite issue.

But in a nod to public pressure, the government also tightened visa and work permit requirements for Chinese and deported 182 Chinese laborers from a cement plant in June, saying they were working illegally.

Vietnam generally bans the import of unskilled workers from abroad and requires foreign contractors to hire its citizens to do civil works, though that rule is sometimes violated by Chinese companies — bribes can persuade officials to look the other way, Chinese executives say.

At the Haiphong power plant, the Vietnamese company that owns the project grew anxious this year about the slow pace of work. It sided with the Chinese managers in pushing government officials to allow the import of more unskilled workers.

The Chinese here are sequestered in ramshackle dorm rooms and segregated by profession: welders and electricians and crane operators.

A poem written on a wooden door testifies to the rootless nature of their lives: “We’re all people floating around in the world. We meet each other, but we never really get to know each other.”

Wednesday, December 16, 2009

Federal running of Medicare

... and they want to use this 'expertise' to run ALL healthcare .

Note the very last paragraph that shows the expertise and efficiency of the current Medicare program and how it is managed by the Federal Gov't :

The raids came a week after a report that Miami-Dade County got more than half a billion dollars from Medicare in home health care payments intended for the sickest patients in 2008, more than the rest of the country combined, even though only 2 percent of those patients nationwide live there.

December 16, 2009

26 Arrested in Three States in Medicare Fraud Schemes

FORT LAUDERDALE, Fla. (AP) — Federal agents arrested 26 suspects in three states on Tuesday, including a doctor and nurses, in a crackdown on Medicare fraud totaling $61 million.

Arrests in three separate cases in Brooklyn, Detroit and Miami included a Florida doctor accused of running a $40 million home health care scheme that falsely listed patients as blind diabetics so he could bill for twice-daily nurse visits.

The Department of Justice and the Department of Health and Human Services said 32 indicted suspects lined up bogus patients and otherwise billed Medicare for unnecessary medical equipment, physical therapy and infusions for H.I.V.

The doctor in Miami, Dr. Fred E. Dweck, along with 14 people with whom he worked, was accused in an indictment of running a scam to tap a Medicare program that pays high rates to care for the sickest patients.

Dr. Dweck referred about 1,250 Medicare beneficiaries for expensive and unnecessary home health and therapy services, the indictment said, and bribed the owners of two clinics in Miami to join the scam. He also faked medical certifications, according to the indictment.

A telephone listing for Dr. Dweck could not be found.

Also arrested in Miami was Yudel Cayro, owner of Courtesy Medical Group. He is accused of stealing millions of dollars from Medicare.

“No matter what type of fraud is committed, there is one common denominator and that denominator is greed,” said Lanny Breuer, an assistant attorney general. “Medicare fraud is not a victimless crime. It hurts every American taxpayer by raising the cost of health care.”

The raids came a week after a report that Miami-Dade County got more than half a billion dollars from Medicare in home health care payments intended for the sickest patients in 2008, more than the rest of the country combined, even though only 2 percent of those patients nationwide live there.


A feel good story.

Finally many 'victims' of predatory lending are getting the relief they 'deserve'.

At the bottom of the article they discuss the case of Rosie Brooks.

She bout her house for $38,000 so the mortgage was originally less than this. She then used her house as an ATM, she ' ....had refinanced the loan a couple of times..' , so that eventually her mortgage had swelled to $42,000.

So what does she get for this behavior ? 'The bank forgave her entire debt in exchange for a one-time payment of just $3,000.'

So this is a feel good story?

Well , for these fortunate few no doubt.

Not so for the vast majority of mortgage holders who did not get involved with the re-mortgage-a-round ride of the last 10 years.

I have not re-mortgaged my house numerous times, but I would like some 'relief' from my mortgage payments also.

Fat chance.

They system rewards the abusers. And those who stay the straight-and-narrow actually pay for the abusers, i.e. the bank gets the money to 'forgive' from other depositers and honest loan keepers.

Extreme modifications: 2% mortgages

By Les Christie, staff writer

NEW YORK ( -- At 8 a.m., homeowner Rodney Wynn was drowning under his $1,800-per-month, 13.4% interest rate mortgage. But by 5 p.m., he had found some relief: a 4.7% loan with a $970 monthly payment.

Wynn, a program director for a youth home in North Carolina, is just one of a growing number of homeowners getting dream workouts on their mortgages. Some are even getting sweet 2% deals.

Rosie Brooks had her $48,000 mortgage forgiven in exchange for a one-time $3,000 payment.

