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July 31st, 2015

7/31/2015

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Thanks for coming back each day----I sometimes get caught in all day conferences!


If we do not protect human rights then injustice comes to us all.  That is what is happening now as those left with no rights are being used to take away all rights.  Please think how easy it is to work for equity for all when you have Rule of Law protecting you rather than watch Rule of Law and Equal Protection being dismantled and then having to fight to get it back.  WE THE PEOPLE CAN STOP THIS SLIDE INTO AUTOCRA
CY!


Progressive liberals protect labor and justice----that is the Democratic platform.  Clinton neo-liberals do not ---they work for wealth and profit---GET THEM OUT OF THE PEOPLE'S DEMOCRATIC PARTY!

The Department of Labor, Licensing, and Regulation DLLR is the tool to protect labor and consumers.  The fact that these agencies are dismantled is what drives the systemic fraud and corruption against consumers----and the reason workers are being abused and exploited.  Maryland is supposedly a Democratic state----they even try to make it sound progressive yet it has absolutely NO DLLR.  When we rebuild these agencies citizens do not have their disposable income stolen and they consume more driving the local economy.  IT IS BASIC ECONOMIC POLICY HAVING MONEY TO SPEND DRIVES AN ECONOMY.  To create an economy of thievery====creates a stagnant economy.  Whether Republican or Democratic voter----stop allowing race and class take away that stable and thriving first world economy by allowing the rich to become super-rich.  They want people to believe that deregulation creates jobs but it does the opposite.


About the Department of Labor, Licensing and Regulation

      Mission Statement:
The Maryland Department of Labor, Licensing and Regulation (DLLR) is committed to safeguarding and protecting Marylanders. We're proud to support the economic stability of the state by providing businesses, the workforce and the consuming public

with high quality customer-focused regulatory, employment and training services.   Vision Statement:
The Maryland Department of Labor, Licensing and Regulation (DLLR) continues to change Maryland for the better by providing a predictable and inclusive regulatory environment through efficient and responsive processes. DLLR safeguards Maryland's work environments through outreach and educational programs, by establishing partnerships and encouraging ongoing improvements in workplace safety and health. We're fostering economic growth through our collaborative, comprehensive employment and job training programs that best ensure Maryland workers have the skills Maryland employers need to succeed and grow into the future. Our vision for Maryland dri
ves the work of the Department’s employees each and every day.

I am focusing on immigrant labor this week but all the protection of all labor is the same.  Rawlings-Blake of Baltimore and Governor O'Malley of Maryland actually advertized around the nation for immigrants to come to Maryland ---they are welcome and immigrants came.  A REAL progressive does not bring immigrants to a state just to exploit them and progressives do not do so when unemployment is soaring---especially in Baltimore.  We protect immigrants now here while ending the flow until Marylander's have REAL full employment.  Remember, we can have a thriving economy employing both immigrant and domestic labor--global pols simply need to create competition for resources.  Below you see our Federal government and media are lying about economic upturns and 5.8% employment and as the comment below states---they are moving the US to a third world shadow, black market economy for most citizens as has been the case in Baltimore.  This assures people cannot climb a social ladder and are always trying to undermine the next person causing derision.  THIS IS THE GOAL OF CLINTON NEO-LIBERALS AND BUSH NEO-CONS IN IGNORING RULE OF LAW. 

Do not believe the stats of 5.8% unemployment---that does not include the long-term unemployed at record numbers and neo-liberals and neo-cons have no intention of employing Americans in any number.  Women and people of color are hurt the most-----but all Americans will be brought to poverty if you keep electing these same global pols that see the US as a third world economic colony!



January 14, 2014

Who Is Dropping Out Of The Labor Force, and Why?

By Diana Furchtgott-Roth
Although many economic indicators are heading in a positive direction, last week's December jobs report highlighted the problem of the declining labor force participation rate, the percentage of people aged 16 and over who choose to work or look for work.

The labor force participation rate moved back to 62.8 percent from its November level of 63 percent. In 2007, before the recession, 66 percent of Americans were in the labor force. Today's levels are equivalent to 1978, before the Reagan Revolution and the movement of women into the labor force during the 1980s
.



'But it yet another sign that the formal economy  is utterly failing to create enough
for everyone'.


The $2 trillion shadow economy is the recession’s big winner


By Brad Plumer April 23, 2013


In this week's New Yorker, James Surowiecki considers one theory for the recent and drastic decline in the U.S. labor force. More and more Americans might be working off the books, in informal jobs that aren't counted by statistical agencies:

Psst, want a job? Bernard Baumohl, an economist at the Economic Outlook Group, estimates that, based on historical patterns, current retail sales are actually what you’d expect if the unemployment rate were around five or six per cent, rather than the 7.6 per cent we’re stuck with. The difference, he argues, probably reflects workers migrating into the shadow econom
y.

“It’s typical that during recessions people work on the side while collecting unemployment,” Baumohl told me. “But the severity of the recession and the profound weakness of this recovery may mean that a lot more people have entered the underground economy, and have had to stay there longer."

This "underground economy" could include anything from illicit activities — selling drugs, say — to off-the-books jobs in things like construction. There are plenty of examples of the latter: Bloomberg recently interviewed an unemployed woman who walks neighborhood children to their bus for $2 per kid. Surowiecki cites a study finding that "between eighty and ninety-seven per cent of nannies were paid under the table." And so on.

But those are anecdotes. Is there any hard data on the underground economy? Some. A 2011 paper (pdf) Richard Cebula and Edgar Feige estimated that as much as “18-19 percent of total reportable income is not properly reported to the IRS." That's as much as $2 trillion in underground economic activity, with about $500 billion in taxes that aren't being paid to the government.

And here's another suggestive piece of evidence that the shadow economy has been growing during the downturn. The amount of U.S. currency in circulation has been soaring in the last six years, from $803 billion in 2007 to $1.18 trillion in March. Some of that reflects growing overseas demand for dollars. But some of it could reflect growth in unreported economic activity in the United States — people getting paid under the table in cash, say.

If the shadow economy is in fact growing, that has upsides and downsides. It's certainly a good thing that people are finding ways to survive during a brutal downturn. But it yet another sign that the formal economy  is utterly failing to create enough
for everyone.


________________________________________
Already New York City and San Francisco are seeing huge slums of immigrant workers brought to the US thinking they would have a better life but instead simply living as they did in that third world nation.  Baltimore City has been allowed to reach a third world level of poverty all in the effort of erasing what it is like to have a quality of life and developing the culture of criminal and corruption as a norm in corporations and businesses.  If your Baltimore City Hall comes from that kind of poverty---they will work with Baltimore Development and Johns Hopkins in fleecing the working and middle-class.

Trans Pacific Trade Pact seeks to allow global corporations to bring these third world citizens to US to work as they do in those nations so we are seeing Americans being forced to survive under the same black market conditions and the percentages of Americans doing so is soaring.  Remember, in autocratic societies 90% of people live in poverty and the people hired as administrators to government come from that culture and care little for human life.  It is bad for the immigrant brought to live in the US under the same conditions in their nation and it is bad for Americans being forced to live like these immigrants.

THIS IS WHAT CAUSES ALL THE VIOLENCE IN BALTIMORE CITY AND IT IS DELIBERATE.

Allowing the poor to afford TVs allows autocratic governments to keep people in-tuned to what wealth buys and to aspire for what people will not be able to attain as is happening with inner city kids wanting Michael Jordan tennis shoes.

India Slums: 1 In 6 Indian City Dwellers Live In Conditions 'Unfit For Human Habitation'

 |  By KAY JOHNSON Posted: 03/22/2013 9:10 am EDT Updated: 05/22/2013 5:12 am EDT



MUMBAI, India — About one in six Indian city residents lives in an urban slum with unsanitary conditions that are "unfit for human habitation," according to the first complete census of India's vast slum population.

More than 40 percent of households in Mumbai, India's financial capital and largest city with 19 million people, are located in overcrowded shantytowns where most residents are squatting illegally and many have little access to basic sanitation.

While the report described open sewers and poverty, it also shows that many slum residents have cellphones and televisions in their shacks and have made do with a lack of government infrastructure by rigging up elaborate, mostly illegal, systems to supply electricity.

Life in Mumbai's slums has been portrayed in the Oscar-winning film "Slumdog Millionaire" and last year's bestselling book "Behind the Beautiful Forevers," but until now India has never had a complete census of its slum dwellers.


There was an incomplete head count in 2001 that only included the country's largest slums. In the 2011 census, survey takers took pains to visit every shantytown – they counted 108,000 of them – and also made detailed records of their lives, according to the report Thursday by census commissioner C. Chandramouli. Detailed information from India's latest census is still trickling out.

The census report identified 13.8 million households – about 64 million people – located in city slums nationwide. That's 17.4 percent of all urban households, which account for roughly one-third of India's 1.2 billion people
.

"A slum, for the purpose of census, has been defined as residential areas where dwellings are unfit for human habitation by reasons of dilapidation, overcrowding ... lack of ventilation, light or sanitation facility," Chandramouli said.

New Delhi, the Indian capital, had a relatively low 15 percent of households in slums, while major cities Kolkata and Chennai had 30 percent and 29 percent respectively. High-tech center Bangalore had only 9 percent of its households in slums.

Nationwide, more than one-third of slum homes surveyed had no indoor toilets and 64 percent were not connected to sewerage systems.

About half of the households lived in only one room or shared with another family.

However, 70 percent had televisions and 64 percent had cellphon
es. That's about the same cellphone ownership rate as the general urban population and only slightly less than the number of general city dwellers with televisions.

____________________________________________
Even the gains Hispanics already in the US have made are disappearing and they are already falling to the level of Asian immigrants working the harshest conditions so this current move to bring immigrants from all developing nations will even lower the already deep poverty Hispanic immigrants in America face.  There will be a high-skilled tier of immigrants in the short term taking American middle-class jobs-----but that tier will soon disappear and even those higher paid immigrants will revert to what they earn in third world nations taking American workers with them.  The cycle has any worker gaining power and rights get beaten back with another group brought in with fresh hopes----so do not allow these corporate pols pose progressive with immigration policies that are market-based.

THIS IS THE GOAL OF GLOBAL POLS AND IMMIGRATION POLICY SO YOU SEE IT IS BAD FOR BOTH IMMIGRANTS AND US WORKERS.

Limiting this kind of immigration as we work to reinstate Rule of Law and get US workers back in the workforce is the progressive thing to do!

In a Shift, Biggest Wave of Migrants Is Now Asian


By KIRK SEMPLEJUNE 18, 2012


  Asians have surpassed Hispanics as the largest wave of new immigrants to the United States, pushing the population of Asian descent to a record 18.2 million and helping to make Asians the fastest-growing racial group in the country, according to a study released Tuesday by the Pew Research Center.

While Asian immigration has increased slightly in recent years, the shift in ranking is largely attributable to the sharp decline in Hispanic immigration, the study said.


About 430,000 Asians — or 36 percent of all new immigrants, legal and illegal — moved to the United States in 2010, compared with 370,000 Hispanics, or 31 percent of all new arrivals, the study said. Just three years earlier, the ratio was reversed: about 390,000 Asians immigrated in 2007, compared with 540,000 Hispanics.

“Asians have become the largest stream of new immigrants to the U.S. — and, thus, the latest leading actors in this great American drama” of immigration, Paul Taylor, executive vice president of the Pew Research Center, wrote in the report.



Immigration scholars have attributed the decrease in Hispanic immigration to a mix of factors, including the economic downturn in the United States, increased deportation and border enforcement by the American authorities, and declining birthrates in Mexico.

Tougher enforcement measures have made a greater impact on the Hispanic immigrant population than on the Asian immigrant population because a much higher percentage of Hispanics are in the United States without immigration papers,
experts said. About 45 percent of Hispanic immigrants in the United States are here illegally compared with about 13 percent to 15 percent of Asian immigrants, Pew demographers found.


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July 28th, 2015

7/28/2015

0 Comments

 
As  I say all the time, Clinton neo-liberals deliberately took control of the people's party to Wall Street and in the process posed progressive while dismantling all that was progressive liberalism.  So, when a Clinton neo-liberal poses progressive with a market-based Immigration Reform tied to Trans Pacific Trade Pact by making the major group of immigrants already in the US-----the Hispanic undocumented----come out to support a bill that will kill they and all workers in the US----that is lying, cheating, and stealing elections.  This is how Clinton neo-liberals have won for a few decades---saying what labor and justice wants to hear and then ignoring them.  Neo-liberals make clear they are not going to support labor and justice when they write and embrace with Executive Order the Federalism Act and when they push TPP.  So, we know all these laws they are pushing just before an election is all progressive posing. 

Real progressives have a hard time these days because we must support labor and justice and that means we protect the unemployed American workers and the immigrant workers.  Believe it or not both can and will be done by REAL progressives.  Today I want to address what is a divide on the issue of Immigration policy -----the status and Rule of Law of immigrant vs illegal alien.
  My friend David calls me on this all the time.


If you do not see the chaos and instability occurring in Latin America as fitting this Displaced Persons Act-----and see our Hispanic and Latino refugees as immigrants and not illegal aliens----then you will soon feel how injustice for one becomes injustice for all!

*****************************************************************

1948 Displaced Persons Act


(An act to authorize for a limited period of time the admission into the United States of certain European displaced pe...rsons for permanent residence, and for other purposes)

S. 224; Pub.L. 80-774; 62 Stat. 1009.

80th Congress; June 25, 1948.

You can find the full text of this law here and here or download the PDF.

SUMMARY

This act helped those individuals who were victims of persecution by the Nazi government or who were fleeing persecution, and someone who could not go back to their country because of fear of persecution based on race, religion or political opinions. This act dealt directly with Germany, Austria, and Italy, the French sector of either Berlin or Vienna or the American or British Zone and a native of Czechoslovakia. These individuals were granted permanent residency and employment without making someone give up their current job. The displaced person could bring their family with them as long as they were “good” citizens who could stay out of jail and provide financially for themselves without public assistance. The spouse and children under twenty one is eligible for permanent residency. A child who was under the age of sixteen who became an orphan because their parents either went missing or died would also be cared for by the U.S. Two thousand visas were to be granted for those who qualified as a displaced person. If someone was in the U.S. prior to April 1, 1948 they could apply to the Attorney General to overlook their status to possibly become a permanent resident.


********************************************

We have a flood of African immigrants coming to the shores of Italy to escape the wars in Northern Africa.  No work, no food-----they are refugees.  We have off and on a flood of immigrants from Caribbean Islands when despots become brutal and warring against their people.  These are Haitian or Dominican refugees and immigrants.  The Palestinians for decades have become refugees and immigrants around the world due to the Palestinian-Israel conflict.  In all those cases these refugees for the most part are allowed to enter -----often allowed to disperse and integrate throughout the Middle-East---throughout Europe---throughout the US. 

The numbers of Hispanics fleeing the same conditions as above and coming to the US is greater and that is what creates this concern as to whether we should categorize them as refugees from what we all know is US-led interventions in South and Central America and Mexico meant to destabilize those nations so the US can control them.  It is clear as well the US destabilizes just so these Latino/Hispanic citizens will have to come to the US to be safe and find work and they do that to exploit these citizens as cheap labor.  Now, do we call people who meet the definition of refugee ----illegal aliens----that is the dilemma for REAL progressives.  It is the numbers of refugees that make Hispanics fall in a different category---and it is because Americans vote for these globalists---neo-cons and neo-liberals bent on creating instability for their own gain that we have this problem.


IF PEOPLE OF COLOR IN THE US WOULD LOOK AT THE INSTABILITY AND VIOLENCE IN CITIES CREATED BY THESE SAME PEOPLE FOR THE SAME REASONS----YOU WOULD SEE THESE LATINO/HISPANICS ARE NOT THE PROBLEM---


The instability caused by gangs of color----fighting for resources is the same thing as described above for the world's refugees and it is done for the same reasons----to keep people from organizing and gaining power.





June 27, 2014


Destabiliziation in Latin America


by Matt Peppe


News from the AP about the U.S. government’s secret project to create a Cuban Twitter or “ZunZuneo,” to be used for disseminating propaganda and fomenting unrest in Cuba, spurring young people in that country to overthrow their government, comes as no surprise to anyone with even the most cursory understanding of U.S. policy in Cuba and Latin America in general. It is but a tiny part of a 55-year-old, completely unprovoked, genocidal policy against a nation whose only offense is failing to subordinate itself to the will of the U.S. government.

ZunZuneo was initiated and run by the ostensibly “humanitarian” U.S. Agency for International Development through a series of shell corporations which were not supposed to be traced back to the government. The project is typical of the type of subversion and interference with another nation that the U.S. government has always felt entitled to undertake, regardless of the principles of sovereignty and self-determination fundamental to international law.

Due to Cuba’s successful revolution in 1959 and their ongoing ability to resist U.S. subversion of their socioeconomic system, U.S. actions against the tiny nation in the Carribean have been harsher than any other victim who fails to recognize the U.S. as its rightful master. Early destabilization efforts included a vicious campaign of terrorism against Cuba, part of a massive CIA effort that later evolved into a policy of providing safe haven to terrorist exile groups and looking the other way as they violate the U.S. Neutrality Act and international law.

The largest act of subversion is, of course, the blockade, euphemistically known in the U.S. as an “embargo.” The U.S. blockade against Cuba has now lasted more than a half century as a punishment for Cuba achieving self-determination. The blockade is an act of warfare, as it is based on the Trading with the Enemy Act of 1917 (TWEA), which is only applicable during times of war. The blockade has been expanded and strengthened over the years with various violations of international law such as the Helms-Burton Act and the Torricelli Act. The policy of the U.S. blockade has been found to be an illegal violation of international law for 22 straight years by 99% of the world’s nations, who have demanded its end.

The attempted subversion of a country’s political system is not unique to U.S. actions against Cuba, nor is it unique to USAID. Other U.S. government agencies, such as the National Endowment for Democracy (NED), have long carried out similar actions. Such organizations purport to be apolitical groups for “democratic” promotion but are in reality nothing more than fronts, essentially political action committees (PACs). Due to the concealment of their purpose, they are more like political slush funds used to advanced the perceived interest of the United States.

Of course, they are not used to promote American “values” or “humanitarian principles” with abstract names like “freedom” and “democracy”, but the interests of the corporate sector eager to seek new investment opportunities outside their own country and control over the resources that they refuse to recognize as the property of local populations.

For example, over the last 15 years in Venezuela the U.S. spent $90 million funding opposition groups, including $5 million in the current federal budget. During this time, since Hugo Chavez first assumed office, his revolutionary party has won 18 elections and lost only 1. The margins of victory during Chavez’s tenure reached higher than 20%. After his death, his hand-picked successor Nicolás Maduro won by a margin of 1.6% in 2012. This is a very narrow margin, to be sure, but as Dan Kovalik points out it is a margin of victory larger than JFK’s victory over Richard Nixon and certainly larger than George Bush’s victory over Al Gore. Bush actually lost the popular vote but was declared the winner by the Supreme Court in an instance of political mettling that would be hard to imagine in any other democracy in the world.

Despite the success of the Chavista party, the opposition, aided and abetted by the U.S. government, has tried to portray the elections as “questionable” or “illegitimate”. Secretary of State John Kerry led the way by calling for a recount, encouraging the opposition to challenge the results of the election and refuse to concede.

“Washington’s efforts to de-legitimise the election mark a significant escalation of US efforts at regime change in Venezuela,” wrote Mark Weisbrot. “Not since its involvement in the 2002 military coup has the US government done this much to promote open conflict in Venezuela… It amounted to telling the government of Venezuela what was necessary to make their elections legitimate.”

In fact, international organizations monitoring the Venezuelan Presidential vote attested to the “fair and transparent” election process and former President Jimmy Carter called the country’s electoral system “the best in the world.”

The U.S. government has also refused to recognize the vast advances social progress made under the current government. Under Chavez, the country drastically reduced poverty, especially extreme poverty, with the latter falling from 23.4% in 1999 to 8.5% in 2011. As the government has put its massive revenues from oil sales to use to provide universal education and health care for all Venezuela’s citizens, people traditionally shut out of the country’s economic gains have benefited tremendously. Venezuela has gone from one of the highest rates of income inequality in Latin America to the lowest, a truly Herculean accomplishment.

Yet this does not even factor into the U.S.’s policy toward Venezuela. As a cable published by Wikileaks from 2006 demonstrates, the U.S. policy of destabilization and regime change against Hugo Chavez was pursued until his death. Now, with the perceived weakness of Maduro and the propaganda value of violent street protests portrayed in the international media as a “student movement”, it seems that Kerry is like a shark who smells blood in the water when he slanderously proclaims a “terror campaign” and foments further unrest.

U.S. government officials must feel frustrated at their inability to project their will for Venezuela to be subservient to the United States. After all, it has proved much easier in countries such as Honduras to oust a democratically elected President as happened with Manuel Zelaya.

“Zelaya was initiating such dangerous measures as a rise in minimum wage in a country where 60 percent live in poverty. He had to go,” wrote Noam Chomsky, who goes on to note that the U.S. virtually alone in the world in recognizing the “elections” later held under military rule of Pepe Lobo. “The endorsement also preserved the use of Honduras’ Palmerola air base, increasingly valuable as the U.S. military is being driven out of most of Latin America.”

Unsurprisingly, four years after the coup a Center for Economic and Policy Research report finds that “much of the economic and social progress experienced from 2006 – 2009 has been reversed in the years since,” with “economic inequality in Honduras” rising “dramatically.”

The next success of Obama’s administration in Latin America was the coup in Paraguay, in which the right-wing, elite opposition was able to drive democratically-elected Fernando Lugo from the Presidency and thus stop his program of promoting land rights for a long-oppressed peasant population.

“The United States promotes the interests of the wealthy of these mostly-poor countries, and in turn, these elite-run countries are obedient to the pro-corporate foreign policy of the United States,” writes Shamus Cooke.

There was also the coup last year against the progressive former mayor of Bogotá, Colombia, Gustavo Petro. His supposed abuse of power was de-privatizing garbage collection in the capital city, which allegedly harmed the “freedom of free enterprise.” The anti-democratic actions in Colombia, a beneficiary of an enormous amount of U.S. aid, have not affected the U.S. policy toward the nation. Kovalik notes that the actions taken against Petro are part of a much larger pattern.

“While the press, as well as the U.S. government, will not acknowledge it, the elimination of progressive political leaders by coup d’ état is taking place in Latin America with increasing frequency,” Kovalik writes.

Of course this is part of long-standing U.S. policy that has destroyed democracies in countries such as Guatemala, Chile, Brazil, Argentina and many other nations since the end of WWII alone. The anti-democratic measures enabled and supported by the U.S. have taken decades to recover from, if the nations victimized have been able to recover at all.

Media reporting of the story has tended to downplay or apologize for the Cuban Twitter program by stressing the U.S. government denials that it was meant to overthrow the government, or it was beneficial in allowing Cubans to communicate with each other.

Not surprisingly, Cubans themselves do not see it this way. They understandably do not appreciate an underhanded attempt to collect their personal data or to use them as pawns in a political game.

This should be a reasonable position for any American to understand. Would you support China or Russia setting up a social network meant to overthrow your government to impose one more to their liking? Certainly not. The plot in the fictitious House of Cards of infiltration of the U.S. political process by foreign money probably seems shocking to the average American. In this country, it is a crime for foreign countries or nationals to influence democracy and domestic affairs through political contributions.In reality, this is exactly what the U.S. government has carried out in foreign countries for decades. ZunZuneo is demonstrable proof they continue to do so to this day. ZunZuneo is not just a case of USAID and the U.S. government getting caught with their hand in the cookie jar. It is part of an ongoing assault against sovereignty and self-determination of any country who opposes U.S. foreign policy. People of these countries are just as smart, capable, and deserving of a government independent of outside interference as U.S. citizens are.By simply recognizing that their government has no business in determining another country’s political affairs, and demanding that their government stop spending their tax dollars to do so, U.S. citizens could do more to advance democracy and the ideals their country claims to stand for than the U.S. government has ever done.

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You know you do not have Democrats in control of the Democratic Party when no one shouts that the Clintons are the face of all this misery in both Latin America and in the US cities.  THAT IS WHAT GLOBALISTS DO----INSTILL MISERY TO GAIN POWER AND WEALTH.  That is what makes neo-liberals Republicans because Republicans are that party of corporate power and wealth.

Bush's policies in Columbia, South America under the guise of War on Drugs was the same as the Bush invasion of Iraq and Afghanistan----Bush wanted to disperse the drug cartels throughout Latin America just as he wanted to disperse the Taliban and Al Queda throughout the Muslim world----to create instability and a reason for the US to send in operatives.  THAT IS THE FOREIGN POLICY OF GLOBALISTS IN A NUTSHELL.  Now Obama is using asymmetric warfare on Al-Queda in all Muslim nations causing all kinds of instability.  The Columbia drug cartels moved from that one nation to all over South and Central America giving the US a reason to send operatives and creating decades of instability-----THAT IS GLOBALIST STRATEGY.

Then Republicans moved to take control of the Democratic Party in the US and sent Clinton in as a posing progressive and the first thing Clinton did----NAFTA, deregulation, and global markets that placed Bush's globalism on steroids.  It is NAFTA that killed Mexico's economy and impoverished Mexican citizens and Clinton's mid-west BIG AG that killed small farmers----Mexico's major agrarian system that fed and kept Mexico stable.  They did that to destabilize Mexico in order to move immigrants into the US to work cheap.  This is why we had the flood these few decades. 

Lastly, this flood of immigrants created much of the instability in employment in the US cities at the same time Clinton and Republicans attacked US social programs sending people of color in cities into desperation and crime and violence. 

THESE ARE ALL POLITICAL STRATEGIES AND BUSH NEO-CONS AND CLINTON NEO-LIBERALS ARE DOING IN THE US TODAY WHAT THEY HAVE BEEN DOING OVERSEAS FOR MORE THAN A CENTURY.  THEY ARE BRINGING IT HOME TO DESTABILIZE THE US AND AMERICAN PEOPLE.


‘Flee or die’: violence drives Central America’s child migrants to US border



Obama heads to Texas as the mirage of an open door on the southern border triggers a political storm in Washington A group of immigrants from Honduras and El Salvador who crossed the US-Mexico border illegally are stopped in Texas. Photograph: Eric Gay/AP Jo Tuckman in San Pedro Sula

Wednesday 9 July 2014 11.28 EDT Last modified on Saturday 4 October 2014 10.15 EDT

Two weeks ago, Karla arrived at the Texas border with her two very young children, her mother, and three siblings under the age of 15. It had taken the family a month to make the 1,500 mile journey from their home in northern Honduras, travelling by bus through Guatemala and Mexico. They had sold everything they owned to pay a network of people smugglers who bribed the way clear through checkpoints along the route.

Karla headed north, partly because she had heard the US had begun allowing children to enter legally. This is what the smugglers were saying, and the family knew others who had safely made it across the frontier.

But the main motive for the journey was fear: Karla wanted to get beyond the reach of her father and his contacts in the street gangs that have turned Honduras into the country with the highest murder rate in the world.

  A Mexican child joins immigration reform protesters at a rally earlier this week in Washington condemning the president's response to the crisis. Photograph: Win McNamee/Getty Images Karla says her father was seeking revenge after he was convicted of raping her as a child and sent to prison. He had already hired a gunman to kill her older brother who fled illegally to the US.

When the gruelling journey eventually brought them to the banks of the Rio Bravo, Karla thought the family’s nightmare was finally over. But after putting themselves in the care of a US customs agent, a new one began.

Instead of being taken to a detention centre in Texas for processing, they were sent straight back to Mexican immigration control to be sent home.

“They didn’t even let us speak,” said Karla, who is now staying at a spartan facility in San Pedro Sula, the coastal city that is receiving floods of migrants deported from Mexico. “We are back where we started and I don’t know what to do. We haven’t got a dollar between us.”

The mirage of an open door on the southern US border has triggered a political storm in Washington – and helped fuel an unprecedented humanitarian crisis on America’s doorstep.

Republicans have seized on the issue, accusing the Obama administration of overseeing a systemic failure of immigration policy and demanding tougher action against illegal immigrants. Efforts to pursue wider immigration reforms in Congress recently collapsed and the crisis may come to a head on Wednesday when Obama visits Texas on a pre-scheduled trip. Although he will not visit the border for fear of further stoking the political flames, the president has agreed to invite state governor Rick Perry, one of his chief Republican critics on the issue, to a meeting with local politicians and humanitarian charities in Dallas.

Anti-immigration activists protest outside the US border patrol station in California earlier this week. Photograph: Sandy Huffaker/Getty Images Earlier this week, the White House announced plans to introduce fast track deportations and $116m to pay for the cost of transporting unaccompanied children back home, but activists in Central America say that the political debate in the US is missing the point.

“All the talk is about the children in the US, but they are relatively well off,” said Sister Lidia Mara Silva de Souza, a nun from the Scalabrini order that has worked with deportees from the US for decades. “The ones who are the most vulnerable are the ones who are returned to the situations they are running from.”

The vast majority of the child migrants come from Honduras, El Salvador and Guatemala – all struggling with levels of violence tantamount to an undeclared regional war. Honduras has a murder rate of around 90 per 100,000 inhabitants. The rate in Mexico hovers around 20. In the US it is under five.

Heavily armed street gangs such as the Mara Salvatrucha and Calle 18 impose a reign of terror on entire neighbourhoods across the region, which is also a key route for Mexican and Colombian cartels shipping narcotics north.

Drug-fuelled corruption, political instability, and – in the case of Honduras, a rightwing coup – have all contributed to a situation of institutional collapse. As their states fall apart around them, many Central Americans feel that justice and security can only be found elsewhere. .

“For many people the choice is to flee or to die,” says Carlos Paz, director of the San Pedro Sula office of the church organisation Cáritas.

Facebook Twitter Pinterest A pair of discarded jeans begins to blend with the sand on the shore of the Rio Grande at a site where immigrants cross the US-Mexico border illegally in Texas. Photograph: Eric Gay/AP The US political row over child migrants caught fire in early June when leaked photographs showed children crushed together in a Texas holding facility while they awaited processing. Soon after, the government released figures showing that more than 52,000 unaccompanied children had reached the southern border between October 2013 and mid-June – more than double the number for the entire previous fiscal year.

These children cannot be legally deported without first going through the courts because of 2008 legislation designed to prevent child-trafficking.That law was signed by George W Bush, but Republicans blame the recent surge on the practice of placing minors with relatives in the US pending deportation hearings – a process that usually takes more than a year.

The Obama administration says the wave of migration has been triggered by people smugglers who spread rumours that children were being given legal permits to stay in the US.

But perversely, the phenomenon has also been fed by tighter border controls: unable to return home to visit children they left behind, Central Americans already living illegally in the US pay smugglers around $5,000 to bring their sons and daughters across the frontier.

Facebook Twitter Pinterest A migrant sleeps on a bunk bed inside a Catholic migrant shelter in San Luis Potosi. Photograph: Carlos Jasso/Reuters Taxi driver Roberto Cerrato said his 11-year-old granddaughter was now safely in the care of her mother,after being sent to join her 10 years after she headed north. “My granddaughter was the apple of my eye,” he said. “I cried for a month after she left, but it is the best thing. Honduras is not a place for children.”

The migrants include many teenagers travelling alone: some looking for their parents, some seeking work, and others trying to escape the violence. A good few are doing all three.

Carlos, 14, set out last month, hoping to join his mother who had fled to Houston after her employer was killed by gang members. The woman had secretly been selling drugs on gang territory, and Carlos’s mother had heard she was next. Carlos spent nearly a year living with relatives before heading north, but only got as far as southern Mexico. “Maybe I will never see her again now,” he said, wandering aimlessly around the city centre waiting for an elder brother to pick him up.

San Pedro Sula is the most violent city in the world, with a murder rate of around 180 per 100,000. Surviving here begins with knowing the invisible lines that mark the boundaries of rival gang territories, and respecting the de facto curfew that falls at sunset. It is also important to see, hear and say as little as possible. Most residents who agree to speak to a journalist do so anonymously.

There is no choice, they say, but to accept the “war taxes” the gangs extort from businesses, or the “protection taxes” they levy on family homes. If there is a murder, it is better not to go to the funeral. Church organisations and some NGOs do have a presence, but some will admit they have to obtain permission from the gangs and stay away from controversial topics.

Facebook Twitter Pinterest Savadoran Andri Yovani (right), 2, and Honduran Kendri Hernandez, 3, play by a window inside a Catholic migrant shelter in San Luis Potosi. Photograph: Carlos Jasso/Reuters Earlier this month the Honduras government claimed the murder rate had fallen by 17% in the first three months of this year, but the announcement was met with scepticism. Two workers at the San Pedro Sula morgue, interviewed separately, said the number of bodies they receive is significantly higher today than it was a year ago.

Stories are also piling up of young children forced to work as lookouts, messengers or spies for the gangs. Eight children, between the ages of 7 and 13, were kidnapped and killed in La Pardera barrio during May. Word on the street is that they were killed for refusing to join the dominant local gang.

“In this job you become hardened to seeing death,” says one of the morgue workers who recovered some of the bodies, and asks his name not be published. “But to have to recover a child who has been cut to pieces and burned. That was just too much.”

US politicians have called on Central American parents not to expose their children to the many dangers facing migrants on the journey through Mexico, mentioning only in passing the desperate situation they are leaving behind.

“Tens of thousands of young children are being exploited and are being put at great danger,” secretary of state, John Kerry, said last month at a meeting of Central American leaders in Guatemala. “The lives of children cannot be put at risk in this way.”

The threats are real, and activists are receiving increasing reports of kidnapped and missing children in Mexico. But dozens of interviews in Honduras showed that most Central Americans are fully aware of the danger – yet many still feel that they have no choice but risk the journey north.

Facebook Twitter Pinterest Salvadoran Yesenia Elizabeth Orellana, 40, who is pregnant, holds hands with her daughter Valentina, 3, as her friend Mirna Laines, also pregnant, looks on. Photograph: Carlos Jasso/Reuters The gravity of the situation was reflected on Wednesday, when the UN high commission for refugees called for Central American migrants to be treated as refugees displaced by armed conflict. “The US and Mexico should recognise that this is a refugee situation, which implies that they shouldn’t be automatically sent to their home countries but rather, receive international protection,” the agency said.

Many in Honduras believe the Mexican government is stepping up its pursuit of migrants in deference to growing US pressure. During congressional hearings on the crisis in June, the House homeland security committee chairman, Michael McCaul, berated Mexico for not doing more to stem the tide of children. “If we can close the southern border of Mexico, that stops 99% of our problem,” he said.

The Mexican government is unlikely to admit publicly to doing the US bidding, but the number of deportations has risen dramatically. The children’s reception centre in San Pedro Sula received 4,001 child deportees during 2013, compared to 5,767 in the first six months of this year.

Several times a week, a convoy of buses brings the latest group of migrants turned back from Mexico: earlier this year the convoys had four buses and arrived twice a week. Now there are three convoys a week, each with seven busloads – many of them including entire family groups.

Facebook Twitter Pinterest Members of the Salvadoran national police detain two men during an anti-gang raid in San Salvador. Photograph: Esteban Felix/AP The deputy secretary of homeland security, Alejandro Mayorkas, told a press briefing last month that 39,000 adults with children were detained at the border between October and the end of May. Most of the deported families in the San Pedro Sula centre included more than one child; many had three, of whom a good number were still in nappies.

Edin, a harried-looking woman in a tiger print T-shirt, had two small children in tow as she waited nervously for the latest convoy, on which her husband and baby son were being returned. The plan had been for him to get to the US, save enough money for a people smuggler, and then send for the rest of the family.

Edin said they started to consider leaving Honduras after her husband, a milkman, was threatened by a gang for refusing to pay their “war tax”. Soon after, the couple witnessed the murder of a local evangelical pastor and decided to flee.

When the bus finally arrived, Edin interrupted her story to cuddle her baby, hug her husband, and allow herself to cry a little. The moment of relief was brief. “We are staying with my sister, but I am frightened we are putting her in danger as well,” she said.

Another returnee, Martha, 22, said the experience of a few weeks in a Mexican holding centre with her three much younger siblings was not something she wanted to relive. “They treated us like dogs and the little ones were getting very upset at being cooped up,” she said, adding that she decided against applying for asylum in Mexico after officials told her it would mean another six months in detention.

But while she was happy to have regained her freedom, she was nervous about what to do with it.

Her family, from the mountainous state of Olancho, had for eight years depended on remittances sent by their mother, who was working illegally in Houston. Their problems began, she said, when she refused the advances of a local drug trafficker. Soon after, the family home was sprayed with bullets, and the whole family fled to the capital, Tegucigalpa. When the dealer tracked her down once again, she led her siblings north in the hopes of joining their mother. They got to Chiapas before being detained by Mexican officials.

Back in Honduras, Martha wanted to call her mother to discuss what to do next, but she said a Mexican guard had stolen her phone. “The only thing I can think of doing is to try again.”


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So, in comes Obama just as he is doing overseas in the Muslim nations with asymmetric warfare and drones-----only now the excuse of instability in Latin America has Obama moving in with militarization.  Obama super-sized the problem with instability----globalization and too-large global corporations----but the solution is to protect against Latino refugees by military force.  Texas and Bush were the biggest exploiters of those refugee Latinos as was BIG AG in the mid-west----Clinton territory. 

THIS IS THE PROBLEM FOLKS----AMERICA MOVING FROM A DOMESTIC ECONOMY THRIVING AND FUELED BY WELL PAID WORKERS TO GLOBAL MARKETS AND MONOPOLY CORPORATIONS THAT ARE ROGUE THUGS.

Republican voters are the ones that hate the results of globalization the most----all of that aid sent as overseas development and defense----all of those refugees from destabilized nations-----yet they keep voting for a strong US and global markets.  Clinton neo-liberals have spent a few decades indoctrinating Democratic youth especially in cities with this same propaganda.


GET RID OF THE NEO-CONS AND NEO-LIBERALS IF YOU WANT PEOPLE TO LIVE IN THEIR OWN NATIONS.

It is no accident that Republican states in the south are heavy into military and Clinton neo-liberal cities are getting city citizens heavy into global markets----IT IS DELIBERATE.  The people hurt most by policies are tied to employment so they feel they must support them.  Think about the Gulf oil spill and how Gulf citizens had to say OH WELL as the oil industry has been made the only employment.  Then think how cities like Baltimore with its FOXCONN Johns Hopkins controlling all employment does the same thing in the drive for global markets.  IT IS DELIBERATE FOLKS.
The U.S. Re-militarization of Central America and Mexico



The Obama administration has expanded its financing of Mexican and Central American military forces—many of whom committed the mass killing and torture of political opponents and indigenous communities only two decades prior.


Alexander Main

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Honduran paratroopers with U.S. Special Forces soldiers during a “static line jump” (UNASOC News Service / Creative Commons) During his brief visit to Costa Rica in May 2013, President Obama appeared eager to downplay the U.S. regional security agenda, emphasizing instead trade relations, energy cooperation, and youth programs. “So much of the focus ends up being on security,” he complained during a joint press conference with his Costa Rican counterpart Laura Chinchilla. “But we also have to recognize that problems like narco-trafficking arise in part when a country is vulnerable because of poverty, because of institutions that are not working for the people, because young people don’t see a brighter future ahead.” Asked by a journalist about the potential use of U.S. warships to counter drug-trafficking, Obama was adamant: “I’m not interested in militarizing the struggle against drug trafficking.”

Human rights organizations from Central America, Mexico, and the United States see the administration’s regional security policy very differently. In a letter sent to Obama and the region’s other presidents last year, over 145 civil society organizations called out U.S. policies that “promote militarization to address organized crime.” These policies, the letter states, have only resulted in a “dramatic surge in violent crime, often reportedly perpetrated by security forces themselves. Human rights abuses against our families and communities are, in many cases, directly attributable to failed and counterproductive security policies that have militarized our societies in the name of the ‘war on drugs.’” 

The latest round in the ramping up of U.S. security assistance to Mexico and Central America began during President George W. Bush’s second term in office. Funding allocated to the region’s police and military forces climbed steadily upward to levels unseen since the U.S.-backed “dirty wars” of the 1980s. As narco-trafficking operations shifted increasingly from the Caribbean to the Central American corridor, the United States worked with regional governments to stage a heavily militarized war on drugs in an area that had yet to fully recover from nearly two decades of war.

In 2008 the Bush Administration launched the Mérida Initiative, a cooperation agreement that provides training, equipment, and intelligence to Mexican and Central American security forces. A key model for these agreements is Plan Colombia, an $8 billion program launched in 1999 that saw the mass deployment of military troops and militarized police forces to both interdict illegal drugs and counter left-wing guerrilla groups. Plan Colombia is frequently touted as a glowing success by U.S. officials who point to statistics indicating that drug production and violence has dropped while rebel groups’ size and territorial reach have significantly receded. Human rights groups, however, have documented the program’s widespread “collateral damage,” which includes the forced displacement of an estimated 5.7 million Colombians, thousands of extrajudicial killings, and continued attacks and killings targeting community activists, labor leaders, and journalists.

Under President Obama, the U.S. government has renewed and expanded Mérida and, in 2011, created the Central American Regional Security Initiative (CARSI). From 2008 to 2013, these programs have received over $2 billion and $574 million respectively, according to a 2014 report by the Igarapé Institute. Though administration spokespeople emphasize investments made in judicial reform and drug prevention programs, most funds have been spent on supporting increasingly warlike drug interdiction and law enforcement.

The surge in U.S. security assistance has coincided with a notable regional increase in the militarization of law enforcement activities. Starting in 2007, former President Felipe Calderón of Mexico began deploying tens of thousands of troops as part of his government’s crackdown on drugs and organized crime. In El Salvador troops were deployed in the streets in 2009 and their presence was increased in 2011. In 2011 and 2012 Salvadoran president Mauricio Funes appointed active and inactive military officers to top security posts, breaking with the tradition since the country’s 1992 peace accords of keeping these posts in civilian hands. In Guatemala, meanwhile, over 21,000 army troops have taken up policing missions, often far outnumbering the number of police personnel in the areas where they are deployed. According to the Center for International Policy (CIP) approximately 40% of Guatemala’s security-related posts have been filled by former military officers, since former army chief Otto Perez Molina’s 2012 ascension to the presidency.

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U.S. security funding to Honduras was briefly suspended following the June 2009 military coup. But by the following year the United States had resumed funding at a higher rate than before the coup, even though the Center for Justice and International Law noted that “high-ranking Army officers or former members of the Army against whom complaints were brought for their participation in the coup d’état, are occupying executive positions in government offices.” In November 2011 the Honduran government began sending military patrols into the streets to fight common crime, and in August 2013 a new Military Police for Public Order was created, tasked with cracking down on gang activity. Military involvement in policing duties had been prohibited under the Honduran constitution, but in January 2014 the country’s legislature amended the constitution to permit a military police force.

Though the U.S. government has remained silent regarding military involvement in law enforcement activities, the steady increase of U.S. assistance to national armed forces has, if anything, been an indicator of tacit U.S. support. But the U.S. role in militarization of national police forces has been direct as well. In 2011 and 2012, the Drug Enforcement Administration’s Foreign-deployed Advisory Support Team (FAST)—which had previously carried out military-style missions in Afghanistan—set up camp in Honduras to train a local counternarcotics police unit and help plan and execute drug interdiction operations in the Mosquitia, a remote region in eastern Honduras that has recently become a hub for the transit of drug shipments northward.

Supported by U.S. helicopters mounted with high caliber machine guns, these operations were nearly indistinguishable from military missions, and locals routinely referred to the DEA and Honduran police agents as “soldados” (soldiers). According to The New York Times, five “commando style squads” of FAST teams have been deployed across Central America to train and support local counternarcotics units.

In July 2013, the Honduran government created a new “elite” police unit called the Intelligence Troop and Special Security Group, or TIGRES (Spanish for “tigers”). The unit, which human rights groups contend is military in nature, has been deployed in tandem with the new military police force and has received training in military combat tactics from both U.S. and Colombian Special Forces units.

*

Outside of Honduras, Colombian military and police trainers are now active throughout the region as well. Eager to help export the “successful” Plan Colombia model, the United States has funded training programs carried out by Colombian security forces in Mexico, Central America, and beyond. In 2012, President Obama and Colombian president Juan Manuel Santos announced a joint multi-million dollar Action Plan on Regional Security Cooperation that draws on “Colombia’s established and expanding expertise and capacity for countering transnational organized crime…and shared U.S. responsibility to address the demand for illicit narcotics,” according to a State Department release.



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A Honduran paratrooper and U.S. Special Forces soldier shake hands (UNASOC News Service / Creative Commons) Human rights groups such as the Fellowship for Reconciliation (see Lindsay-Poland, this issue) note that many members of Colombia’s police and military forces are—like many of their Mexican and Central American counterparts—implicated in extrajudicial killings and human rights abuses. Transnational crime organizations are believed to have permeated a large number of the region’s police and military units as well.

The U.S. government presents the increased support to Mexico and Central America’s security forces as a necessary response to the alarming rise in drug-trafficking activity which has, in turn, fueled violent crime. But has U.S. policy borne positive results? The question is complicated because the United States and its partners have failed to publicly establish clear metrics to assess counternarcotics efforts. One of the few measures used by the U.S. Congress is “the pace of equipment deliveries and training opportunities” according to a Congressional Research Service Report, though this information says nothing about the effectiveness and impact of aid. U.S. officials highlight statistics showing that there is less cocaine available in the U.S. today than in the years prior to the Mérida Initiative, but it appears likely that this trend is counterbalanced by the increased availability and popularity of other drugs like heroin.