Nearly 80% of all loan modifications resulted in lower payments in the second quarter (the latest figures available), according to the Office of the Comptroller of the Currency (OCC) and the Office of Thrift Supervision. That's up from just over 50% three months earlier. Still, just a paltry 4% of all homeowners in need of workouts are receiving them.

When loans are made affordable, borrowers are less likely to default. A year after modifications, according to the OCC report, just 34% of borrowers whose loan payments had been reduced 20% or more had redefaulted compared with 63% of borrowers whose payments had been left unchanged.

"We're hearing there's a lot more give from lenders," said Rick Sharga, a spokesman for RealtyTrac, the online marketer of foreclosed properties. "It often makes sense for the banks to take anything they can get."

Wynn was able to get his modification at a "Save the Dream" event offered by the Neighborhood Assistance Corporation of America (NACA) in New York City last Friday.

Lenders from nearly all the major banks and servicers were in attendance and promising to restructure loans based on what borrowers could afford. As a result, many homeowners walked in with their mortgage problems and walked out with solutions.

In fact, according to Bruce Marks, NACA's founder, 40% of attendees left with decisions the same day. About 80% are expected to receive workouts within weeks. His organization has already hosted about 400,000 borrowers at more than a dozen of these events.

The most common restructuring seemed to be one that reduced interest rates to the minimum of 2% for the entire life of the loan. That's partially because NACA has agreements with all the top lenders to reduce interest rates to as low as 2% if that's what it takes to make loans affordable.

For example, Californians Steve and Elena Servi received a 2% fixed-rate loan from Wells Fargo that replaced the 6.75% adjustable rate mortgage on their Rowland Heights house.

"We had a jumbo loan and we thought no one would work with us," said Elena.

But it's in the bank's self interest to salvage deals -- even if it means slashing payments -- because the alternative, foreclosure, can cost them more.

"We're getting a lot of borrowers looking for a better interest rate," said Jason Ferebee, a Wells Fargo Community Relations exec who was supervising his company's operation at the NACA event.

He explained that his auditors send each applicant through a kind of flow chart, or "waterfall" as he called it, of possible fixes. It starts with seeing if they fit the guidelines for a Home Affordable Modification Program (HAMP) workout. If borrowers don't qualify, then the bank will go through a series of its own programs, ticking down the list to more radical cuts until they reach one that's affordable for the borrower.

At that point, the lender then decides whether it's more profitable to offer that workout or take the borrower to foreclosure. Most times these days, they try harder to make the modification work; foreclosures are simply too costly.

In the case of the Servis, their house had lost perhaps 40% of its value since they purchased it five years ago. Repossessing the home would have cost Wells Fargo more than $100,000 in lost value alone, plus the legal expenses, commissions, taxes and other expenses the bank would have incurred.

"I'd say we restructure loans for close to half the borrowers we see here," said Ferebee.

But wait, there's more

More severely stressed borrowers in many hard-hit areas have gotten even more radical deals. There are even some who are having their debts forgiven entirely.

"The interest rates they're offering [delinquent borrowers] are a lot lower than they used to be," said Tanya Davis, a foreclosure prevention counselor for Empowering and Strengthening Ohio's People (ESOP) in Cleveland. "They cut them to 0% for three years, then 2% for a year, then 4%, capping out at 5%. I have a case where they lowered the interest rate to zero for the entire life of the loan."

Lenders are very reluctant to repossess properties in the worst hit parts of cities such as Cleveland, according to Jim Rokakis, treasurer of Cuyahoga County, where Cleveland is located. "Rather than going to a sheriff's sale, some banks are just giving back the houses," he said.

Rosie Brooks, a retired hairdresser, has been paying off her house for more than 20 years, but it hasn't been easy since one of her daughters came down with leukemia 10 years ago.

"She was very sick and that cost me every dollar I had," she said. "I got behind."

She had paid $38,000 for the house and had refinanced the loan a couple of times. By last year, her mortgage balance was more than $42,000. She no longer works and is dependant on Social Security. The payments became impossible to afford.

She contacted ESOP, and her counselor, Scott Rose, knew her lender was unusually sympathetic. Three weeks later, Rose was able to tell Brooks that he had gotten her a workout -- and it was a real dream.

The bank forgave her entire debt in exchange for a one-time payment of just $3,000, which Rose was able to obtain through a loan from the county's foreclosure-prevention program.

Why was the bank so generous?

"To some extent, there an altruistic component to it," said Rose. "Mostly though, it's because it's in the bank's financial interest." To top of page