What is certain is that the surge in U.S. security assistance has been accompanied by a dramatic spike in violent crime in several countries. Homicide rates have skyrocketed in El Salvador, Guatemala, and Honduras, the countries that have received the bulk of CARSI funding. Today those countries—often referred to as the Northern Triangle—comprise one of the most violent regions on earth. In Mexico, meanwhile, Human Rights Watch estimates that around 80,000 people have died in drug-related killings since 2006. Drug violence has also led to the displacement of over 200,000 Mexicans, according to the Internal Displacement Monitoring Center.

U.S. officials have suggested that the epidemic of violence in the region actually indicates the effectiveness of the war on drugs. The head of the State Department’s Bureau of International Narcotics and Law Enforcement Affairs, William Brownfield, recently told the Associated Press that “the bloodshed tends to occur and increase when these trafficking organizations…come under some degree of pressure.” This theory doesn’t seem to be supported by any concrete evidence, and appears to disregard the fact that many of those killed have no links to drug trafficking.

The chilling reality is that the majority of U.S. security assistance flowing to Mexico and Central America is going to police and military forces that only two decades earlier were engaged in horrifying acts of killing and torture against political opponents and indigenous communities. With few exceptions, security forces across Central America have undergone no serious reform since the 1980s, and the state agents responsible for past human rights violations have not been brought to justice for even the most egregious crimes, such as the massacre of entire villages. Today, the region’s judicial institutions—particularly in Mexico and the Northern Triangle—remain deeply corrupt and inefficient, and only a tiny proportion of crimes involving security forces are successfully investigated and prosecuted.

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The U.S. government has been reluctant to acknowledge the growing number of extrajudicial killings and human rights abuses reportedly perpetrated by members of state security forces receiving U.S. support. In 2011, Human Rights Watch presented evidence of Mexican security forces’ involvement in “more than 170 cases of torture, 39 “disappearances,” and 24 extrajudicial killings since 2006.” And these incidents are likely only a drop in the bucket. From 2007 to April 2011 Mexico’s Federal Prosecutor’s Office opened 1,615 investigations into alleged military crimes against civilians, but not a single one of these investigations resulted in a prosecution.

As documented in an in-depth report by Rights Action and the Center for Economic and Policy Research, and by journalist Kaelyn Forde in NACLA’s Fall 2013 issue, on May 11, 2012, a drug interdiction operation involving Honduran police and DEA FAST team agents flew into the tiny municipality of Ahuas and opened fire on a passenger boat, resulting in the killing of four indigenous villagers, none of whom were known to have links to drug trafficking. To this day, the families of the victims of the Ahuas killings await justice and compensation from the Honduran and U.S. governments. And in a number of documented instances across Central America, attacks by security forces have targeted civil society groups engaged in peaceful protests or other forms of non-violent opposition. In Guatemala troops have killed indigenous protestors demonstrating against the government’s economic reforms. Honduran military and police units are accused of killing dozens of land rights advocates in the Bajo Aguán valley close to the Atlantic coast, and a peaceful demonstrator protesting a hydroelectric project further west in the Rio Blanco Valley.

Killings and attacks against women, human rights defenders, lawyers, journalists, LGBT activists, union leaders, and political opposition leaders have risen sharply. In Honduras, many occur in death squad fashion, with individuals kidnapped by masked men in unmarked vehicles, shot and left by the roadside, sometimes with evidence of torture. Given the tactics, many suspect the involvement of security forces, but those responsible are almost never brought to justice.

Citing these widespread abuses, human rights groups and many members of Congress have pushed back against the U.S. security spending frenzy. In 2012, 94 members of the U.S. House of Representatives demanded the complete suspension of police and military assistance to Honduras. Congressional appropriators have conditioned portions of security aid to Mexico and Honduras pending State Department certification of governments’ compliance with human rights and accountability provisions. They have also maintained a long-standing ban on foreign military funding and training of Guatemalan army units in appropriations funneled through the State Department.

But the Obama administration has consistently certified Mexico and Honduras as compliant with human rights conditions in spite of, in the case of Honduras, public objections from over 20 U.S. senators. The ban on some security assistance to Guatemala is amply compensated by direct Department of Defense support to military units, among them those that reportedly include members of the Kaibiles, Special Forces troops implicated in past massacres.

*

Recently, the United States began channeling more sophisticated and insidious forms of support to the region’s security forces. Through CARSI, the U.S. government has equipped police institutions with surveillance technology and encouraged widespread wiretapping activity. The overt intention may be to improve local law enforcements’ ability to intercept drug traffickers’ calls, but—given the absence of effective judicial accountability—civil society actors legitimately fear that this enhanced surveillance capacity is being directed at them.

Despite the United States’ enormous investment, the State Department’s 2014 International Narcotics Control Strategy Report notes that “approximately 90 percent of illegal drugs from South America destined for the United States are smuggled through the seven Central American countries and Mexican corridor.” Why have billions of dollars been spent on a failed policy that has only generated more violence? And why, in an apparent repetition of the dark days of Central America’s dirty wars, does Washington invest so heavily in strengthening and empowering corrupt security forces with appalling human rights records?

U.S. officials’ unwavering faith in the Colombian militarized model is no doubt part of the reason. But a stubbornly persistent Cold War mindset may also be at play. Based on hours of interviews with State Department officials and Congressional staffers, investigative journalist Hector Silva Avalos recently observed in an Inter-American Dialogue report that the U.S. security agenda in the Northern Triangle is driven in part by the perceived threat of the growing regional power of the Venezuelan government. A new “anti-American narrative,” he argues, has replaced the prior communist threat in the eyes of key policy makers.

Avalos’s findings echo a 2007 U.S. strategy memorandum—part of the WikiLeaks trove of diplomatic cables—on the “Southern Cone Perspective on Countering Chávez and Reasserting U.S. Leadership.” Though the memo focuses on policy toward the Southern Cone, its message would no doubt resonate among U.S. Central America policy makers. “We should continue to strengthen ties to those military leaders in the region who share our concern over [late Venezuelan president Hugo] Chávez,” stated the memorandum

The U.S. government’s failed and destructive regional anti-drug policy now faces a swelling movement of resistance from Central American leaders and grassroots movements alike. Governments are debating alternative policies that include potential decriminalization of drug possession and use.

Human rights groups and social movements are increasingly united in decrying the use of army troops and militarized police in repressing popular movements and defending corporations in their efforts to wrest resource-rich lands from communities. The priority, they believe, is building strong, transparent judicial institutions to address human rights crimes and ensure accountability. To eradicate the scourge of violent crime, investment is needed, not in military equipment and police and military training, but in equitable and sustainable economic development that addresses the basic needs of the poor.

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The cities and states that were the forefront of REAL progressive Democratic politics were taken during the Reagan/Clinton neo-liberalism by these global corporate pols that had a goal of killing all that is progressive.  That is why all of what were BLUE Democratic states are now mostly PURPLE neo-liberal states and they are as abusive and exploitative of labor and justice as Republican states.

SUSPENDING ALL CONSTITUTIONAL RIGHTS TO EQUAL PROTECTION UNDER LAW----WITH THE FEDERALISM ACT BY CLINTON AND OBAMA PUSHES THE BLUE DEMOCRATIC STATES INTO THIS SAME CORPORATE AND WEALTH POLICY STANCE.

Refugees overwhelmingly DO NOT WANT TO BE IN THE US ----THEY WANT TO BE IN THEIR OWN NATIONS WITH THEIR CULTURE AND FAMILIES.

This is why immigrants do not trust the Democratic Party any more than people of color and labor-----CLINTON NEO-LIBERALS ARE CONTROLLING GOVERNMENT IN DEMOCRATIC STATES AND THEY ARE NOT DEMOCRATS! This is deliberate to break up the Democratic base of labor and justice


Hispanic dairy workers step out of the shadows to protest abuses


by David Sommerstein & Julia Botero, in Lowville, NY


About 40 farm workers and advocates marched to the front gates of Marks Farm, south of Lowville, N.Y., to protest alleged worker abuses. Photo: David Sommerstein. Listen to this story May 06, 2015 — For more than a decade, undocumented Hispanic workers have been indispensable on dairy farms across New York's North Country. That is largely because Congress has failed to act on immigration reform and provide a legal visa program.

The immigrants live largely invisible lives and rarely stray off the farm to avoid detection by federal agents. They are also less likely to report abuses.

For the first time in the North Country, farm workers and their advocates stepped out of the shadows and held a public protest. Last Friday, they marched to the gates of the region’s largest dairy farm, Mark's Farm, near Lowville, N.Y., to call attention to what they called widespread wage theft, harassment, and other forms of abuse.

About 40 people chanted “Milk cows, not workers,” and other slogans as they marched up a gravel road past long rows of cow barns. They waved signs that read “No Blood in Milk” and “Say No to Workplace Violence.” The protestors said some farmers treat their cows better than the humans who milk them.

Lazaro Alvarez, originally from Mexico City, addressed his former co-workers inside the farm. "Maintain your dignity," he told them. He now works on a farm in Fonda, N.Y. Photo: David Sommerstein."Workers should be treated with dignity," said Lázaro Álvarez, who is originally from Mexico City. Álvarez used to work here on Marks Farm, one of the state’s largest dairy farms. According to farm officials, about 40 of its 55 employees are Hispanic. The Worker Justice Center of New York and the Workers' Center of Central New York targeted Marks Farm for this march because of an incident under investigation by state police. A farm manager, Michael Tabolt, allegedly beat a worker named Francisco and threw him to the ground several times after Francisco was reluctant to work on his day off. Advocates said there were witnesses, but they were scared to testify. Francisco was fired.

Report the beatings! Report the injustices, the abuses, the racism. Don't be afraid!Marks Farm spokeswoman Lindsay Peck would not comment on specifics because of the investigation, but she said the farm supports Tabolt’s actions and said Francisco violated an employee policy. "We support the workers' cause, in that we want our workers to be well taken care of," said Peck. She said the farm pays a competitive wage, offers good housing, and provides soccer fields for the workers to play on during their free time. “To our fellow workers working on this farm,” José Cañas shouted into a megaphone, as the marchers lined up facing Marks Farm’s front door. Facing back at them, two farm representatives leaned against a car. Curious cows peered out from the barn. “Report the beatings! Report the injustices, the abuses, the racism,” shouted Cañas.

Most of the advocates came up from Syracuse or Rochester, although there were a couple North Country marchers. Photo: David Sommerstein.Advocates said it is not the first time workers have complained about Mark’s Farm. Rebecca Fuentes of the Workers' Center of Central New York said on many farms, abuse of workers is common; things like poor and unsafe housing, ignoring health problems, physical and verbal abuse, failure to pay minimum wage and wage theft. She said, "When workers don’t get paid for all the hours, or they don’t get paid at all, or they don’t get the last paycheck. For these workers who are supporting their families, every dollar counts." It is estimated several thousand undocumented immigrants work on New York and Vermont dairy farms. They present false Social Security cards that farmers do not have to verify. Federal agents generally look the other way, but this legal limbo leaves workers vulnerable to abuse.

Steve Ammerman, spokesman for the New York Farm Bureau, which lobbies on behalf of New York’s 5,000 dairy farms, agreed the lack of immigration reform "does pose challenges both for the farmers and the farm employees." He said workers should report any kind of substandard work condition, but he said farmers bristle at the suggestion that abuses are common. He said, "The overwhelming majority of the dairy farms take good care of their employees because they have to. They need them. Their farms wouldn’t exist without them. And they could lose a worker to another farm down the road if they weren’t doing what’s right."

Advocates from the Worker Justice Center of New York handed a letter of protest to representatives of the farm, who were watching the march. Photo: David Sommerstein.Some workers do walk away to farms with better conditions, but Rebecca Fuentes said that is not so easy for immigrants who do not know English or the region and fear deportation. "When you are not from this country, you don’t have many options," Fuentes said. Most of the marchers were advocates from Syracuse or Rochester. Only a handful were farm workers. Kathy Tucker, a union activist from Gouverneur, was one of just a couple North Country people at the march. She said after hearing the farmworkers’ stories, she believes abuses are more widespread than people want to believe. Tucker said, "Unfortunately, I believe this is the norm. That really is very, very disturbing to me."

The marchers delivered a protest letter to Marks Farm's office and called for the supervisor under investigation to be let go. Álvarez said it is true not all farms are the same. He said he found better conditions on a farm in the Mohawk Valley. Alvarez said Hispanic labor is a critical part of the Upstate economy. Dairy farms need them to milk the cows. He said the workers just want to be treated with dignity, equality, and respect.

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The first thing a city does to stop decline is stabilize communities to keep people already here in the city.  If your goal is to further destabilize a city you allow high unemployment and scarce jobs and resources to grow at the same time you invite all kinds of immigrants to a city.  LA and Chicago is the example of this dynamic and we see these cities with gangs bringing quality of life to third world levels.  These cities are like cities in developing nations.

That is what Maryland is doing with its move to welcome immigrants.  You put out the welcome mat for Hispanics and then flood the city with citizens from nations around the world at the same time a planned economic crash that seeks to bring a Depression-era stagnation to the US and VOILA-----everyone is fighting for jobs while Johns Hopkins does its global market operating completely separately from the cities economy.   The goal at the end of a few decades of this----to have all those immigrants and impoverished US citizens desperate enough for those global sweat shop factories.  If left to move forward it may be less than a few decades.

IF YOU THINK YOUR INDIVIDUAL RIGHT TO GET RICH TRUMPS THE KIND OF SOCIETY YOUR CHILDREN AND GRANDCHILDREN WILL LIVE----WE WANT YOU OUT OF POLITICS!

Clinton neo-liberal pols know that is to where this is going as do Baltimore's neo-conservative working for Hopkins but running as Democrats. 


Baltimore puts out welcome mat for immigrants, hoping to stop population decline



By Carol Morello and Luz Lazo
July 24, 2012 The fate of Baltimore may rest with immigrants like Alexandra Gonzalez.

A native of Puebla, Mexico, Gonzalez feels more at home in Baltimore with every passing year. She attends city-run nutrition and exercise classes in Spanish and takes her two young children to a Spanish-language storytelling hour at her neighborhood library. She plans to earn a GED and become a teacher.

“I like living here,” said Gonzalez, 24, as she pushed a stroller holding her sleeping 1-year-old daughter and bags of purchases from a dollar store in the blue-collar Highlandtown neighborhood. “They don’t look at you weird because you don’t speak English.”

The degree to which Gonzalez feels welcome is no accident.

After decades of seeing the city’s population slide with every census count, Baltimore officials are trying to turn things around. One key strategy is embracing immigrants, in the hope they will encourage friends and family to join them.

Mayor Stephanie Rawlings-Blake (D) has told Latinos, in particular, that she is counting on them to help Baltimore gain 10,000 families within a decade. As a first step, she signed an order in March prohibiting police and social agencies from asking anyone about immigration status — and in the order, she explicitly asked federal immigration authorities to tell anyone they arrest that they are not agents of the city.

Baltimore joins an increasing number of U.S. cities, most of them manufacturing behemoths fallen on hard times, that are courting immigrants to reverse half a century of population loss.

The Global Detroit effort includes programs that help immigrants start small businesses, get driver’s licenses and learn English. As part of the Welcome Dayton Plan adopted last year, the Ohio city sponsors a soccer tournament for immigrant teams. Not to be outdone, Chicago Mayor Rahm Emanuel (D) says he wants his home town to be known as the most “immigrant-friendly city in the country.”

The welcome mats thrown out by struggling cities and states stand in stark contrast to the reception immigrants have faced in places such as Arizona and Alabama. There, laws requiring police to ask a person’s immigration status have raised concerns about racial profiling among many immigrants, whether or not they are in the country legally, and many have left because of the stricter laws, as well as the recession.

In the Washington region, Prince William County saw a drop in its immigrant population, both legal and illegal, after it mandated that police make immigration checks.

A new attitude Baltimore has undergone a shift in attitude. In 2004, then-Maryland Comptroller William Donald Schaefer (D), a former mayor and governor, chastised immigrants who don’t speak English well after a Spanish-speaking cashier at a McDonald’s had trouble understanding his order.

“I don’t want to adjust to another language,” Schaefer said. “This is the United States. I think they ought to adjust to us.”

Eight years later, Baltimore and many other cities are adjusting.

The 2010 census was a tipping point. Most cities that grew had Hispanics and, to a lesser degree, Asians to thank. Cities with few immigrants lost political power and federal money as district lines and funding formulas changed to reflect new census numbers.

“The census has shown cities definitively what the population trend is,” said Margie McHugh, an immigration expert with the nonpartisan Migration Policy Institute. “It got a lot of smart people in city and state governments looking 10 years ahead and thinking hard about what the economic future for cities could be.”

In Michigan, former state House majority leader Steve Tobocman (D) heads Global Detroit, built around the idea that immigration can drive an economic rebound. The group plans to provide training in how to start “micro enterprises” and has created a “welcome mat” network of social service agencies that offer English and citizenship classes. It hopes to draw both entrepreneurial engineers who graduate from the state’s universities and working-class immigrants who can start small neighborhood businesses.

“Immigrants have a lot to contribute to job creation and economic growth,” Tobocman said.

Most of the immigrant-friendly measures around the country are in their infancy, so it is difficult to assess how effective they are. Philadelphia, for example, saw its population grow for the first time in 60 years after the mayor ordered police in 2009 not to ask about immigration status, but the rise in Hispanic and Asian residents that was responsible for the increase might have happened anyway. Hispanics and Asians are the two fastest-growing groups in the country, more because of their higher birth rates than to immigration.

Critics of ‘sanctuary cities’ Critics say cities that lure immigrants end up with high numbers of undocumented migrants. That also is difficult to measure, particularly now that immigration from Mexico, the largest source of illegal immigration, has dwindled to essentially zero.

The census does not ask immigration status, so it is not possible to say how many of Baltimore’s 45,000 foreign-born residents are here legally. But the Pew Hispanic Center estimated that in 2010, Maryland had the nation’s 10th-largest population of unauthorized immigrants.

Del. Patrick L. McDonough (R-Baltimore County) said he is consulting with Judicial Watch, a conservative think tank, about whether Rawlings-Blake is “aiding and abetting” people who are in the country illegally.

McDonough said the mayor’s order in effect creates a “sanctuary city” that will draw undocumented immigrants who will compete for jobs with current residents. Baltimore’s unemployment rate tops 10 percent; for African American men, it is at least double that.

“For the mayor to want to increase the population of Baltimore City in principle is an admirable thing,” McDonough said. “But by going after people who don’t have a lawful presence, and all of the accompanying cultural and criminal issues associated with that policy, you are counterproductive. You’re going to discourage people who live in the city from continuing to be there.”

Immigrant outreach — such as the city-run classes in Spanish — is just one part of the mayor’s agenda for growing Baltimore. She has programs that aim to improve public schools, reduce crime, cut property taxes and create jobs, increasing the city’s appeal to all residents. The mayor’s order has been her only action aimed at immigrants, though other initiatives are being considered.

“What we want to do is attract immigrants who call home and say: ‘Maybe you should think about coming to Baltimore. I’m having a great time here,’ ” said Ian Brennan, a mayoral spokesman.

Widespread support Support for the policy appears to be broad.

“I agree with her policy in terms of trying to increase the city’s numbers,” said Del. Curtis S. Anderson (D), chairman of the city’s House delegation in Annapolis. “Her idea now to reach out to the non-documented population is one way. But I don’t think it’s the most important thing she’s doing.”

More important, he said, is reducing the property tax rate and creating jobs.

Ryan O’Doherty, another mayoral spokesman, said the city has several pillars of economic strength offering jobs at all skill levels: Johns Hopkins University, the port and tourism.

As if to underscore the urgency of stemming the city’s population dive, new census estimates show that Baltimore lost an additional 1,500 residents in the 15 months after the census, bringing it below 620,000. The figures, which are being contested by the city, show a continued exodus of black residents, while the numbers of Hispanics, Asians and non-Hispanic whites were on the upswing.

Only Cleveland and Detroit lost more residents than Baltimore. During the same period, the District gained 16,000 residents and is closing in on its northern neighbor in the rankings of big cities. Baltimore is now the nation’s 24th largest city. In 1980, it ranked 10th.

Hispanics in particular have helped slow the decline in the city’s population, which peaked at 950,000 in 1950. Their numbers more than doubled over the past decade, from 11,000 in 2000 to 26,000 in 2010. They now make up 4 percent of Baltimore residents, a fraction of their share of the state and national population.

Hispanics born in Mexico, Central America and South America make up more than a third of all foreign-born residents of Baltimore, according to census figures. The city also draws many immigrants from Africa, China and the Middle East.

Reviving Highlandtown One place where the influx of immigrants is most evident is Highlandtown, a neighborhood of narrow rowhouses, corner bars and grocery stores on Baltimore’s east side. It was settled by European immigrants, mostly Greeks, Italians and Poles who never moved to the suburbs and left their homes to their children. Merchants say that by the early 1990s, the neighborhood was dying.

But today, it is a bustling crossroads. Convenience stores advertise Corona and Modelo beers. Restaurants featuring Mexican and Honduran fare stand beside diners serving up Coney dogs. A storefront church, Jesus de Vida, occupies a building next to the Madina Grocery and Halal Meats, which is run by a Chinese couple. A refu­gee resettlement center guides newcomers from Nepal and French-speaking Africa on orientation tours, including a stop at the Southeast Anchor Library.

“One of the first things they do is get a library card,” said branch manager Cindy Kleback. “Then they can use the computers for free to communicate with people back home. I walk past the computers and see people watching TV from Eritrea.”

Every Thursday, the library hosts a ­children’s storytelling hour in Spanish. Non-Hispanic parents also bring their children to expose them to another language and culture, fostering friendships that have led to baby showers in the library and a potluck Thanksgiving dinner.

The spreading Latin influence has been a welcome change to Fidelita Portillo, who found few familiar products at the corner grocery when she moved to Baltimore eight years ago to join her sister. Today, several grocers carry the chiles, sweet breads and Goya products that remind her of her native El Salvador.

This year, Portillo enrolled her 4-year-old in preschool and readily found information in Spanish. The school has an interpreter available as well.

When the mayor held a small town hall meeting at the library this spring to explain her new, immigrant-friendly policy, Portillo attended. She acknowledges not having the proper documents to be in the country.

“I feel better knowing the mayor has assured us that the police are not going to be going after the immigrants,” she said, adding that she wants her children to grow up without worrying that their parents will be deported. “People feel free. We don’t have to live in hiding and in fear.”





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July 27th, 2015

7/27/2015

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This week I will talk about the movement of immigrants and foreign students to America. This is a good segue from rebuilding public health care as immigrant labor fills the privatized health chains and is central to Johns Hopkins' global  empire.

It is safe to say that upwards of 95% of citizens of Baltimore do not like having Hopkins as a FOXCONN Enterprise Zone----even students and staff know how power corrupts and knows Hopkins is front and center to the stagnant economy, high unemployment, and fraud and government corruption.  So, only the few profiting from that with no care for the future generations would support this----


First let me describe other nations and autocratic despots that have a government structure and economy built like Baltimore's.

There is Assad of Syria who enriched a minority Alawite known to be from outside Syria and made up most of the government and high-paying jobs in his regime.
  Saadam Hussein empowered the minority Sunni to control the Shiite. Libya's Gaddafi was found at the end to be protected by African immigrants.  In each case these autocratic dictators called themselves Socialists and controlled all the nation's assets for their own wealth and power and as is norm for autocratic dictatorships---they were ruthless and violent against their people.  All of the Middle East dictators were installed by the US----Johns Hopkins is behind the Afghanistan presidents for example.  Socialism does not have as a goal brutal supression by dictators folks-----right-wing Stalinism does and that is what we have seen across nations falling under US control.  When these leaders decide to go Socialist and not capitalist----they meet with demise with US oil interests moving in.  In Afghanistan's case it is rare earth minerals the US is after.

My point is this-----the last decades of American leadership has shown its predilection to these autocratic, dictatorial, and brutal regimes operating with minority casts filling government circles.

The form of government Assad presides over is an authoritarian regime.[4] The Assad regime has described itself as secular,[5] while experts have contended that the regime exploits ethnic and sectarian tensions in the country to remain in power.[6][7][8] The regime's narrow sectarian base relying upon the Alawite minority has also been noted


Below you see why the US spent last century installing what became autocratic dictatorships that repressed the nation's people often using minorities to control the majorities.  Then think how the NEW WORLD ORDER has the first world Western nations brought to colonial international economic zones with an end to national sovereignty and US Constitutional rights and you can deduce the plan is to install the same kind of government in the US as these autocratic dictatorships had.  Finally, think about how a neo-liberal and neo-con global corporate tribunal 'center' want to move US politics further right to neo-conservative Liberatarianism which will become/has been seen to be Stalinism as in Baltimore.


Those not living in Baltimore may not know how much Baltimore resembles these autocratic dictatorships----as a FOXCONN global corporate controlled city.  This week is about sharing with my friends around the nation how cities being made International Economic Zones are exporting to smaller cities and towns this same autocratic structure as it intends to spread across the country.  Baltimore is ground zero for this as is Texas so we are farther ahead of this curve.  That is why dismantling all connections of Hopkins and Balitmore Development ----which is simply Wall Street----is the first step in reversing the NEW WORLD ORDER----and it is easy peasy.
  Qatar is Wall Street of the middle-east and was built by Wall Street and it is the model of the global corporate tribunal party for here in the US.

In all cases immigrants play a major role in autocratic dictatorships both as the administrators closest to the despots and as slave labor.  The citizens of these nations are almost always left without jobs and deeply impoverished.  SOUND FAMILIAR??????

Why is the United States supporting the Bahraini dictatorship?

Mo Battah,

The U.S. does not necessarily support the 'dictatorship' in order to oppress the Bahraini people. The U.S. wants to make sure its guys are in power and a dictatorship or an absolute monarchy is the way to go since the leader is somewhat stable and will remain unchallenged if the population is kept oppressed.

It is the same policy the U.S. has with all Middle Eastern countries. Look at Egypt, the U.S. opposed the democratically elected Morsi because he was against U.S. interests, a democracy isn't good for the U.S. if the people elect someone the U.S. does not like. The U.S. now supports Sisi, essentially a military dictatorship. You can say he ran in an election yet it was rigged. He barred many political parties from participating and jailed them.

There are many examples but I don't have the time right now so I will use two more uncontroversial examples.

1. Saudi Arabia. Saudi has one of the worst human rights records. Women will be able to vote in local elections in 2015, I am not kidding. Beheadings beat ISIS beheadings. Although, the U.S. gives weaponry and cash to these ruthless rulers. It is an absolute monarchy and a direct opposite to democracy.
2. Qatar. In 2013, Qatar's total population was 1.8 million. 278,000 of which were citizens. So who are these extra 1.5M people? They are expatriates working in the country. An extremely small minority make a lot of money there, but that accounts for maybe 1% of the expatriates. The rest are human slaves. Amnesty International, Human Rights Watch and many other organizations have condemned Qatar but the U.S. relentlessly backs Qatar and Qatari efforts.

After these examples, Bahrain isn't too much of a surprise.


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Qatar is a Wall Street invention and note the dynamics---an extremely small minority earn a lot of money and the rest are human slaves.  Most of the population are immigrant.
  This is where Clinton neo-liberals and Bush neo-cons are going with this restructuring for the global corporate tribunal rule.  Government is increasingly being filled with Ivy League grads and foreign nationals as consultants et al.

Florida, Texas, and California ----all early to this Trans Pacific Trade Pact transition are already a majority immigrant.


Again, immigrants are not bad----it is the policy goals that are bad and as we see with Qatar----slave labor for immigrants is getting more and more common.

Qatar's migrants: how have they changed the country?


Qatar has become almost unrecognisable from the tiny nation it once was. We look at the data to find out how migration changed everything and what happens when a nation swells so quickly.


Thursday 26 September 2013 07.34 EDT Last modified on Tuesday 13 January 2015 10.34 EST

Back in 1980, Qatar was a country of just 0.2 million people, making it one of the smallest in the world, and in terms of residents, 1/37th of what London is today. But things have rapidly changed, largely because of an explosion in immigration. Here are some of the numbers that show what happened.

Population size Early on, Qatar's expansion was fast - it's population grew at a rate of 10.2% between 1980 and 1985. That rate slowed from 1990 to 1995 but leapt again in 2005 when Qatar's numbers climbed by 15.3% over the space of five years.

And although the rate of growth is expected to slow, Qatar's population is forecast to continue its growth over the next 40 years.

Baby boomers? A quick look at the fertility of female Qataris shows that they're having far fewer children - on average, just 2.4 each compared to the 5.45 children per woman in 1980. The number of children dying before their 5th birthday has fallen - but not by enough to explain that growth.

So if it's not bigger families, what else is making Qatar grow?

Migration The real answer lies in Qatar's migrant population, otherwise bluntly referred to in government statistics as 'non-Qataris'. In terms of rights, migrants might not be powerful - but in numbers they are.

'Qataris' in work: 71,076
'Non-Qataris' in work: 1,199,107

That means immigrants make up an astounding 94% of Qatar's workforce, and 70% of it's total population. The numbers are closely watched by Qatar's statistics authority whose motto is:

Statistics are the eyes of the policymakers. If you can't measure it, you can't manage it.

Emigration numbers are small - just 1,078 Qataris left in 2011, of whom 615 headed to Canada, 193 went to the US and 121 went to Germany.

Where are they coming from? Surprisingly, those numbers are harder to find. Peoplemovin, which pulls together data from the World Bank estimates that in 2011, most migrants came from India and Pakistan.

What do they do? Only a handful of those migrants make it into skilled jobs as the Qatari census data shows.

Man man man woman Many of those migrants are men - which goes some way to explain why 3 out every 4 residents in Qatar is male.

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We are told this flood of immigrants is about the population decline from baby boomers leaving the workforce but the US has has around 25% unemployment these several years----lowest employment since the 1960s----and this coming economic crash will take those numbers much higher.  Americans are being made more impoverished with less access to successful tracking to higher education----10% of Americans are slated to entrance in strong 4 year universities with the rest vocationally tracked into poverty jobs.


Americans are being pushed to smaller and smaller families through impoverishment or the need for both husband and wife to work.  You can see where the long-term result will be much like Qatar-----


The immigrants at the lower wage scale we all know already face the worst of workplace conditions, wage theft, and exploitation.  The new immigrants coming from Asia and Africa are seeing themselves transferred constantly -----not able to set roots and staying in the country for a handful of years.  This is causing high unemployment especially in a city like Baltimore where unemployment is 35-50% for black citizens.

THIS IS NOT PROGRESSIVE IMMIGRATION POLICY----IT IS REGRESSIVE AND WILL END AS A MODEL OF THE ABOVE AUTOCRACIES.


Keep in mind this would be a conservative number if TPP is installed they will open the gate to global corporations bringing immigrant labor with temporary worker status.

Over one million immigrants to come to US in 2016



July 21, 2015


Over one million immigrants will arrive in the United States next year, according to the US Census Bureau, with future projections showing that the nation may add up to another 49 million new residents from overseas over the course of the next 35 years.
The agency’s new International Data Base has revealed that 2015’s net immigration figure is likely to rise to 1.25 million, with this figure reached by taking the number of immigrants leaving the United States and subtracting them from the figure for new arrivals. The net immigration figure is expected to rise a little next year and even further – to 1.31 million – by 2025.

Over the course of the next decade it is anticipated that 14 million new immigrants will move to the United States. The great majority of immigration to the US is legal, with foreign citizens able to get a green card by applying via overseas American diplomatic posts. The continual increase in the amount of newcomers is due to legislation introduced in the 1960s in the Coolidge administration to remove caps.

Back in 1970 less than 1 in 21 Americans were born overseas; however, this figure has now grown to one in seven, with around 80 million Americans being either immigrants or the children of immigrants. Americans seem generally unconcerned, however, with just 13% of those responding to a poll from ImmigrationWorks USA last month worried that immigrants were taking American jobs.


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Keep in mind that Maryland's middle-class is disappearing as are all state funding of scholarships and financial aid to 4 year universities.  You will go to KIPP in Baltimore to get a scholarship or you will graduate from a Baltimore High School and get a scholarship to the Baltimore City Community College.

O'Malley spent his entire terms in office building these global structures for our state universities as it became more important to look overseas for the rich there than to make sure all Maryland students get a strong public education and pathway to higher education.  Right now Maryland is becoming more and more selective about which students are chosen to go to college and it is the corporate structure that chooses.

All of this leads more and more away from citizens have Equal Rights and Opportunity and Access.  It is eliminating a family's ability to decide and pay for higher education for their children.

This is why reversing course and returning to a domestic economy as the primary fuel.  This brings back the emphasis on making sure all Marylanders are ready to contribute to workplace. 

THE AMERICAN PEOPLE WILL BE HUMAN CAPITAL IN A GLOBAL LABOR POOL IF WE DO NOT GET RID OF THESE GLOBAL CORPORATE POLS.


If you live in Baltimore you see Hopkins revolving door of Asian students many becoming employees in the US or overseas with very few Maryland and Baltimore citizens involved other than paying ever higher taxes to support this global campus headquarters.

We are feeding the needs of the world's rich for higher education as the American people are loaded with education debt and unable to afford access for their children......this is where we see the goal of making Americans increasingly impoverished growing foreign force in our higher government and as consultants to state and local governments.


University of Maryland brings business education to Asia



Jun 29, 2012, 6:00am EDT
Sarah Gantz Reporter Baltimore Business Journal Bizspace Huang Xu-Hong | oop of Republic of China (Taiwan)

University of Maryland’s Wallace Loh and Taiwan President Ma Ying-jeou.… more

The University of Maryland, College Park may partner with universities in Taiwan and South Korea to offer a dual business degree to Asian students who want to learn the ropes of American business.

The proposed degree program would allow Taiwanese and Korean students to earn a business degree from their home university and from the University of Maryland. The idea came out of UM President Wallace Loh’s recent trip to Taiwan and South Korea during which Loh made several connections that will allow students at UM and in Asia more interaction with each other and foreign culture.

“The graduates of the University of Maryland will be competing not only with graduates from Boston and San Francisco, they’re going to be competing with graduates from Shanghai and Bangalore,” Loh said. “To experience the global world we’re in, it’s absolutely essential students have some opportunity to spend time abroad.”

The University of Maryland is among many higher education institutes flocking to Asia as those countries gain status as economic and entrepreneurial players.


  Asia — specifically China — has been a top area of focus for public colleges and universities for at least a decade, according to the American Association of State Colleges and Universities.

“I can’t imagine any state research university that is not deeply involved in expanding its international academic partnerships, specifically in Asia,” said Daniel Hurley, director of state relations and policy analysis for the association.


Towson University sent representatives to China and Vietnam with Gov. Martin O’Malley in 2011, a trip Loh also made. Towson has robust math, business and actuarial science programs at universities in China and last fall launched a program to bring Chinese school administrators to Maryland to study the American educational system. On June 28, Towson hosted a conference for international school administrators.

Demand for college education as a middle class emerges within Asian countries, China especially, is also driving American institutions to set up shop there
.

“It’s such a large market that is thirsting for access to post-secondary — and quality post-secondary — education. And American education is among the best,” Hurley said.

Asian universities have been launching at schools across the U.S. programs similar to the one proposed for UM, to satisfy a demand among students for a business education that will help them tap the American market, Loh said.

During his trip, Loh secured opportunities for Asian and UM students to interact:

• Twenty awards for UM students to teach English at Korean schools, funded by the National Institute for International Education Development in South Korea.

• Five scholarships for Taiwanese students to study at the University of Maryland, provided by Taiwan’s Ministry of Education.

• More courses taught through an Internet video feed by professors in College Park and in Asia. The university already offers about five courses, including a course on culture and the environment in Russia, taught with a Moscow college class. Through the course, University of Maryland students partner with students in Moscow for projects and presentations and interact with both professors through the video feed.

• Six scholarships for UM students to spend August studying culture and language in Taiwan, through the National Central University in Taiwan.

The annual trips begin this August. Within days, all six slots were spoken for.

Mohammad Zia, a junior who created his own major in global development, was among the first to leap at the opportunity.

“When you’re a little kid, you love adventure and I think traveling presents you no matter how old you are a chance to have an adventure and be exposed to different cultures and experience new ideas,” Zia said.

“Classroom experience doesn’t give you enough of a challenge or real-life application of knowledge,” he added.

Zia said he hopes to leverage his experiences abroad into a job as an entrepreneur, developing resources for underdeveloped countries in Africa. As a growing economic power, Taiwan will have a lot to teach him, he said.



______________________________________________
This is not meant as a scare tactic.  We should know the dynamics of our national population.  Immigrants add vitality to our communities.  It is the goal that is not good----and especially not good for immigrants.



'Even in the Washington-Baltimore CMSA, the number of immigrants who arrived in the 1990s (348,000) was equal to almost half of the 701,000-person increase in the area’s total population. If the 175,000 children born to immigrant parents in the Washington-Baltimore metropolitan area during the 1990s are added to the number of immigrants who arrived in the 1990s, then immigration is equal to almost 75 percent of the CMSA’s population growth'.

Please glance through this long article----also, if time allows go to this site for the tables that do not post in this blog.  This is census from 2000----the numbers are much larger 15 years later.  As this article states----many US states are seeing US citizens leaving as immigrant populations grow---and what does an autocratic society look like?  High immigrant population and high impoverishment of sovereign citizens.


'This is because there is a significant out-migration of natives from these states'. 

Immigrants in the United States — 2000 A Snapshot of America's Foreign-Born Population


By Steven A. Camarota January 2001

Download this Backgrounder as a pdf

Each month the Census Bureau conducts the Current Population Survey (CPS), the primary purpose of which is to collect employment data. The March CPS includes an extra-large sample of Hispanics and is considered the best source for information on persons born outside of the United States — referred to as foreign-born by the Census Bureau, though for the purposes of this report, foreign-born and immigrant are used synonymously.1 Analysis of the March 2000 CPS done by the Center for Immigration Studies indicates that 28.4 million immigrants now live in the United States, the largest number ever recorded in the nation’s history, and a 43 percent increase since 1990. As a percentage of the population, immigrants now account for more than one in 10 residents (10.4 percent), the highest percentage in 70 years.

Other findings in the new Center report:


  • More than 1.2 million legal and illegal immigrants combined now settle in the United States each year.

  • The number of immigrants living in the United States has more than tripled since 1970, from 9.6 million to 28.4 million. As a percentage of the U.S. population, immigrants have more than doubled, from 4.7 percent in 1970 to 10.4 percent in 2000.

  • By historical standards, the number of immigrants living in the United States is unprecedented. Even at the peak of the great wave of early 20th century immigration, the number of immigrants living in the United States was less than half what it is today (13.5 million in 1910).

  • Immigration has become the determinate factor in population growth. The 11.2 million immigrants who indicated they arrived between 1990 and 2000 plus the 6.4 million children born to immigrants in the United States during the 1990s are equal to almost 70 percent of U.S. population growth over the last 10 years.

  • The percentage of immigrants without a high school diploma is 30 percent, more than three times the rate for natives. Also, of all persons without a high school education, one-third are now immigrants. Immigrants are also slightly more likely than natives to have a graduate or professional degree.

  • In 2000, 37.4 percent of immigrants are naturalized citizens, and immigrants account for 5.5 percent of all eligible voters.

  • The poverty rate for immigrants is 50 percent higher than that of natives, with immigrants and their U.S.-born children (under age 21) accounting for 22 percent of all persons living in poverty.

  • The proportion of immigrant households using welfare programs is 30 to 50 percent higher than that of native households.

  • One-third of immigrants do not have health insurance — two and one-half times the rate for natives. Immigrants who arrived after 1989 and their U.S.-born children account for 60 percent or 5.5 million of the increase in the size the uninsured population.

  • Immigration accounts for virtually all of the national increase in public school enrollment over the last two decades. In 2000, there were 8.6 million school-age children from immigrant families in the United States.

  • Immigrants and natives exhibit remarkably similar rates of entrepreneurship, with about 1 in 9 of both groups being self-employed.
Because all children born in the United States to immigrants are by definition natives, the sole reason for the dramatic increase in the immigrant population is new immigration. While some immigrants die and others return home, the issuance of 700,000 to 900,000 permanent residency visas annually and the settlement of several hundred thousand illegal aliens each year greatly exceeds deaths and out-migration. In the March 2000 CPS, just under three million immigrants indicated they had entered the country between 1998 and March of 2000. An additional 2.2 million immigrants responded they had arrived in 1996 or 1997. These numbers indicate that at least 1.2 million immigrants, and perhaps 1.3 million, now arrive in United States each year.

In any discussion of immigration’s effect on the country it is important to keep in mind that the number of legal immigrants allowed in each year, the selection criteria used, and the level of resources devoted to controlling illegal immigration are all discretionary policies of the federal government. Given the sampling and non-sampling error that exists in any survey, the results of this Backgrounder for states and immigrant groups with relatively small populations should be interpreted carefully.

Historical Comparison

While immigration has played an important role in American history, the level of immigration and the size of the immigrant population has varied considerably. Figure 1 shows the number of immigrants living in the United States over the course of the last 100 years. The 28.4 million immigrants residing in the United States in 2000 are the most ever recorded. Even during the great wave of immigration at the turn of the century, the immigrant population was less than half what it is today.

Figure 1 shows that, after growing in the early part of this century, the immigrant population stabilized at around 10 or 11 million for about four decades. In the mid-1960s, changes in immigration law and other factors caused the annual level of legal immigration to rise steadily, from about 300,000 in the 1960s to 800,000 in the 1990s. As a result, between 1970 and 1980 the number of immigrants living in the United States grew by a record 4.5 million. Reflecting the continuing increase in legal and illegal immigration, the immigrant population grew by 5.7 million in the 1980s — another record — and by 8.6 million in the 1990s, again surpassing the previous record.

The foreign-born population’s growth rate since 1970 is higher than at any other time in history, far surpassing growth at the beginning of the 20th century. Between 1900 and 1910, the immigrant population grew by 31 percent, less than the 47 percent increase in the 1970s, the 40 percent increase in the 1980s, and the 43 percent growth of the 1990s.

Additionally, immigrants now account for a much larger share of the increase in the total U.S. population. For most of last century, the growth in the immigrant population accounted for little or none of the increase in the size of the U.S. population. Even during the first decade of the last century, when immigration was an important part of population growth, the immigrant contribution to U.S. population growth was much less than it is today. The 3.2 million increase in the size of the immigrant population between 1900 and 1910 accounted for only 20 percent of the total increase in the U.S. population. In contrast, the 8.6 million-increase in the immigrant population from 1990 to 2000 accounted for 34 percent of U.S. population growth in the 1990s. Immigration now accounts for such a large percentage of population because the fertility of natives was much higher in the early 1900s. As a result, the population grew regardless of immigration. Today natives have only about two children on average, with the result that immigration now accounts for a very large share of population growth. Also in contrast to the past, a much higher percentage of today’s immigrants remain in the United States rather than returning home. Because so many immigrants in the early 20th century eventually returned to their home countries, immigration at that time did not add permanently to the overall size of U.S. population in the way that it does today.2

While the number of immigrants and the growth rate of the immigrant population are higher now than at any other time in the last 100 years, the immigrant percentage of the population was higher in the first few decades of the 1900s. Table 1 shows that in 1910, the immigrant population reached a high of 14.7 percent of the total U.S. population. As a result of World War I and changes in immigration law in the early 1920s, the level of immigration began to fall, as did the foreign-born percentage of the population. The 1930 Census was the last time the percentage of immigrants was as high as it is today.

In terms of the impact of immigrants on the United States, both the percentage of the population made up of immigrants and the number of immigrants are clearly important. The ability to assimilate and incorporate immigrants is partly dependent on the relative sizes of the native and immigrant populations. Still, 28.4 million immigrants are likely to have an enormous effect on the socio-economic life of the United States, regardless of whether this represents 10 or 15 percent of the nation’s population, especially because immigrants are largely concentrated in only a few states.

Population Growth

The CPS can be used to provide insight into the likely impact of immigrants on the size of the U.S. population. Table 2 reports six different methods using the March 2000 CPS to estimate the effect of immigration on U.S. population growth in the 1990s.

The first column in Table 2 shows the growth in the U.S. population based on a comparison of the total population as enumerated in the 1990 Census and the March 2000 population estimate prepared by the Census Bureau.3 The first three rows of Table 2 use the growth in the size of foreign-born population to estimate the effect of immigration on population growth between 1990 and 2000. As already pointed out, the 8.6 million increase in the size of the immigrant population between 1990 and 2000 is equal to approximately one-third of total U.S. population growth over this period. As shown in the second row, the impact of immigration on population growth is even larger (40 percent) if births to immigrants who arrived in the 1990s are added to the growth of the foreign-born population. The third row indicates that if births to all immigrant women during the 1990s, including those who arrived prior to 1990, are added to the growth in the immigrant population, then immigration is equal to almost 59 percent of population growth.

Instead of using the growth in the foreign-born population, the last three rows of Table 2 use the number of immigrants who arrived in the 1990s as the basis for estimating the impact of immigration on population growth. Analysis of this kind is possible because the CPS asks of foreign-born persons their year of arrival to the United States. In 2000, 11.2 million immigrants in the survey indicated that they had entered the country between 1990 and 2000.

The 11.2 million figure is larger than the 8.6 million growth in the foreign-born because the immigrant population shrinks as a result of deaths and out-migration. Thus, even though 11.2 million immigrants arrived in the 1990s, the immigrant population grew by only 8.6 million because 2.6 million immigrants here in 1990 had either died or gone home by 2000. It is reasonable to view the 11.2 million immigrants who arrived in the 1990s as the basis for estimating immigration’s effect on population growth because this flow reflects current U.S. immigration policy — both legal immigration and the level of resources devoted to controlling illegal immigration.

The 11.2 million immigrants who arrived in the 1990s are equal to 43.8 percent of population growth in the 1990s. If births only to immigrants who arrived during the 1990s are added to this figure, then immigration accounts for 50.3 percent of U.S. population growth. The last row in Table 2 adds all births to immigrants between1990 and 2000 to the 11.2 million immigrants who arrived in the 1990s. Births to immigrants plus 1990s immigration are equal to 68.8 percent of population growth between 1990 and 2000. Taken together, the estimates in Table 2 make clear that no matter what assumption is used, immigration policy has very significant implications for U.S. population growth.

State Data

Table 3 ranks the states by the size of their immigrant populations. It also shows the number of immigrants who reported arriving in the 1990s. California clearly has the largest immigrant population; New York, the state with next largest number of immigrants, has fewer than half as many. Table 3 also shows how concentrated the immigrant population is: Only a few states represent the vast majority of the foreign-born population. The nearly 8.8 million immigrants in California account for 30.9 percent of the nation’s total immigrant population, followed by New York (12.8 percent), Florida (9.8 percent), Texas (8.6 percent), New Jersey (4.3 percent), and Illinois (4.1 percent). Despite having only 39.3 percent of the nation’s total population, these six states account for 70.5 percent of the nation’s immigrant population.

Table 4 ranks states by the percentage of their populations composed of immigrants. While the rankings by "percent immigrant" are similar to those in Table 3, there are some significant differences. Because of their relatively small total populations, several states such as Hawaii and Nevada, with high percentages of immigrants, rank lower in terms of number of immigrants.

Table 5 compares the 1990 Census counts of the immigrant population with the March 2000 CPS and ranks the top 15 states by the numerical increase in their immigrant populations. While the states that had large immigrant populations in 1990 continue to account for most of the growth in the immigrant population, Table 5 shows substantial growth in the foreign-born populations in such states as Arizona, Colorado, North Carolina, and Nevada.

Table 6 examines immigration and state population growth for the top immigrant- receiving states. The first column in the table reports population growth between 1990 and 2000 by state. Columns 2, 3, and 4 show the number of 1990s immigrants in the state, births to 1990s immigrants, and births to all immigrants during the 1990s. Column 5 uses 1990s immigrants plus births to only 1990s immigrants, while column 6 uses 1990s immigrants and all births to immigrants to estimate immigration’s impact on state population growth. Table 6 shows that using either assumption, there are a number of states in which immigration has had a very large impact on population growth.

While the arrival of natives from other parts of the country plays a significant role in population growth in states like Arizona, Washington, and Colorado, immigration has also become an important component of population growth. For Virginia, Maryland, Michigan, Florida, and Texas, immigration plays an even larger role — accounting for at least one-third to more than half of the increase in the population of these states between 1990 and 2000.

In New York, New Jersey, Massachusetts, Illinois, and California it appears that absent immigration, these states may have declined in population or at least grown very little. This is because there is a significant out-migration of natives from these states. There is, however, both anecdotal and systematic evidence indicating that in high- immigration states some natives leave because they are adversely affected by immigration. In particular, less-skilled native-born workers may leave to avoid job competition, and some parents may leave high-immigration areas because of the strains it creates on public schools. Therefore, it is by no means certain that without immigration all of these states would have declined in population.

Region and Country of Origin

Table 7 shows the distribution of immigrants by region of the world, with Mexico and Canada treated separately. Mexico accounts for 27.7 percent of all immigrants, with 7.9 million immigrants living in United States, more than the number of immigrants from any other part of the world. Immigrants from Mexico, Central and South America, the Caribbean, and East Asia make up the majority of immigrants, with 69 percent of the foreign-born coming from these areas. For immigrants who have arrived in the 1990s, these regions account for 71.2 percent of the foreign-born. Sub-Saharan Africa and Europe make up a relatively small portion of the immigrant population, accounting for only 17.1 percent of all immigrants and 13.8 percent of immigrants who arrived in the 1990s.

Table 8 ranks the top-20 immigrant-sending countries by the number of post-1970 immigrants living in the United States as of March 2000. Mexico is, of course, the largest sending country, accounting for more than five times as many immigrants as the combined total for China, Taiwan, and Hong Kong. As is clear from Table 8, Latin American, Caribbean, and East Asian countries dominate the list of immigrant-sending countries, accounting for 14 of the top-20 post-1970 countries.

Labor Market Characteristics

Immigrants now comprise 12.8 percent of the nation’s total workforce.
4 This is somewhat higher than the 10.4 percent of the total U.S. immigrant population because, in comparison to natives, a slightly higher percentage of immigrants are of working age. Table 9 reports the educational attainment and other characteristics of immigrants and natives in the workforce. In 1998, almost 30 percent of immigrants who worked full time did not have a high school diploma, and of those who arrived in the 1990s, 34.4 percent were dropouts. In comparison, slightly less than 9 percent of natives lacked a high school education. At the highest level of education, immigrants tend to be slightly more educated than natives, with 10.7 percent of immigrants holding a graduate or professional degree compared to 9.3 percent of natives.

The large number of immigrants with low levels of education means that immigration policy has dramatically increased the supply of workers with less than a high school degree, while increasing other educational categories more moderately. The last column in Table 9 shows the portion of each educational category composed of immigrants. While immigrants comprise 13 percent of the total workforce, they comprise more than 35 percent of the high school dropouts in the workforce. This means that any effect immigration may have on the wages or job opportunities of natives will disproportionately affect less-skilled workers.

Given the large proportion of immigrants with few years of schooling, it is not surprising that the income figures reported in Table 9 show that as a group, immigrants have lower median incomes than natives. The annual median income of immigrants is only about 76 percent that of natives. And for the most recent immigrants, median income is only 58 percent that of natives. While as a group immigrants earn significantly less than natives, the income data by year of entry suggest significant progress over time.

Since the cohort data is only based on one point in time, March 2000, it is possible that the seeming economic progress of immigrants is at least partly caused by the departure of those immigrants who did not fare well in the U.S. labor market. Moreover, the age data in Table 9 indicate that 1970s immigrants are by 2000, on average, older than natives in the workforce. Because greater workforce experience comes with age, one would expect this to translate into higher income. Despite this, the median income of immigrants who arrived in the 1970s is actually slightly below that of natives, even though they are on average older than natives and have been in the United States for more than 20 years. Only the cohort that arrived before 1970 had higher incomes than natives, which is expected given that they are much older than natives on average. In addition to their age, the higher income of immigrants who arrived prior to 1970 may also be explained by the fact that most were admitted under the pre-1965 immigration system, which tended to produce a more educated flow of immigrants relative to natives than today’s policies.

Table 10 shows the occupational concentration of immigrants and natives by occupation. The upper half of the table lists those occupations in which the immigrant component is less than or nearly equal to their proportion in the overall workforce. The lower half lists those occupations in which immigrants comprise a proportion larger than their representation in the workforce (henceforth referred to as low-immigrant and high-immigrant occupations, respectively). Given the low level of educational attainment of a large proportion of immigrants, it is not surprising that high-immigrant occupations are those that tend to require fewer years of education. For example, while immigrants make up 18 percent of those holding non-private household service jobs, such as janitor, security guard, and child-care worker, they comprise only 10 percent of individuals in managerial and professional jobs.

Table 10 reveals that only 26 percent of natives are employed in occupations that have a high concentrations of immigrants. This suggests that most natives are not in competition with immigrants.5 However, as Table 10 shows, high-immigrant occupations pay an average of only 56 percent of what low-immigrant occupations pay. Additionally, high-immigrant occupations have an unemployment rate more than double that of low-immigrant occupations. By itself, this does not necessarily mean that immigrants have lowered the wages or increased unemployment in these occupations. What it is does mean, however, is that any negative effect from immigration will likely fall on the 26 million native-born workers who already have the lowest wages and the highest unemployment.

Table 10 also shows that 40 percent of native-born blacks work in high-immigrant occupations, compared to only 22.9 percent of whites. This means that blacks are much more likely to be affected by any decline in wages or benefits resulting from immigrant-induced increases in the supply of labor.

Self Employment

One of the most common perceptions of immigrants is that they are uniquely or distinctly entrepreneurial. Table 11 examines the self-employment rates of immigrants and natives. Consistent with other research, Table 11 shows that immigrants and natives exhibit remarkably similar levels of entrepreneurship. The table shows that 10.7 percent of immigrants and 11.6 percent of natives are self-employed. Thus, less than one percentage point separates the self-employment rate for immigrants and natives. Turning to self-employment income reported at the bottom of Table 11, we see that the average self-employment income (revenue minus expenses) or both immigrants and natives is very similar. While immigrants overall are not more entrepreneurial than natives, immigrants from some countries are significantly more likely than natives to be self-employed. Those from China, Korea, Canada, Poland, and Iran are much more likely to be self-employed than natives.

Clearly, entrepreneurship is neither a lacking nor a distinguishing characteristic of the nation’s immigrants. If one removed immigrants from the data, the overall rate of self-employment in the United States would be virtually unchanged. Therefore, one simply must look elsewhere to make an argument for or against current immigration.

Poverty

Based on the March 2000 CPS, 16.8 percent of immigrants compared to 11.2 percent of natives lived in poverty in 1999 (poverty statistics are based on annual income in the year prior to the survey). The poverty rate is 23.5 percent for immigrants who entered in the 1990s, 15.2 percent for 1980s immigrants, and 11.5 percent for 1970s immigrants. As is the case with the income data in Table 9, it is unclear to what extent this progress reflects the out-migration of unsuccessful immigrants, the different selection criteria used in the past, and the changing origins of immigrants over the last few decades.

Table 12 also reports poverty rates for persons from the top-20 post-1970 immigrant-sending countries. The data indicate that there is an enormous variation in poverty rates among immigrants from different countries. For example, the 32.5 percent poverty rate for Dominicans is more than six times that of persons from United Kingdom and five times that of immigrants from the Philippines. The last column in Table 12 shows the proportion of persons 21 years of age and older from each country who have not completed high school. These educational data indicate that those countries that have the highest percentage of adults without a high school education also tend to have the highest poverty rates.

The higher incidence of poverty among immigrants as a group has significantly increased the overall size of the population living in poverty. Immigrants accounted for almost 15 percent of all persons living in poverty. While this is a large percentage, it would be even larger if the native-born children (under age 21) of immigrants, who are included in the poverty figures for natives, are counted with their parents. The poverty rate for children and for most young adults reflects their parents’ income, therefore it is reasonable to view poverty among the U.S.-born children of immigrants as attributable to their immigrant parents. The bottom portion of Table 12 shows that the poverty rate for immigrants and their U.S.-born children together is 18.3 percent.

Of the 27.5 million natives living in poverty, 2.27 million (8 percent) are the U.S.-born children of immigrant mothers. If the native-born children of immigrants are excluded, poverty among natives drops from 11.2 percent to 10.7 percent. And if the 4.75 million immigrants in poverty are also excluded, along with their U.S.-born children, from the nation’s overall poverty counts, the overall number of people living in poverty drops by 7.02 million. This means that immigrants and their U.S.-born children account for 21.8 percent of the 32.26 million people living in poverty in the United States. Among persons under age 21 living in poverty, 24.2 percent are the children of immigrants.

In addition to poverty, Table 12 also reports the percentage of immigrants and natives living in or near poverty, with near poverty defined as income less than 200 percent of the poverty threshold. As is the case with poverty, near poverty is much more common among immigrants rather than natives. Table 12 shows that 41.4 percent of immigrants compared to 28.8 percent of natives live in or near poverty. Among the children of immigrants (under age 21), 53 percent live in or near poverty, in contrast to 35.6 percent of the children of natives. If the native-born children of immigrants are excluded from the figures for natives, the rate of poverty/near poverty among natives drops from 28.8 percent to 27.8 and the poverty rate is 44 percent for immigrants and their native-born children combined. If the 11.7 million immigrants in or near poverty are excluded, along with their U.S.-born children (5.17 million), then the overall number of people living in or near poverty in the United States drops by 16.9 million. This means that immigrants and their U.S.-born children account for 20.5 percent of the poor and near poor in the United States.

Welfare Use

Table 13 shows the percentage of immigrant- and native-headed households in which at least one member of the household receives public assistance (including Temporary Assistance to Needy Families and general assistance programs), Supplemental Security Income (SSI), Food Stamps, or Medicaid (health insurance for those with low incomes). Table 13 indicates that even after the 1996 welfare reforms, which curtailed eligibility for some immigrants, immigrant welfare use remains higher than that of natives for all four major programs and for all entering cohorts after 1970. In fact, the year of entry data suggest that in some cases immigrant welfare use actually rises over time as they “assimilate” into the welfare system.

As was the case with lower income and higher poverty rates, the higher welfare use rates by immigrant households are at least partly explained by the large proportion of immigrants with few years of schooling. Less-educated people tend to have lower incomes and higher levels of unemployment and poverty. Therefore, it is not surprising that immigrant use of welfare programs is significantly higher than that of natives.

While immigrants’ welfare use is higher than natives’, Table 13 shows that most households, immigrant or native, do not use means-tested programs. On the other hand, even though a relatively small portion of the population uses welfare, for 1999 the total costs of just the first three programs listed in Table 13 is more than $70 billion a year, and Medicaid by itself costs an additional $190 billion. Moreover, there are other welfare programs not listed in the table that are linked to those reported in Table 13. For example, 15.5 percent of immigrant households reported having at least one child receiving subsidized school lunches, compared to only 5.8 percent of native households. Finally, there is the question of whether native use of welfare is the proper yardstick by which to measure immigrants. Some may reasonably argue that because immigration is supposed to benefit the United States, our admission criteria should, with the exception of refugees, select only those immigrants who are self-sufficient.

In addition to welfare programs, Table 13 reports use of the Earned Income Tax Credit (EITC). With an annual cost of $25 billion, the EITC is the nation’s largest means-tested cash assistance program for workers with low incomes. Persons receiving the EITC pay no federal income tax and instead receive cash assistance from the government based on their earnings and family size. Table 13 shows that immigrant households use the EITC at almost double the rate of natives.

While on the whole immigrant households have higher welfare use rates, this is not true for immigrants from all countries. Table 14 shows that immigrants from those countries with higher education levels tend to have lower welfare use rates. From the list of countries in Table 14, it is also clear that refugee-sending countries, such as Russia and Vietnam, tend to have higher rates of welfare use. On the other hand, Mexican and Dominican households have welfare use rates that are as high or higher than Russian or Vietnamese immigrants, and virtually none of these immigrants are refugees. Thus, it is clear that the higher rate of welfare use by immigrants overall is not caused simply by immigrants admitted for humanitarian reasons. In addition to being more likely overall to receive welfare, Table 14 indicates that the average payments received by immigrant households on public assistance, SSI, or the EITC are larger than those of natives.

Uninsured

According to the Census Bureau, since 1989 the uninsured population has grown by almost 9.2 million. and stood at 42.6 million (almost one-sixth of the total U.S. population) in 1999. (Figures for 1999 are based on the March 2000 CPS.) Much of this growth has been driven by immigration. Immigrants who arrived after 1989 along with their U.S.-born children account for 60 percent or 5.5 million of the increase in the uninsured population in the 1990s.6

Table 15 reports the percentage of immigrants and natives who where uninsured for all of 1999. The table shows that lack of health insurance is a significant problem for immigrants from many different countries, including countries that tend to have lower poverty rates and higher education levels, such as China and Korea. The lower portion of Table 15 reports the percentage of immigrants and their U.S.-born children (under 21) who are uninsured. Almost 31 percent of immigrants and their children lack health insurance, compared to 13 percent of natives. The large percentage of immigrants and their children without insurance has significantly increased the overall size of the uninsured population. Immigrants and their U.S.-born children account for almost 28 percent of all uninsured persons in the country, double their percentage of the overall population. The high percentage of immigrants without health insurance is even more striking when one recalls from Table 13 that immigrant households were more likely to use Medicaid.

The low rate of insurance coverage associated with immigrants is primarily explained by their much lower levels of education. Because of the limited value of their labor in an economy that increasingly demands educated workers, many immigrants hold jobs that do not offer health insurance, and their low incomes make it very difficult for them to purchase insurance on their own.

A larger uninsured population cannot help but strain the resources of those who provide services to the uninsured already here. Moreover, Americans with insurance have to pay higher premiums as health care providers pass along some of the costs of treating the uninsured to paying costumers. Taxpayers also are affected as federal, state, and local governments struggle to provide care to the growing ranks of the uninsured. There can be no doubt that by dramatically increasing the size of the uninsured population, our immigration policy has broad-ranging effects on the nation’s entire health care system.

School-Age Children

In the last few years, a good deal of attention has been focused on the dramatic increases in enrollment experienced by many school districts across the country. The Department of Education recently reported that the number of children in public schools has grown by nearly 8 million in the last two decades. All observers agree that this growth has strained the resources of many school districts. While it has been suggested that this increase is the result of the children of baby boomers reaching school age (the "baby boom echo"), it is clear from the CPS that immigration policy explains the growth in the number of children in public schools.

Table 16 shows that there are 8.6 million school-age children of immigrants (ages 5 to 17) in the United States. While fewer than one-third of the 8.6 million children are immigrants themselves, the use of public education by the native-born children of immigrants is a direct consequence of their parents having been allowed into the country. The children of immigrants account for such a large percentage of the school-age population because a higher proportion of immigrant women are in their childbearing years, and immigrants tend to have more children than natives. In addition, the effect of immigration on public schools will be even larger in the coming years because 17.6 percent of children approaching school age have immigrant mothers.

Table 16 also shows that immigration has significantly increased the school-age population in all of the top-eight immigrant-receiving states. Of course, a dramatic increase in enrollment may not create a problem for public education if tax revenue increases proportionately. But as we have seen, immigrants generally have lower incomes than natives, so their tax contributions are unlikely to entirely offset the costs they impose on schools. This is especially true because of the higher costs associated with teaching children whose first language is not English.

The absorption capacity of American public education is clearly an important issue that needs to be taken into account when formulating a sensible immigration policy. Table 16 suggests that the failure to consider this question may have significant consequences for America’s schools.

Characteristics of Immigrants by State

Table 17 reports selected characteristics for immigrants in the leading immigrant-receiving states. The first column reports the percentage of immigrants 18 and over in each state who indicated that they were naturalized citizens of the United States. While there is some variation, the percentage of immigrants in most states who are citizens falls near the national average of 40 percent. As a share of all eligible voters in each state, immigrants vary significantly: in California immigrants account for 15.7 percent of eligible voters; in New York, 11.8 percent; in Florida, 10.8 percent; in Texas, 5.6 percent; in New Jersey, 9 percent; in Illinois, 5.2 percent; in Massachusetts, 6.5 percent; and in Arizona, 6 percent. It is worth noting that research indicates that some immigrants, primarily those from Mexico and Central America, tend to report that they are naturalized citizens when in fact they are resident aliens. Thus, the actual citizenship rate of immigrants is likely to be somewhat overstated in the CPS.

The second and third columns of Table 17 report the percentage of immigrants and their U.S.-born children (under 21) who live in or near poverty, with near poverty defined as income below 200 percent of the poverty threshold. Despite the fact that the demographic characteristics of immigrants differ significantly by state, immigrants and their U.S.-born children (under age 21) have much higher rates of poverty and near poverty than natives, with the exception of Illinois. As a share of all persons in or near poverty, immigrants and their children account for more than one-half of the poor and near poor in California and roughly one-third in New York, Florida, and Arizona. In Texas, immigrants and their children represent 27 percent of all persons in or near poverty and 29.3 percent in New Jersey.

Turning to health insurance coverage by state, Table 17 shows a similar pattern to poverty. With the exception of Illinois, immigrants and their children in every major immigrant-receiving state are significantly more likely than natives to be uninsured. The impact of immigration on the overall size of the uninsured population in some states can only be described as enormous. In California, 58.8 percent of the uninsured are immigrants or the U.S.-born children (under age 21) of an immigrant. As Table 17 shows, if immigrants and their children are not counted in California, the uninsured rate would be 13 percent — precisely the rate for natives. But, because of immigration the actual state uninsured rate is 20 percent, making it one of the highest in the country. In New York, immigrants and their children represent nearly half (47.7 percent) of the uninsured; in Florida, 39.5 percent; in Texas, 32.5 percent; in New Jersey, 34.7; in Illinois, 22.6 percent; in Massachusetts, 27.5 percent; and in Arizona, 36.4 percent.

The last two columns in Table 17 show the percentage of immigrant and native households using at least one of the major welfare programs. Not surprisingly, with the exception of Illinois, immigrant household use of welfare is higher than that of natives in every state. As a result of their higher use rates, immigrant households account for a very significant percentage of the welfare caseloads in these states. In California, immigrant households account for 42.2 percent of all households using at least one major welfare program; in New York, it’s 31.8 percent; in Florida, 26.4 percent; in Texas, 21.8 percent; in New Jersey, 23.7 percent; in Illinois, 10.2 percent; and in Arizona, immigrant households account for 26.6 of all households receiving welfare. While higher than the rate of natives in almost every state, it is important to note that there is no state in which a majority of immigrant households are on welfare.

Metropolitan Statistical Areas

Table 18 reports figures for the nation’s top-six immigrant-receiving Consolidated Metropolitan Statistical Areas (CMSA). While the Los Angles and New York CMSAs have the largest immigrant populations, the Miami CMSA ranks first in terms of the percentage of immigrants. These six metropolitan areas account for nearly 53 percent of all immigrants living in the United States but only 23.1 percent of the nation’s entire population. These six cities continue to attract a large share of new immigrants. Of immigrants who arrived in the 1990s, 48.7 percent settled in these six CMSAs.

The fourth column in Table 18 reports population growth for each metro area between 1990 and 2000. All six metro areas grew significantly in population during in the 1990s. If we compare the population growth figures to the number of immigrants who arrived in the 1990s, it is clear that immigration has played a very large role in growing the population of all six metro areas. Even in the Washington-Baltimore CMSA, the number of immigrants who arrived in the 1990s (348,000) was equal to almost half of the 701,000-person increase in the area’s total population. If the 175,000 children born to immigrant parents in the Washington-Baltimore metropolitan area during the 1990s are added to the number of immigrants who arrived in the 1990s, then immigration is equal to almost 75 percent of the CMSA’s population growth.

Table 19 examines the distribution of immigrants and natives between the nation’s central cities, suburban, and rural areas. With 44.8 percent of immigrants living in the nation’s central cities compared to 26.2 percent of natives, immigrants are clearly much more likely than natives to live in central cities. But contrary to the general impression, most immigrants do not live in the nation’s central cities. In fact, immigrants are just as likely as natives to live in the suburbs. As Table 19 shows, the primary difference between the two groups is that natives are much more likely to live in rural areas while immigrants are more likely to live in central cities. The large number of immigrants who live in suburban areas may be a positive sign that immigrants are successfully integrating into American society and obtaining a middle class standard of living. On the other hand, it is in suburban areas where the problems of sprawl and congestion are most acutely felt. Thus, the nearly 13 million immigrants who have settled in suburbia are likely to have contributed to these problems.

Conclusion

While immigration’s impact continues to be the subject of intense national debate, there can be no doubt that the large number of immigrants now living in the United States represents an enormous challenge. With more than half of post-1970 immigrants and their U.S.-born children living in or near poverty and one-third having no health insurance, the situation for immigrant families is clearly precarious. While the current economic expansion may tempt some to ignore these facts, when the next economic downturn occurs the costs of immigration will likely become glaringly apparent. Setting aside the lower socio-economic status of immigrants, no nation has ever attempted to incorporate more than 28 million newcomers into its society. Moreover, without a change in immigration policy, the Census Bureau projects 11 to 12 million immigrants will arrive in the next decade alone. Thus, immigration’s impact will continue to grow if current trends in immigration are allowed to continue.





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July 25th, 2015

7/25/2015

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I will be using weekends to talk elections as the 2016 election season approaches.  I tend to talk much about Baltimore politics because I live in Baltimore and it has a great deal of power in Maryland politics-----which I obvious feel could be supporting better political policy goals.  It is no secret that Baltimore politics are largely controlled by a black majority population and it is again no secret that politics is captured by a very neo-conservative Johns Hopkins and a completely controlled Wall Street Baltimore Development.  So, my posts about Baltimore politics does have a heavy black political outing of bad players THAT IS NOT RACIST.  MANY BLACK CITIZENS WANT TO GET RID OF BAD BLACK POLITICIANS IN CITY HALL AND MARYLAND ASSEMBLY.

Today I want to look at who drives Baltimore politics outside of the gorillas in the room----Johns Hopkins and Baltimore Development and that Montgomery County....VERY WHITE AND VERY RICH AND THE SOURCE OF ALL THAT IS CORPORATE FRAUD AND GOVERNMENT CORRUPTION.  So, my organizations is not just beating up on one set of players undermining the Democratic Party and US electoral politics----

WE ARE OUTING THE RICH WHITE PLAYERS DRIVING ALL OF THE LOWER LEVEL FRAUD AND ELECTION CORRUPTION.


Republican voters have no doubt loved having Clinton neo-liberals controlling Montgomery County and Prince Georges County and Hopkins neo-conservatives controlling Baltimore City because both are pushing Republican policies.  But, Republican voters let this go on too long before they realized that both Clinton neo-liberals and Bush neo-cons are dismantling their rights as citizens and the US Constitution and national sovereignty-----meaning it is bad for both Republicans and Democrats.

The American people are beginning to hate the Federal government as they hate the defunded public schools and transportation because it is dysfunctional and corrupt.  THAT DOES NOT MEAN THE FEDERAL GOVERNMENT IS BAD WHICH IS WHAT BUSH NEO-CONS AND CLINTON NEO-LIBERALS WANT YOU TO THINK AS THEY HAND AMERICANS OVER TO A GLOBAL CORPORATE TRIBUNAL.  The wealth around Washington DC is connected to the private outsourcing of all Federal work to global corporations and the areas in Maryland and Virginia around the Washington beltway are loaded with those global corporations sucking the US Treasury dry with fraud.  This is why those counties around the beltway are the ones richest----THEY ARE THE SOURCE OF THE FLEECING OF OUR US TREASURY.

Much of this is done with overseas funding of foreign development and military protection of US global corporations and markets------the NGOs and the Defense/Spy Industry.  A great deal of this has to do with using poor cities like Baltimore to suck dry all Federal funding that comes from social programs and social services.  THIS HAS BEEN MODUS OPERANDUS FROM REAGAN/CLINTON TO BUSH/OBAMA.  It is deliberate.  It makes us hate our Federal government and it allows movement of all the nation's wealth to these few rich players.

MONTGOMERY COUNTY DRIVES ALL OF THE FRAUD AND GOVERNMENT CORRUPTION IN BALTIMORE AND ITS POLS ARE AS BAD AS BALTIMORE POLS.



WJLA, September 20, 2012


Top 10 richest counties in U.S. - 7 in D.C. area According to The Washington Post, seven counties in the D.C. area are in the top 10 richest in the nation. One boasts a median income of $119,000! Do you live in one of the richest counties?



New numbers from the Census Bureau hint that the economy may be turning for the better.



And the same report shows many local communities are doing quite well financially.

The District is is surrounded by counties that are among the top in the nation for household incomes.

Least surprised to hear that Loudoun County tops the country with the highest household incomes in America? Those that live there.

They cite great schools as a reason for moving there and they say the houses are expensive.

Counties within the Washington region claimed seven of the top ten spots for median income. And all average over $90,000. Loudoun averages more than $119,000.

Behind Loudoun and Fairfax Counties, Arlington County is number three on the list. And that's especially impressive because single-income households make up 40 percent of the households.

Also in the top ten are Howard, Prince William, Fauquier, and Montgomery.


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So, when the politics of Affordable Care Act play out with only people earning around $250,000 affording what we all know to be first world health care----it will be these citizens----and they are only a few percentage of an entire state------will be the ones getting access to that health care. That is why they are out their posing progressive pushing these very Republican policies in Montgomery County----posing progressive as Clinton neo-liberals. The same dynamic plays ou...t across the nation in each state to a lesser degree because these states get much less Federal funding. In states it is always the richest counties that are sucking our Federal Treasury dry using these frauds centered in the poor cities using social programs and services to defraud----like Medicare/Medicaid frauds, subprime mortgage frauds. Montgomery County was ground zero for the subprime mortgage frauds with MERS being the tool of fraud----as was the San Francisco area where many of the mortgage origination corporations were located. THAT IS WHERE YOU FIND THE WEALTH IN A STATE AND IT IS ALL CENTRALIZED ON GAINS FROM MASSIVE FRAUDS THROUGH THE CLINTON/BUSH/OBAMA ADMINISTRATIONS. It is this dynamic that REAL progressive labor and justice needs to change. As black professionals and labor union members are beginning to see where all this ends----they are waking up to the need to move away from global market and neo-liberals and keeping global corporations at bay. There are still people of color and former labor union people rolling in the dough for now---these are the sociopaths that will take the nation anywhere as long as they are made wealthy. Most US citizens are not sociopaths.
Notice Howard and Mongomery County lead ----and know where all of the Baltimore City contract bids go every year?  To Howard County and Montgomery County corporations largely global corporations now.  This is also where much of the corporate fraud and government corruption is found.
A few percentage of black and Hispanic citizens are brought into this enrichment on a lower level and they are the ones sent to Maryland Assembly and local government to push bad policy always running as Democrats in largely poor communities.

This dynamic worked well for these players these few decades but with Trans Pacific Trade Pact and the huge economic crash taking out government and the stock market----these players are going to fall with everyone.

WE CAN PROTECT AGAINST ALL THIS IF WE ENGAGE NOW IN POLITICS SO GOOD PEOPLE ARE CONTROLLING LOCAL AND STATE GOVERNMENT AS THESE CRASHES AND TPP UNFOLD.


The D.C. suburbs dominate the list of wealthiest U.S. counties

By Carol Morello December 12, 2013

The Census Bureau has confirmed that, once again, the Washington region dominates the list of the most affluent places in the United States.

Among more than 3,000 counties across the nation, Loudoun County is the richest, with a median household income last of almost $119,000. Maryland’s Howard County and Virginia’s Fairfax, Arlington and Stafford counties also made it into the top 10. Three New Jersey counties outside New York City also were among the well-off top 10.

The Census Bureau listed the city of Falls Church, where the median income is $121,000, as the richest location, but that’s just because of a quirk in how the census ranks independent cities in Virginia alongside much larger counties instead of with cities or towns. Montgomery County and Prince William County fell just below the 10 wealthiest counties. Also in the top 30 were Charles, Calvert, Anne Arundel and St. Mary’s counties in Maryland, and the city of Fairfax in Virginia.

The Washington area has reigned at the top of the most affluent counties for years, in large part because it has so many residents with college degrees working at professional jobs. That gives the region a disproportionately large share of two-income households in which both adults have well-paying jobs.

Here’s the Census Bureau list of the counties with the highest median incomes (including tiny Falls Church):

  1. Falls Church city, Va. $121,250
  2. Loudoun County, Va. $118,934
  3.  Los Alamos County, N.M. $112,115
  4.  Howard County, Md. $108,234
  5.  Fairfax County, Va., $106,690
  6.  Hunterdon County, N.J. $103,301
  7.  Arlington County, Va. $99,255
  8.  Douglas County, Colo. $98,426
  9.  Stafford County, Va. $95,927
  10. Somerset County, N.J. $95,574
  11.  Morris County, N.J. $95,236
  12.  Montgomery County, Md. $94,365
 13.       Prince William County, Va. $93,011


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  1. I started my state organization several years ago in response to this group below knowing they were Clinton neo-liberal progressive posers.  Not without coincidence they are based in Montgomery County as and they have a branch in Baltimore City as is true of most  non-profits posing progressive.  Progressive Maryland gathers REAL progressive citizens to push what they think are progressive issues and then tell everyone connected to them to VOTE FOR THE MOST RAGING OF CLINTON NEO-LIBERALS IN ALL STATE ELECTIONS.  IT IS A SCAM FOLKS.
Progressive Maryland is run by people appointed by the rich in Montgomery County to capture Maryland politics away from real progressive labor and justice.  The talking point issues always come from Congressional Clinton neo-liberals and always push policy these global corporate pols know will go nowhere.  This group does support some good issues but when you tell people to vote for raging Clinton neo-liberals---you know those progressive bones will never happen.

Black voters in Baltimore are not fooled----they know all of this is corrupt and so the word progressive is tied to all of this corruption coming from Montgomery County which is indeed very elite and white-----ergo, the bad vibe for REAL progressive liberalism.


THAT BAD VIBE IS THE GOAL OF CLINTON NEO-LIBERALS TRYING TO KILL ALL THAT IS PROGRESSIVE POLICY!










PROGRESSIVE MARYLANDProgressive Maryland builds power for working families by mounting issue campaigns and organizing people to take action on issues that will improve the lives of working families. We are made up of over 23,000 members and supporters and over 30 affiliated religious, community and labor organizations making change through research, public education, and direct political action in Annapolis, Washington and communities statewide.  

Progressive Maryland provides statewide leadership and coordination in a range of national and regional campaigns and coalitions. Working together with hundreds of community, religious, labor and other grassroots allies at all levels, we have succeeded in educating the public and building popular support to achieve numerous progressive reforms including the following.

_____________________________________________

It is no coincidence as well that the last two Maryland Attorney General's came from Montgomery County in place as the bulk of the systemic corporate fraud is revealed and global corporations and Wall Street needing people in these public justice offices to make sure no fraud is recovered or convicted.  We are talking about the massive billions and trillions of dollars and not the low-level local fraud by the players being used to move all this larger fraud.

Maryland Attorney General Doug Gansler from Montgomery County was the I SEE NOTHING THAT IS FRAUD ALL LAST TERMS IN OFFICE AND BRIAN FROSH WILL BE THE NEXT AS THIS BOND MARKET FRAUD AND ECONOMIC CRASH HITS.



Brian Frosh went so far as to make writing and pushing a bill that makes his office the only one able to prosecute government corruption cases because the bond market fraud involves huge government corruption.  These laws are illegal and unconstitutional ----but Brian Frosh from Montgomery County is in there fighting away for the global corporate fraudsters all while running as a progressive Democrat in Maryland.


5 questions with new Maryland Attorney General Brian Frosh Jan 13, 2015, 2:21pm EST

Rick Seltzer Reporter Baltimore Business Journal Bizspace Spotlight Sponsor Listing Property Spotlight: Buckingham See All Bizspace Properties Enlarge Brian E. Frosh

Brian Frosh brought up business issues when he was installed as Maryland's attorney general last week — issues like creating an attractive business climate in Maryland and protecting the environment.

The new Democratic attorney general, a former state senator from Montgomery County who won election in November, will have plenty of interactions with the state's business community. He's the state's top legal officer, a role that has him overseeing business-centric topics such as the Maryland Antitrust Act, consumer protection and enforcement of securities regulations.

Frosh answered questions this week about his role, his ideas on business and his prospects for working with Republican Gov.-elect Larry Hogan.

What can businesses expect from you as attorney general?


One thing that I don't think people focus on necessarily when they look at the attorney general or the attorney general's office is that the office can have a favorable impact on business by being responsive or prompt.

I've heard during the campaign that people see the office as a bottleneck on many occasions. They need an answer to something. They'd like a "yes," but they often don't get any answer. I know from my clients in private practice, they want a "yes," but if they're not going to get a "yes" they want a "no" and they want it right away.

One thing I think the office can do that would have a very favorable impact on business is to be responsive and prompt. That's something that will be at the top of our list.

Do you have any other priorities?

Another thing I think is important to the business climate is making sure the rules are simple, clear and fair. We don't get to write the rules, per say, but we certainly have an impact on making them simple, clear and fair.

Enforcing the rules according to the law is important to business. If people can cut corners, some folks will cut corners. They put the law-abiding business at a competitive disadvantage if the laws are not enforced.

Is it the role of the attorney general's office to clarify rules?

Many of the rules are written in agency regulations. Assistant attorneys general get to review those, make suggestions and make changes. They don't get to set the policy, but they can have important input.

When you were installed you pledged to hold polluters accountable. How does that fit into your attitude toward business?

That area is a good example of what I was talking about a minute ago. There are lots of businesses that have permits to admit pollutants. They're regulated. You can't have more than X milliliters per gallon in your effluent or in the gasses that are admitted from your business.

If folks are cheating on that, it puts competitors at a disadvantage. It's important the law be enforced.

You're a Democrat who cares about environmental issues and Larry Hogan is a Republican who ran against what he called a "rain tax." Do you see possible clashes with the governor in the future?


The governor is and will be my client. State agencies are my clients. So we'll have a cooperative relationship. There will be differences of opinion regardless of who the governor is between the governor and the attorney general. It could be my mother and I would have differences of opinion. That's inevitable.

The overarching principal is we will have to work with each other. We will have to cooperate. I will give him the best possible legal advice, and I think we can get along.


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Across the nation after 2008 crash made the massive subprime loan fraud public lawsuits started against the multiple levels of fraud.  Maryland was ground zero for the MERS end of this massive fraud as MERS corporations were located in Washington suburbs of course.  This is where all those tens of millions of subprime mortgage loans that were securitized and sold over and over again with each time moving those mortgages through MERS retitling of these home titles.  Massive amounts of personal and Federal Housing subsidy for those low-income homeowners went to these MERS operations. 

THIS IS WHY MONTGOMERY COUNTY IS RICH.  THIS IS WHERE DOUG GANSLER AND BRIAN FROSH SERVED AS LAWYERS AND POLS.

Now, we all know the courts failed to protect the American people and give justice and we can get rid of judges that protected this crime by impeachment----what is important is to see how all of Democratic politics is tied with getting these people in office and they run as Clinton neo-liberal Democrats.

At the same time these Clinton neo-liberal candidates aways embrace a few progressive bones to bring environmentalists, labor and justice groups giving them only that issue as they are fleecing America of all public wealth.  Almost all of these people in Maryland are white-----and many are found in the Washington beltway. 


Below you see Maryland courts ruled protecting MERS while Washington State courts and many others ruled against MERS.
  Because no one pursued this issue----MERS is still operating and more subprime mortgage loans will crash in this coming economic crash.


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MARYLAND Suss vs. JP Morgan Chase Bank US District Court Maryland   "As to...MERS, courts that have considered the issue have found that the system of recordation is proper and assignments made through that system are valid".

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State Supreme Court rules against MERS in mortgage foreclosure challenge

By Connie Thompson Published: Aug 20, 2012 at 7:27 PM PDT



A new state Supreme Court ruling could put hundreds of home foreclosures in question in this state, where the foreclosures were initiated by an organization known as MERS.

MERS stands for Mortgage Electronic Registration System. It's a central tracking system that essentially represents the person  or investor that holds the note on a loan when a mortgage is sold.   

Lenders have been using MERS to initiate foreclosures, even though MERS doesn't actually hold the loans. MERS and lenders maintain that under their system MERS is a legal beneficiary of the promissory note.  But in a 9-0 decision justices ruled that's not what Washington state law intended.

When Kristin Bain hired an attorney to fight illegal lending practices involving her Tukwila condo, she never dreamed the case would end up in Olympia.  Bain's case is one of two similar cases argued before the state Supreme Court last Spring.

Years earlier, Bain was the victim of a predatory mortgage loan that Huelsman says violated the law and stuck Bain with unfairly high mortgage rates and mortgage payments.  While settling that case, Bain got laid off, and began to miss mortgage payments. 

She was sent to foreclosure by MERS.  Attorney Melissa Huelsman cried foul when no one could identify the actual loan holder and.  Citing state law, Huelsman filed lawsuits, and stopped the foreclosure while attempting to identify the loan holder who could rightfully address Bain's concerns about the foreclosure process.  

Huelsman says the loan holder was never identified.  Her lawsuit made it's way to the state Supreme Court in March, where Huelsman presented oral arguments against MERS, the lenders and their Attorney Robert Pratte.

In a unanimous decision, the 9 justices just ruled August 16th that under our state law,  the beneficiary must hold the promissory note. 

The bottom line- based on Washington state law, MERS is not a legal beneficiary unless it actually held the promissory note secured by the deed of trust when foreclosure was initiated- which in Bain's case, it did not.

"Obviously the court said no, MERS cannot be that entity, because it is not the note holder and it never is the note holder," explained Huelsman.

Huelsman says the implications are huge- with the potential to affect hundreds, perhaps thousands of foreclosures initiated by MERS in this state in the past 10 years.

The ruling could open the door for legal action by homeowners who've been foreclosed by "MERS,"  instead of an actual loan holder who's name is on the promissory note.  It also has the potential to affect foreclosures currently being challenged because of MERS.

But the justices ruled that simply having MERS on your loan doesn't mean you  have a case. The question is whether you suffered unfair ramifications because of MERS.

Washington state is one of several states where the legality of MERS initiated foreclosures is being challenged in court.



______________________________________________



THIS IS THE CLINTON NEO-LIBERAL STRATEGY TO KILL REAL PROGRESSIVE LIBERALISM-----

Here is Baltimore's Johns Hopkins neo-conservative voice------Ben Carson telling us that progressive liberals are white elitists -----he's not telling people that Clinton neo-liberals are Wall Street global naked capitalists like Bush neo-cons and have controlled the Democratic Party for the few decades that all civil and labor rights and liberties have been under attack. Carson's job as a Hopkins' ambassador is to make people think progressive liberalism is bad ------not Clinton neo-liberalism. Bush neo-cons and Clinton neo-liberals are a tag team for global corporate tribunal rule. Black citizens are welcome to vote any way they want-----but REAL progressive liberals want that message honest and straight!





Ben Carson: White Liberals Are 'The Most Racist People'



The Huffington Post  |  By Luke Johnson and Preston Maddock

Posted: 04/02/2013 11:52 am EDT Updated: 04/02/2013 6:38 pm EDT  Huffington Post


Dr. Ben Carson, a black Johns Hopkins University neurosurgeon and conservative favorite after challenging President Barack Obama at the National Prayer Breakfast, said Monday on "The Mark Levin Show" that white liberals are "racist."

"And you're attacked in many respects because of your race. You're not supposed to think like this, and supposed to talk like this. A lot of white liberals just don't like it, do they?" said Levin, host of the syndicated radio show.

"Well, they're the most racist people there are. You know, they put you in a little category, a little box -- you have to think this way. How could you dare come off the plantation?" responded Carson.

Carson is scheduled to speak at the Hopkins' School of Medicine commencement ceremony this year. A group of students petitioned to have him replaced as speaker after he compared gay marriage to bestiality and pedophilia last week. Carson said Friday that he was prepared to withdraw.

The school told HuffPost Friday that it had heard of no change in plans and said he was chosen for his medical accomplishments, not personal views.

Carson said Monday that it was "to be determined" whether he would speak and that he was going to "wait and see."


_______________________________________________

Looking locally----Baltimore citizens are used to this-----Baltimore Board of Estimates is jammed with fraud and corruption as its awards often times than not are loaded with hundreds of millions of dollars in overpricing.  What also happens is those awards go to contracting corporations often in Howard or Montgomery County and if one looked closely these are almost all global corporations posing local.  So, Howard and Montgomery County gets all that Baltimore City revenue and work often bringing in crews filled with immigrant workers who are fleeced and impoverished and VOILA-----Howard and Montgomery County become the most wealthy in the nation.

This has been happening for a long time and it is how local businesses tied to Hopkins and Baltimore Development went from being small to global and believe me----this involves just a few percentage of the rich in Baltimore.

You can see they are using bidding regulations to skirt all laws meant to protect citizens wanting their business to win and citizens wanting to work at the same time it allows awards to go to global corporations all over the nation that then milk the city of revenue-----ALL FRAUD.

Now, there is not one Democrat coming from Baltimore City----these are not pols folks----they are simply working for Wall Street Baltimore Development and Johns Hopkins so we do not want people hating the Democratic Party because of these corrupt players. 

WE MUST REBUILD BALTIMORE DEMOCRATIC COMMITTEES AND MARYLAND DEMOCRATIC PARTY WITH REAL PROGRESSIVE LABOR AND JUSTICE LIBERALS.  THIS HAPPENS BY DEMANDING THAT LOCAL PRIMARY ELECTION PROCESSES---FROM MEDIA, TO 501C3s, TO BALTIMORE BOARD OF ELECTIONS WORKS.  ALL ARE CORRUPTED AND OPENLY ACTING ILLEGALLY ACCORDING TO ELECTION LAW!


Cost of city's water meter overhaul rises



Water is spilling out of the water meter cover on the sidewalk in front of Monica Amneus' and Aaron Smith's house. (Amy Davis, Baltimore Sun) By Luke Broadwater The Baltimore Sun contact the reporter
  • Bernard C. Young
Baltimore's water meter overhaul costs rise to $105.8 million. The cost of a massive project to overhaul all of Baltimore's more than 400,000 water meters is rising again — this time by about $4.2 million.

On Wednesday, Baltimore's Board of Estimates is expected to allocate the additional money to the project, approving a $3.2 million contract with Metra Industries Inc. to perform "urgent" infrastructure repairs as part of the overhaul. The additional $1 million is going to the Department of Public Works for administration, officials said. The city is seeking several more contractors to perform similar work.

The latest contract award brings the project's price tag to $105.8 million.

City officials say the additional contractors will deal with time-consuming construction situations that arise during the overhaul, thereby freeing up the main contractor, Itron Inc. of Washington state, to install other meters. City officials want Itron to finish installing the new meters by 2017.

  Kurt Kocher, a spokesman for the Department of Public Works, noted that Itron's contract has not increased. "Sooner or later these repairs would have had to be done," he said of the crumbling infrastructure.

In 2013, city officials awarded an $83.5 million contract to Itron to install meters for a wireless meter system to serve the system's more than 400,000 customers in Baltimore and Baltimore County. Mayor Stephanie Rawlings-Blake has said the upgrade is part of an effort to end "outrageous" water bill mistakes that have infuriated residents and forced the city to issue millions in refunds.

Waiting for water: Residents count on city crews to deliver The Itron bid was about $100 million less than a competitor's, and City Council President Bernard C. "Jack" Young and Comptroller Joan Pratt said they planned to watch the project closely to make sure costs did not rise over time.

The Board of Estimates has already authorized $9.7 million more to hire contractor EMA Inc. to "ensure that the program moves forward efficiently and expeditiously," and $8.4 million to hire Belgian company Itineris to overhaul the water-billing system, which connects to the new meters.


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The US has always needed more political parties.  We have tried for decades to open up left-leaning politics to Socialists, Green Party, et al.  One thing I try to say to my Socialist and Communist left-leaning friends-----NOW IS NOT THE TIME AS EVEN THE MAJOR LEFT PARTY----THE DEMOCRATIC PARTY ----IS UNDER ATTACK.

As I showed the Clinton neo-liberals and Bush neo-cons are simple the same pols working for a global corporate tribunal party as I call it.  They worked these few decades making Clinton neo-liberals look progressive and now they are ready to corrupt left-leaning politics with this far-right Libertarian neo-conservative Marxist Stalinism.  Make no mistake----until we reinstate Rule of Law, Equal Protection, and stabilize our election process absolutely no political party will be allowed to be what it intends.  We all know who the Economist works and as they try to make it seem a moderate party is needed-----I would suggest they are working for a global corporate tribunal party.  Spector did not fit well with a Democratic Party because it is raging Clinton neo-liberal and looking just like the Bush neo-cons he was seeking to avoid.

So, please work for social Democracy to rebuild those structures and then we can return to working to expand political parties.



America needs more political parties



Apr 29th 2009, 5:07 by The Economist | NEW YORK



FOR any truly moderate person, the most disappointing aspect of Alren Specter's defection was not that he left the Republicans, but that he joined the Democrats. And so the two-party system wins again.

Mr Specter will likely feel as unwelcome with the Democrats as he did with the Republicans. Political hackery nowadays is measured by how often you disagree with your own party. Just ask Ben Nelson or Evan Bayh, who are constantly taking heat for their more moderate positions. But does anyone really believe that two parties should represent all of America's diverse political viewpoints? It's a ridiculous notion, one that leaves moderate politicians like Mr Specter in political no man's land.

Democrats may seem to have the bigger tent right now, but in order to truly enter you still have to agree with those inside. Already there are calls to mount a strong primary challenge to Mr Specter. In this way, I have almost come to respect Republicans for (unintentionally) shrinking their party. What would be unfortunate is if other defectors felt their only choice upon leaving was to become a Democrat.







0 Comments

July 24th, 2015

7/24/2015

0 Comments

 
I would like to end for now the talk on health care policy by reminding people that if Baltimore went with a public health system to compete with Maryland's private one and if Baltimore built oversight and accountability in all Medicare and Medicaid use in Baltimore then there would be no interest by the private MedStars or the non-profit as privatization EverGreen insurance plans because they only exist to defraud and privatize.  Could Baltimore have done this 3 decades ago and protect those citizens dying 20 years too soon from lack of access to health care?  YES, IF THEY WERE REAL DEMOCRATS AND NOT WORKING FOR NEO-CONSERVATIVE JOHNS HOPKINS.

Each state should do the same in the cities having the most use of Medicare and Medicaid to get this EXPANDED AND IMPROVED MEDICARE FOR ALL on the road.....you cannot simply shout at state legislatures.



MARYLAND IS THE ONLY STATE SEEKING AN EXEMPTION FROM MEDICARE REGULATIONS AND BOASTS OF HAVING MORE HEALTH CARE WITHOUT HOSPITALIZATION----THAT IS CODE FOR CITIZENS ARE NOT ALLOWED ACCESS TO ORDINARY CARE WHICH IS WHY THERE IS A 20 YEAR LIFE SPAN DIFFERENCE IN BALTIMORE.....SAME AS THIRD WORLD NATIONS. THIS IS SUPPOSED TO BE A GOOD MODEL BECAUSE HOSPITAL PROFITS WERE SUSTAINED.



Maryland has used the model of excluding citizens from access to hospitalization they deserved for decades pretending that was bringing down hospital costs all while health industry fraud soared.  That is why more and more health care happens in Maryland without hospitalization especially in Baltimore.  Even Maryland Assembly pols admit that Medicaid funding is mostly not spend on health care.

Keep in mind it is Baltimore's pols that lead the way in complete deregulation from Medicare over a few decades just so citizens could be denied the level of care they were guaranteed by Federal Medicare.

'Today, more and more health care happens without hospitalization'.


This hurt mostly the working class and people made poor by long-term unemployment--ergo, the industrial workers in the city et al and that was a large crowd.  Now, Baltimore pols have set the stage for city pensions to go down the drain with those citizens falling into Medicaid-level care.  You see below as well this pressure to decrease spending as baby boomers hit making it a sure thing access is cut to slow spending.

If you wonder how these pols running as Democrats and serving as Hopkins' neo-conservatives stay in office -------over 600,000 Baltimore citizens do not vote.  The ones that do do so to keep a job.


WE CAN REVERSE THIS EASY PEASY IF DEMOCRATIC VOTERS WOULD BECOME ENGAGED AND BE THE CANDIDATES IN ALL PRIMARIES AGAINST CLINTON NEO-LIBERALS.


Maryland’s Medicare waiver now front and center


May 4, 2012, 6:00am EDT

Ben Fischer Staff Reporter Washington Business Journal

Independent hospitals such as Doctors Community Hospital would have to negotiate on the… more

Maryland hospitals reluctantly swallowed a near freeze on rates May 2, but the state’s health care industry will now turn to an all-hands-on-deck attempt to save the unique system that allows strict government regulation of hospital rates in the first place.

The state’s authority comes from a 35-year-old exemption from standard Medicare rules, but the waiver comes with an important condition: Hospital costs must grow more slowly in Maryland than in the rest of the country, or the exemption goes away.


After meeting that standard by wide margins for decades, Maryland’s health care inflation has nearly caught up to national trends in the past year, putting the exemption in imminent danger. The .3 percent rate hike — comprised of a 1 percent cut to inpatient rates and a 2.59 percent boost to outpatient services — will delay Judgment Day, but Maryland officials agree the only long-term solution is to change what they call outdated rules for the exemption.

Stakes are high. Hospitals and politicians nearly universally defend the protection offered by public utility-style regulations, and many predict turmoil if they goes away.

  “There would clearly be some market consolidation, and we’d probably have fewer hospitals,” said Michael Stitcher, director at the Berkeley Research Group in Baltimore, who advises hospitals on financial policy. “I think it would be a pretty tumultuous road for several years.”

Hospitals serving predominately poor patients, such as Prince George’s Hospital Center, would be further challenged to stay in the black. Independent facilities such as Doctors Community Hospital in Lanham would struggle to stay afloat without the clout to demand higher rates from insurers in direct negotiations. And lenders would factor new uncertainty into the cost of long-term debt, experts say.

The Health Services Cost Review Commission, which sets rates, has formed a work group that is “kicking around some of the major concepts” of reforming the exemption rules, said Executive Director Patrick Redmon. The commission hopes to present a white paper to the federal Centers for Medicare & Medicaid Services, which would ultimately approve the changes.

There’s not much time for what will surely be a complicated process, both technically and politically, said Carmela Coyle, president of the Maryland Hospital Association. She believes the issue needs to be solved by November, in time for next year’s rates to be set. “There’s still quite a bit of work to be done,” she said.

The “waiver modification effort” is set on addressing two major flaws that have developed in the federal exemption rules, as defenders see it: The rules reflect the 1970s-era hospital industry, in which most care involved overnight admissions and cost-containment strategies built around cutting days off of stays.

Today, more and more health care happens without hospitalization.
As lower-cost cases migrate to the outpatient side of the ledger, it drives up the per-case cost on the inpatient side, hurting Maryland in the “waiver test.”

Maryland has also assessed hospitals a fee to generate more federal matching funds in the Medicaid program.
And those fees contribute to higher inflation, as defined in the rules. The state has included various reform efforts, such as not paying hospitals for re-admitting patients for the same condition, in the rates.

The ultimate solution would have to satisfy Maryland regulators, the hospital industry writ large and the mega-players Johns Hopkins Medicine and the University of Maryland Medical System, influential insurance companies such as CareFirst BlueCross BlueShield and the federal government.

CareFirst, which unsuccessfully argued for a cut to outpatient rates too, will work with hospitals, the commission and other stakeholders in doing “everything possible to preserve the waiver,” the insurer said in a corporate statement distributed by spokesman Scott Graham.

“CareFirst believes it is imperative that Maryland retain its unique hospital all-payer system,” the statement reads. “It brings more than $1 billion in additional federal (Medicare and Medicaid) funding to the state, which we cannot afford to lose.”

Politically, the stars could be aligned for proponents of the system, observers say: For the moment, Maryland has influential politicians on its side, namely Sen. Barbara Mikulski, the Democrat who wrote the waiver into federal law in 1980. Also, the Obama administration will likely be amenable to saving a system that enables many of his reform initiatives.

“The hospitals will have to believe the reforms make sense from their perspective,” Stitcher said. But he added: “I think there’s a good chance the waiver can be redesigned and modernized.”

Rate regulation is a nearly dead concept elsewhere in the country. About 30 other states regulated hospital rates to one degree or another at one point, but now Maryland is alone. Throw in the possibility of the Supreme Court overturning the 2010 federal health care overhaul law and the possibility of a new Republican administration taking over Medicare in January, and it’s an open question whether the new rules would win federal approval.

“Part of this depends on the federal government’s time frame,” Redmon said. “We’ve been in informal discussions back and forth, but there’s no formal process at this point.”

______________________________________

So far I have explained how Baltimore City would develop a public health system to compete with Maryland's very private one and given many examples of how to fund this.  One thing that makes a domestic economy work is local businesses hiring locally and earning enough money to consume locally to fuel the economy.  Baltimore has none of that and it is deliberate-----Baltimore City Hall and Maryland Assembly passed laws that create the environment for high poverty and unemployment because they want it that way.....well, Baltimore Development and Johns Hopkins wants it that way.

One of the first things a REAL progressive liberal would have done a few decades ago when Baltimore's industrial base left would be to subsidize just as Baltimore subsidizes global corporations now, local factories and manufacturing.  One example would be manufacturing all of the generic drugs that our citizens and surrounding areas will use in the course of a year.  We must get people used to buying local and spending just a little more as we move away from a global economy.  Building a domestic economy does not exclude global markets-----it simply makes local markets dominate and that is what will make Baltimore a healthy stable economy with most people employed.

Now, call me crazy but it seems a city government could be that business gearing up for manufacturing generic drugs.  Now, remember, Trans Pacific Trade Pact seeks to make it harder to produce generics in nations tied to this treaty so we are going to start now to fight this. 


Drug Patents and Generic Pharmaceutical Drugs




By Dr Ananya Mandal, MD

When a pharmaceutical company first develops a new drug to be used for a disease condition, it is initially sold under a brand name by which the clinicians can prescribe the drug for use by patients. The drug is covered under patent protection, which means that only the pharmaceutical company that holds the patent is allowed to manufacture, market the drug and eventually make profit from it.

In most cases, the drug patent is awarded for around twenty years in the United States. The lifetime of the patent varies between countries and also between drugs. Since the company applies for a patent long before the clinical trial to assess a drug’s safety and efficacy has commenced, the effective patent period after the drug has finally received approval is often around seven to twelve years.


Once the patent has expired, the drug can be manufactured and sold by other companies. At this point, the drug is referred to as a generic drug. According to guidelines in most countries, including those from the US FDA, generic drugs have to be identical to the branded drug in terms of efficacy, safety, usage, route of drug administration, pharmacokinetics and pharmacodynamics.

Therefore, a drug can be manufactured as a generic drug when the following apply:

  • Its patent has expired
  • The company that would manufacture the generic drug certifies that the patents held on the drug are either unenforceable, are invalid or would not be infringed upon
  • There has never been any patents on the drug before
  • In countries where the drug has no patent protection
Once the generic drug is on the market, the monopoly of the patent holder is removed. This encourages competition and results in a significant drop in drug costs, which ensures that life-saving and important drugs reach the general population at comparative prices.

The company holding the initial patent may, however, renew the patent by forming a new version of the drug that is significantly changed compared to the original compound. However, this may require new clinical trials and re-application of the patent. Furthermore, the new compound may have to compete with the original generic molecule on the market, unless the drug regulators find faults and remove the original from the market altogether.


__________________________________________________

Now, Clinton neo-liberals have all of use busy with 'innovations' and 'startups' because all of that creates new business ideas and products that global corporations can then buy cheap----THEY ARE USING CITIZENS TO CHEAPEN PRODUCT DEVELOPMENT FOR GLOBAL CORPORATIONS.  All of Maryland's economic funds go to this huge corporate subsidy.

Imagine if instead of robotics and other advanced STEM projects our schools would simply design ordinary medical products----not too fancy because we do not want to be sued for injury---that we could then patent and produce right in a community factory and have our public hospitals, clinics, home care, and outpatient care purchase.  This could go to things from bandages to walking canes.

The point is this-----Clinton neo-liberals and neo-cons deliberately have focused all economic development to global markets and corporate subsidy while doing nothing to build a local economy. 

THAT IS THE DIFFERENCE BETWEEN A REAL PROGRESSIVE LABOR AND JUSTICE LIBERAL AND A CLINTON NEO-LIBERAL PHONY DEMOCRAT

All of this is easy peasy and all we need to do is GET RID OF ALL MARYLAND POLS ----THEY ARE NEO-LIBERALS AND NEO-CONS.

*********************************************************

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______________________________________________

This is what I call an example of profiteering. MRI machines have been around for decades. When they were first brought to hospitals the costs for the machines were high and hospitals worked the costs for these expensive medical equipment into the charges per patient. Well, those machines have been long paid for and what once compensated for cost is now simply profit. It is the fact that Clinton neo-liberalism removed the Democratic Party from public interest to corporate profit that allowed hospitals to continue to charge too much for services. With the new code word 'innovation' in medicine----the goal is to place this on steroids. Never allowing patented drugs to sunset for example to generics is the goal of reformulation going on in BioTech labs connected to universities.

One thing about a Federal stimulus meant simply to pay for these university research facilities and all that is in them----ALL THE EQUIPMENT IS PAID FOR AND SHOULD NOT BE FIGURED INTO HEALTH COST.


Simply auditing Medicare and Medicaid for these kinds of things will stop profiteering.  Our pols could have found all of these billing gimmicks easily and ignored them as health industry looted our Medicare and Medicaid Trusts.


Why an MRI costs $1,080 in America and $280 in France


By Ezra Klein March 3, 2012 Follow @ezraklein   New York Times


There is a simple reason health care in the United States costs more than it does anywhere else: The prices are higher.

That may sound obvious. But it is, in fact, key to understanding one of the most pressing problems facing our economy. In 2009, Americans spent $7,960 per person on health care. Our neighbors in Canada spent $4,808. The Germans spent $4,218. The French, $3,978. If we had the per-person costs of any of those countries, America’s deficits would vanish. Workers would have much more money in their pockets. Our economy would grow more quickly, as our exports would be more competitive.

There are many possible explanations for why Americans pay so much more. It could be that we’re sicker. Or that we go to the doctor more frequently. But health researchers have largely discarded these theories. As Gerard Anderson, Uwe Reinhardt, Peter Hussey and Varduhi Petrosyan put it in the title of their influential 2003 study on international health-care costs, “it’s the prices, stupid.”

As it’s difficult to get good data on prices, that paper blamed prices largely by eliminating the other possible culprits. They authors considered, for instance, the idea that Americans were simply using more health-care services, but on close inspection, found that Americans don’t see the doctor more often or stay longer in the hospital than residents of other countries. Quite the opposite, actually. We spend less time in the hospital than Germans and see the doctor less often than the Canadians.

“The United States spends more on health care than any of the other OECD countries spend, without providing more services than the other countries do,” they concluded. “This suggests that the difference in spending is mostly attributable to higher prices of goods and services.”

On Friday, the International Federation of Health Plans — a global insurance trade association that includes more than 100 insurers in 25 countries — released more direct evidence. It surveyed its members on the prices paid for 23 medical services and products in different countries, asking after everything from a routine doctor’s visit to a dose of Lipitor to coronary bypass surgery. And in 22 of 23 cases, Americans are paying higher prices than residents of other developed countries. Usually, we’re paying quite a bit more. The exception is cataract surgery, which appears to be costlier in Switzerland, though cheaper everywhere else.

Prices don’t explain all of the difference between America and other countries. But they do explain a big chunk of it. The question, of course, is why Americans pay such high prices — and why we haven’t done anything about it.

“Other countries negotiate very aggressively with the providers and set rates that are much lower than we do,” Anderson says.
They do this in one of two ways. In countries such as Canada and Britain, prices are set by the government. In others, such as Germany and Japan, they’re set by providers and insurers sitting in a room and coming to an agreement, with the government stepping in to set prices if they fail.

In America, Medicare and Medicaid negotiate prices on behalf of their tens of millions of members and, not coincidentally, purchase care at a substantial markdown from the commercial average. But outside that, it’s a free-for-all. Providers largely charge what they can get away with, often offering different prices to different insurers, and an even higher price to the uninsured.

Health care is an unusual product in that it is difficult, and sometimes impossible, for the customer to say “no.” In certain cases, the customer is passed out, or otherwise incapable of making decisions about her care, and the decisions are made by providers whose mandate is, correctly, to save lives rather than money.

In other cases, there is more time for loved ones to consider costs, but little emotional space to do so — no one wants to think there was something more they could have done to save their parent or child. It is not like buying a television, where you can easily comparison shop and walk out of the store, and even forgo the purchase if it’s too expensive. And imagine what you would pay for a television if the salesmen at Best Buy knew that you couldn’t leave without making a purchase.

“In my view, health is a business in the United States in quite a different way than it is elsewhere,” says Tom Sackville, who served in Margaret Thatcher’s government and now directs the IFHP. “It’s very much something people make money out of. There isn’t too much embarrassment about that compared to Europe and elsewhere.”

The result is that, unlike in other countries, sellers of health-care services in America have considerable power to set prices, and so they set them quite high. Two of the five most profitable industries in the United States — the pharmaceuticals industry and the medical device industry — sell health care. With margins of almost 20 percent, they beat out even the financial sector for sheer profitability.

The players sitting across the table from them — the health insurers — are not so profitable. In 2009, their profit margins were a mere 2.2 percent. That’s a signal that the sellers have the upper hand over the buyers.

This is a good deal for residents of other countries, as our high spending makes medical innovations more profitable. “We end up with the benefits of your investment,” Sackville says. “You’re subsidizing the rest of the world by doing the front-end research.”

But many researchers are skeptical that this is an effective way to fund medical innovation. “We pay twice as much for brand-name drugs as most other industrialized countries,” Anderson says. “But the drug companies spend only 12 percent of their revenues on innovation. So yes, some of that money goes to innovation, but only 12 percent of it.”

And others point out that you also need to account for the innovations and investments that our spending on health care is squeezing out. “There are opportunity costs,” says Reinhardt, an economist at Princeton. “The money we spend on health care is money we don’t spend educating our children, or investing in infrastructure, scientific research and defense spending. So if what this means is we ultimately have overmedicalized, poorly educated Americans competing with China, that’s not a very good investment.”

But as simple an explanation as “the prices are higher” is, it is a devilishly difficult problem to fix. Those prices, for one thing, mean profits for a large number of powerful — and popular — industries. For another, centralized bargaining cuts across the grain of America’s skepticism of government solutions. In the Medicare Prescription Drug Benefit, for instance, Congress expressly barred Medicare from negotiating the prices of drugs that it was paying for.

The 2010 health-reform law does little to directly address prices. It includes provisions forcing hospitals to publish their prices, which would bring more transparency to this issue, and it gives lawmakers more tools and more information they could use to address prices at some future date. The hope is that by gathering more data to find out which treatments truly work, the federal government will eventually be able to set prices based on the value of treatments, which would be easier than simply setting lower prices across-the-board. But this is, for the most part, a fight the bill ducked, which is part of the reason that even its most committed defenders don’t think we’ll be paying anything like what they’re paying in other countries anytime soon.

“There is so much inefficiency in our system, that there’s a lot of low-hanging fruit we can deal with before we get into regulating people’s prices.” says Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University. “Maybe, after we’ve cut waste for 10 years, we’ll be ready to have a discussion over prices.”

And some economists warn that though high prices help explain why America spends so much more on health care than other countries, cutting prices is no cure-all if it doesn’t also cut the rate of growth. After all, if you drop prices by 20 percent, but health-care spending still grows by seven percent a year, you’ve wiped out the savings in three years.

Even so, Anderson says, “if I could change one thing in the United States to bring down total health expenditures, it would definitely be the prices.”


0 Comments

July 23rd, 2015

7/23/2015

0 Comments

 
The American people fought back on managed care over decades of Wall Street wanting to make health care a global profit-making enterprise.  In the 1970s a progressive liberal Congress beat back HMOs-----then the Clinton neo-liberals tried as hard as they could and again, a progressive liberal Congress beat that back.  The same policies came about through Affordable Care Act only this time there were no progressive liberals in Congress to beat it back----Clinton neo-liberals are now controlling the Democratic Party.  This is because for these few decades national labor union and justice organization leaders were appointed neo-liberals.  So, you have this ultra-corporate consolidation and deregulation of our health industry with the ending of our Federal Trusts Medicare and Medicaid because you have allowed Clinton neo-liberals to control the Democratic Party----

GET RID OF THEM AND WE CAN REVERSE THIS.

Raise your hand if you know a group of health corporations working to build a managed care model will make sure profit over people exists!  That's right everyone.  These global pols like to say the fee for service was a bad model----it worked fine until Clinton neo-liberals and Bush neo-cons dismantled all oversight and accountability and fraud went wild.  If you provide oversight---fee for service works fine.  Managed care is made to sound effective and efficient but it is just an excuse to end Hippocratic Oath doctor working for the good of the patient out---and maximizing profits in.  Look to the last article---a long one for what was a good analysis made back when Clinton tried to install managed care. 
Maryland's private health system is the most profit-driven in the nation and most consolidated and deregulated because ALL MARYLAND POLS ARE CLINTON NEO-LIBERALS AND BUSH NEO-CONS.  All of Baltimore's pols worked hard for Johns Hopkins in pushing all policy that made Baltimore City the worst in the nation.....
but Maryland hospitals have never been more profitable.

People that think it is fine to deny low-income people access to health care that the Federal health programs were meant to provide had better think of this----WE ARE ALL GOING TO BE THOSE LOW INCOME.  DEFUNDED MEDICAID FOR ALL IS WHAT LOWERED THESE CITIZENS' LIVES BY 20 YEARS.  Baltimore is compared to third world Africa in most measures and it is because of the Baltimore City Hall and Maryland Assembly pols that work for neo-conservative Johns Hopkins.

Maryland Community Newspapers Online

Friday, April 20, 2007

Operating profits Prince George’s public hospitals are financially strained, but most in Maryland are fiscally fit by Kevin J. Shay | Staff Writer      



Laurie DeWitt⁄The Gazette

Staff hustle at Shady Grove Adventist Hospital’s orthopedics department Thursday. The 268-bed Rockville hospital posted an operating profit of $9.3 million in 2005.
While Prince George’s County’s public hospital system struggles to stay open, most privately held Maryland hospitals are posting operating profits.

All told, seven Maryland hospitals not in the Prince George’s system — plus the two in it — had operating losses in fiscal 2005, a state report shows.

***********************

20-year life gap separates city's poorest, wealthy


October 16, 2008
|By Annie Linskey | annie.linskey@baltsun.com

In West Baltimore's impoverished Hollins Market neighborhood, where the average life expectancy is about 63 years, residents shared beers and cigarettes on their front steps at midday yesterday while pedestrians using canes gingerly avoided two dead rats on the street.

Across town in wealthy Roland Park, where residents live on average to be 83, the scene predicably changed. One gray-haired woman rushed to swimming lessons, while a family rode past on bikes and a man with an iPod jogged nearby.

The two-decade difference in life expectancy between Hollins Market and Roland Park was revealed in data released yesterday by the city Health Department, which for the first time has compiled comprehensive death data on a neighborhood level.

The results are striking. In some impoverished neighborhoods, the death rates from heart disease and stroke are more than twice as high as in wealthier places just a few blocks or miles away. At the extreme, the difference in mortality rates between some neighborhoods is as wide as the disparity in life expectancy between the United States and a Third World nation such as Burma.

______________________________________________

Obama and Clinton neo-liberals in Congress wrote the Affordable Care Act so as to make it very hard for progressive labor and justice to stop this global corporatization of our health care like they have in the past.  The managed care ACOs entwine our Medicare and Medicaid into these systems making all that money fungible----as Maryland has been doing.  So, for people working for EXPANDED AND IMPROVED MEDICARE FOR ALL----we must make of our public health system the same managed care consolidated structure which is a good way to rebuild all of our public health structures.

In Baltimore, that means Enterprise Zone and Medical Enterprise Zone money can be used to build new public community health clinics----new public outpatient treatment centers in communities----new public home care system buildings all able to work in our communities and hire our community citizens.  Since Medicare and Medicaid is the insurance platform-----all consolidate into a system that competes with those in Maryland's private health system including Beilenson's non-profit.

WE WILL USE THE AFFORDABLE CARE ACT'S REQUIRED ACO FORMAT TO REBUILD ALL OF OUR PUBLIC HEALTH STRUCTURES.

Many public health structures will simply be taken from non-profits that are not performing and should never have been taken private and those employees will simply return as public sector employees----earning a solid wage.

Below you see who writes these deregulation laws---always the most conservative Republican think tanks----and who installs them?  Clinton neo-liberals running as Democrats!  Cato Institution says deregulate-----Maryland Assembly and Baltimore City Hall says deregulate----AS THEY SERVE AS DEMOCRATS!


  1. To Expand Health Coverage, Deregulate Health Care... www.cato.org/...health-coverage-deregulate-health-care The soaring cost of health care has become one of this nation's most pressing public issues. Politicians and pundits regularly talk of new programs and changes in law ...



    Here you see during Bush Administration Maryland was moving fast to deregulate health care as access and quality of care fell.  Home health care in Maryland has some of the worst of small business operators and some of the worst national chains all operating with no oversight and accountability.  We do have good  home health business people trying to do a good job amid a sea of bad operators all because of deregulation.  That is what Affordable Care Act does to health care as a whole with an emphasis on seniors and low-income. 


    THIS IS YOUR O'MALLEY FOR PRESIDENT FROM MARYLAND FOLKS-----POSING PROGRESSIVE IN THE MOST REPRESSIVE OF STATES----AND CITIES.


Home health care facing deregulation


Dec 5, 2005, 12:00am EST Updated Dec 1, 2005, 4:11pm EST Alan Zibel Staff Bizspace Spotlight  



Health care agencies that provide medical care to elderly and sick patients at home, would no longer need state permission to open in Maryland under a new proposal.

The recommendation by a 24-member task force set up by the Maryland Health Care Commission to streamline state health care regulations has sparked opposition from some home health care companies.

They say eliminating state regulations would enable new companies to enter the state and not serve poor patients. Opponents say those firms could pay higher wages to nurses and other staff, making it tougher for existing companies to recruit workers in an already difficult market for nursing staff.

  "This will have a serious negative impact on agencies such as ours [that are] committed to servicing all types of patients, a problem that will only stress an already difficult recruitment environment" wrote Daniel B. Smith, president of Johns Hopkins Home Care Group in a September letter to the health care commission.

Elizabeth Weglein, president of the Maryland National Capital Homecare Association, which represents the agencies in Maryland and Washington, D.C., said some of her group's members hope to convince the health care commission not to enact the panel's recommendation.

"They believe that the access to good quality care would be jeopardized," Weglein said.

Supporters of relaxing regulations argue that home health agencies are already regulated by the federal Medicare program and say the state could benefit by eliminating a time-consuming regulatory process.

The panel was split on whether to eliminate the home health care regulations. State law would have to be changed to do so.

The health care commission is scheduled to consider the proposed changes at its Dec. 15 meeting.

The task force worked from May to November examining state regulations for hospitals and other health care facilities. In Maryland, health providers must get state approval, or a "certificate of need" for new buildings or services.

In addition to hospitals, the law also applies to nursing homes, surgery centers and home health and hospice agencies.

The task force decided not to eliminate regulations on hospice care, baby delivery, open heart surgery, organ transplants, burn care and neonatal intensive care units.


"Down the road, I suspect that there will be other things that will be deregulated," said Robert Nicolay, a member of the health care commission and chairman of the task force.

Hal Cohen, a health care consultant who represented health insurers CareFirst BlueCross Blue-Shield and Kaiser Permanente on the panel, said the task force should have recommended removing more services -- including hospice care and baby delivery -- from state regulation.

With those services, he said, adding more capacity doesn't increase demand for care.

"I don't expect anybody has a baby because there's more capacity," Cohen said.

However, Cohen said, the state needs more constraints on the addition of emergency department space. When hospitals add more emergency department space, he said, they tend to fill up with patients, creating more expensive health care bills.

The panel also recommended allowing more costly expansion projects and information technology projects to go ahead without state approval. Under the proposal, for hospitals, expansions over $10 million would require state review, up from $1.6 million. For other heath care facilities that size would be $5 million. Those changes would also require legislative approval.

____________________________________________

Below you see the results so far------This is of course what is expected to happen---just as with teachers leaving an embattled public school system that devalues professionals.  Maryland is one of the first to deregulate even what constitutes a doctor to replace the MD and it is bringing tons of foreign doctors to replace our well-paid upper middle-class of course.  I'm going to make many nurses mad by being against this but it is just like any policy no one wants to give in-----once one exception is made---lots more will follow.  That is what deregulation is about.  So, instead of doctors Maryland citizens will have nurses and instead of filling our medical schools with Maryland citizens we are already seeing them filled with foreign students that will work in Maryland health care.

SEE WHERE PROFITEERING COMES IN AS THE LOWEST WAGE EARNER IS BROUGHT IN?
Trans Pacific Trade Pact will place all this on steroids if left in place and it will lower that doctor's wage to poverty as is now true in the third world.  That never attracts the best does it?

This is what O'Malley and Maryland Assembly had in mind for the citizens of Maryland and BAltimore City has much worse coming as its citizens will be mostly Medicaid for All.
  See why Maryland primary elections must be rigged to these Clinton neo-liberals and Bush neo-cons!

Whether retiring or fleeing, doctors are leaving health care




By R. Jan Gurley March 27, 2014 In practical terms, we doctors are a fairly elderly bunch. Nationwide, despite churning out roughly 20,000 newly-minted medical school graduates a year, one in three doctors is over 50, and one in four is over 60.

One reason doctors are older than you think -- the training alone takes so many years. Or, as one uber-specialized colleague of mine said, “It’s hard to explain to your five-year-old son, without making him petrified to start kindergarten, that you’re actually in thirty-fifth grade.”

Knowing that one in four doctors will reach retirement age in five years is cause for enough concern. Then, there’s the well-documented doctor shortage coming down the pipe simply because not enough new doctors are being trained to meet the needs of the U.S. population. But do impending changes within the medical industry stand to drive doctors into early retirement? There’s evidence to indicate that it will.

In my previous post, I explained how Electronic Health Records (EHRs) have not materialized as the great panacea that would streamline and improve health care. Doctors have felt the weight of EHRs and are letting people know they are not happy, maybe even unhappy enough to leave the profession. During the Doccupy protest about the implementation of the EPIC EHR in Contra Costa County California’s safety net health system, a mass exodus was reported: “‘Six doctors have left this year,’ said Dr. Keith White, a 22-year pediatrician. ‘We were not ready for EPIC and EPIC was not ready for us,’ White told supervisors. ‘As a result, the providers are struggling to provide safe and effective care for 100,000 citizens of the county, many of whom are very ill. We often feel that we are failing. We are very tired ... many doctors have left and all are considering leaving.’” [emphasis mine]

Was this just one person’s exaggerated viewpoint?

Apparently not. Deloitte’s 2013 survey of over 20,000 physicians notes 62% say that “it is likely that many physicians will retire earlier than planned in the next one to three years. This perception is fairly uniform among all physicians, irrespective of age, gender, or medical specialty.”

And if they’re not retiring outright, doctors say they believe physicians will “scale back practice hours (55 percent) based on how the future of medicine is changing.” None of this is surprising when Deloitte reports that “[s]ix in 10 physicians (57 percent) say that the practice of medicine is in jeopardy.”

Retirement may be more of a problem in safety net systems, and in certain types of specialties, like primary care, where both the workload and the reimbursement rates are worse than other fields of medicine. But fleeing from a field with very high burnout rates is not unique to physicians.

Studies have shown that the idea of replacing primary care physicians with nurse practitioners has one fatal flaw - nurse practitioners, not surprisingly, burn out the same as physicians do when placed in high-stress positions. In the last year, I have personally seen an accelerated rate of both talented doctors and talented nurse practitioners retire early in safety net systems, rather than face the combined worsening workloads and impact of EHR rollouts on patient care.

Accelerated early retirement also leads to a critical mass effect: staff retire early, safety net positions are hard to fill, and the remaining smaller staff of providers tries to shoulder a now-even-more-expanded workload. A vicious downward spiral occurs with even faster burnout, more early retirements.

The fleeing of health care providers, especially in primary care and safety net systems, means that we are rapidly losing large chunks of irreplaceable workforce, even before the expansion of health care coverage occurs. Accelerating staff loss means that the remaining staff are even more at risk, as is patient safety.

How big are these combined effects? What does this mean for your community? Here are some questions for reporters to ask:

1)  How vulnerable is your community? Take a brief survey of your safety net and primary care systems. How many of those providers - doctors and physicians assistants and nurse practitioners - are over 50? Over 60? Is it a larger or smaller proportion than the national average?

2)  How fast is your system crumbling? How many people have retired in the last year? In the last two years?

3)  How replaceable are the losses? Does your community start with an appropriate rate of primary care providers per capita, or not? How long does it take to fill a primary care position in your local system? Is the rate keeping up with the losses? What is being done if there is an issue?

4)  How shaky is patient safety? What happens when a provider retires in your area and there’s no replacement? What are the patients’ stories? How many stories can you find of emergency care being necessary, or poor outcomes occurring, due to provider loss?

5)  What about in other fields - like psychiatrists in safety net systems who care for the profoundly mentally ill, and whose EHRs are supposed to be even more onerous to use? What is their rate of staff loss, and how is patient/staff safety holding up?

6)  Why are your local primary care and safety net providers leaving? Is there any exit interview process whose information you can access? If not - particularly for large health systems - why is no one doing exit interviews? You may want to find and interview providers who retired early. There could be a compelling story there. People who have left in crisis are often more willing to openly discuss the problems that led them to remove themselves from a health system.


________________________________________________
But Maryland pols have their eyes on the prize------Johns Hopkins et al are sidelining Maryland citizens and their health care while going global to get whatever the global market will bring from the world's rich---

THAT'S WHAT PROFIT-MAXIMIZATION IS ABOUT SAYS JOHNS HOPKINS!  FORGET HIPPOCRATIC OATH AND TAKING CHICKENS FOR PAYMENT---SHOW ME THE MONEY!


This is indeed what all of this privatization and managed care is about-----going global.  This also is what drives all of the exploding need for technology and ending net neutrality as all of this will move internet service space more and more to a completely corporate platform.

Americans are no better than Africans or Asians say Clinton neo-liberals who want per person health costs in the US to equal that of third world nations----that's progressive they say.  Of course those third world citizens' health care is not getting better as Trans Pacific Trade Pact seeks to end global public health.

WE CAN REVERSE THIS EASY PEASY AND PUT SOME OF THIS MEDICAL TECHNOLOGY TO REAL PROGRESSIVE USE......

The goal of keeping people in their home is not progressive---it is regressive as we watch them dismantle public transit for seniors and disabled----as we watch them close community public rec and health centers----as we watch them make it harder and harder to get into a hospital for the time needed.  They expect a time where WE THE PEOPLE will access health care like we try to do our telecommunications VERIZON services-----


3/21/2012
08:45 AM
Nicole Lewis



Global Telemedicine Market Headed For $27 Billion




BCC Research report says global demand continues to grow, while U.S. market is thriving thanks to the Patient Protection and Affordable Care Act.
10 Top Medical Practice Management Software Systems (click image for larger view and for slideshow) The global telemedicine market grew from $9.8 billion in 2010 to $11.6 billion in 2011 and will almost triple to $27.3 billion in 2016, a compound annual growth rate (CAGR) of 18.6% over the next five years, according to a report from BCC Research. The report, Global Markets for Telemedicine Technologies, is based on interviews with manufacturers and users of telemedicine technologies and services, as well as from reviews of secondary sources such as company literature, conference proceedings, and related government data.

The study's findings come at a time when telemedicine is being adopted by several nations that are using the technology to close the gap in healthcare while lowering the cost of treating patients.

Sponsor video, mouseover for sound A deeper dive into the research shows that the telemedicine market is segmented into telehospital/clinic and telehome markets. In 2010 the telehospital/clinic market was worth $6.9 billion, and the telehome market was valued at nearly $2.9 billion. The study also found that the telehome segment is growing faster than the telehospital/clinic segment--at a projected CAGR of 22.5% vs. 16.8%--and as a result is expected to increase its share of the market from 29.4% in 2010 to 35.6% by 2016.

[ Most of the largest healthcare data security and privacy breaches have involved lost or stolen mobile computing devices. For possible solutions, see 7 Tools To Tighten Healthcare Data Security. ]

The report also pointed out that the telemedicine market is segmented into technology--hardware, software, telecom, network--and service segments. The technology portion grew from $3.8 billion in 2010 to $4.6 billion in 2011 and is expected to reach $11.3 billion in 2016, with a CAGR of 19.8% over the next five years.

The market for telemedicine services increased from $5.9 billion in 2010 to $7 billion in 2011 and is expected to reach nearly $16 billion in 2016, mainly driven by growth in the telehospital service market. The study also found that the telehospital service market grew from $4.8 billion in 2010 to $5.5 billion in 2011 and could reach $10.6 billion in 2016, with a CAGR 13.9% between 2011 and 2016.

A closer look at U.S. trends suggests that telemedicine market growth has been driven by the implementation of the Obama administration's Patient Protection and Affordable Care Act (PPACA), a two-year-old law that has intensified the focus on telemedicine as a way to treat an increasing number of people who will be seeking health insurance and medical services. Telemedicine technology enables healthcare personnel to meet this increasing demand without delays in treatment or rationing care, the BCC Research report concludes.

"The PPACA is a catalyst for the increased use of telemedicine," Andrew Williams, a BCC Research analyst, told InformationWeek Healthcare.

Williams noted that the law contains several provisions that could affect telemedicine. For example, the Center for Medicare and Medicaid Innovation (CMI) has been directed to test new models of care using telemedicine to improve the care of hospitalized patients, including those in intensive care, through electronic monitoring by specialists located at other facilities. The CMI also is developing new care models that use patient-based remote monitoring systems to coordinate care over time and across settings.

In addition, the CMI is exploring the use of providers located in medically underserved areas and facilities that are part of the Indian Health Service to provide telehealth services for treating stroke and behavioral health problems such as post-traumatic stress disorder. The CMI also is studying ways to improve the capacity of non-medical providers and non-specialized medical providers to provide health services for patients with chronic conditions. Williams also noted that accountable care organizations are required to create ways to promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care. Among the tactics being considered: telehealth and remote patient monitoring.

The federal government's initiatives have advanced the adoption of telemedicine at hospitals, and that is reflected in BCC's research, said Williams. In the previous edition of the BCC report, many providers said they weren't sure whether telemedicine was a sound business investment, but now, "a growing number of healthcare providers appear to have become convinced of telemedicine's potential benefits," he said.





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This is long but please glance through as it was written at a time when universities actually did public interest research.

Ethical and Legal Implications of Managed Care


Richard C. W. Hall, M.D.
CourtesyClinical Professor of Psychiatry
University of Florida, Gainesville

Abstract

     This article addresses several ethical, regulatory and legal issues in managed care with attention to recent court cases that focus on physicians' responsibility, fiduciary duty and the impact that these legal decisions have on physicians practicing in a managed care environment. Discussion of the impact of changes in the control of decision making processes for physicians, the use of managed care protocols, restriction of resources and gatekeeping systems are addressed as are the specific duties and obligations of physicians to their patients.

     In spite of the fact that President Clinton's Healthcare Reform proposals were defeated, a vast change in health care is sweeping our country in the form of Managed Care (Managed Cost). The new system has been touted by many in the insurance industry as an innovation that has improved American medicine by lowering health care costs and enhancing its quality by "managing" health care providers. Supporters argue that "managed systems" provide a "managed product" that is (1) better regulated; (2) less expensive than fee for service medicine; and (3) more socially responsible, providing care for the poor and disadvantaged.

     Recent articles have raised questions as to whether these assumptions are true.(1-15) Critics of the system argue that managed care is reducing the introduction of new technology, interfering with the physician-patient relationship, worsening outcomes, restricting clinical research, reducing funding for physician training and adversely effecting community based hospitals. Others raise concern about monopolistic trade practices, ruthless business techniques and the subversion of medical ethics.(1,2,7,12,16-26)

      As managed care continues to grow, the relationships among providers, hospitals, physicians and other healthcare professionals are undergoing change and, in many cases, strain. Emanual and Dobler(21) cogently argue that managed care is producing a major change in the physician-patient relationship which has traditionally been based on what they term the six Cs. I.E.: (1) The patient's ability to choose their physician; (2) provider competence; (3) physician-patient communication; (4) compassion; (5) continuity of care and most importantly (6) that there be no conflict of interest on the part of the health care provider. They warn that when managed care restricts patients' choices of physicians; controls their access to care, limits the treatments their physicians can prescribe; limits their doctors' ability to refer them to specialists, and erodes the patients' trust in their doctors by creating a persistent, corrosive conflict of interest; it will ultimately destroy the doctor-patient relationship. Finally, they argue that many of the currently employed salary schemes which reward physicians and hospitals for not providing needed medical services produce a serious, inescapable and pernicious conflict of interest.(21)

     Many in our profession feel that the juggernaut of manager care is a fait accompli and that modifying change if it occurs, will be too little, too late. The underlying fear of large corporate medicine is summarized by the aphorism, "When money talks, truth is silent." How will health care providers, community hospitals and academic medical centers fare in the new "dance of vertical integration?"(25) As noted in a recent JAMA editorial, no method of health care reimbursement is devoid of financial self-interest.(22) It can be argued that fee-for-service encourages doing more rather than less for patients while capitation encourages the reverse. While physicians are faced with pressure to be cautious in the allocation of resources, they must strive to make decisions that do not adversely affect the health of their patients.

     In any balanced discussion of this topic, one needs to keep in mind that if appropriate ethical standards are employed, managed care programs can work with reasonable success. They can provide systems that encourage effective and long-standing relationships between patients and their primary care providers; they can commit to provide quality medical care to their patients; and they can ethically assume a population-based approach that incorporates public health concerns as well as individual medical strategies. They can encourage-outcome management studies and apply the most current standards to both diagnosis and treatment while rejecting unproven and inefficient treatment methods. The best models of these "optimal" plans are found in the older staff-model HMOs which were established between 1940 and 1970, when cost containment represented an unexpected benefit rather than the primary purpose of the organization.(22) In these instances, the bottom line was not the first item on the company's mission statement and, therefore, did not intrude on the medical decisions made for an individual patient. The best of these programs encouraged academic pursuits, collegial interactions, and team-building. They placed a premium on physician-patient relationships as well as the relationships that existed between these systems' primary care physicians and the specialists they consulted.

     Conversely, in the worst case scenarios which, incidentally, occur more commonly among the newest generation of managed care organizations(22), care delivery is regulated by "managers" who have had no previous experience in providing health care. Their corporate mission is to provide care at the lowest possible price. Corporate goals relate more to cornering a market and locking out the competition than to providing high quality health care. In these systems, clinical leadership is often inadequate or absent and the goals that drive the plan are optimization of profit, not optimization of patient care. These plans control costs through the exclusion of sicker patients, rationing by inconvenience, creating a burden on physicians by forcing compliance with the micromanagement of the clinical environment, which is generally "physician-hostile" and "administrator-friendly". These systems polarize doctors and nurses, and deny beneficial but expensive care through (1) micromanagement, (2) imposition of complex bureaucracy, (3) threats of physician job loss, and (4) perverse financial incentives for providers. They discourage teamwork among providers and often attempt to fractionalize various sub-groups, setting primary case physicians and specialists against each other in their quest to rachet down costs to their lowest possible level.(26-28)

     In an attempt to clarify physicians' responsibilities in dealing with managed care, the American Medical Association issued a report in June, 1990 entitled "Financial Incentives to Limit Care; Financial Implications for HMOs and IPAs".(29) The AMA made clear that patient welfare must remain the first consideration of all physicians working in health maintenance organizations and IPAs and that physicians in such systems must disclose to their patients all relevant financial inducements and contractual constrictions that affect the delivery of their health care to patients. Failure to disclose has become an important element in litigation, as was evidenced in the recent 89 million dollar verdict obtained by the family of Nadine Fox against Health Net, a California HMO.(30)

     In a recent report, the AMA(31) states, "It is therefore essential that the profession and society now act to ensure that managed care techniques are implemented in a way that protects patients and the integrity of the patient-physician relationship." The report emphasizes that physicians must first be committed to the welfare of their patients and avoid the conflicts of interest produced by practicing in a managed care environment. It urges physicians to preserve their fundamental duty as advocates of their patients and in so doing, to reduce the risk of rationing and inappropriate financial incentives.

     The Council notes that while efforts to contain costs are critical and that many of the approaches used by managed care companies can have an impact on constraining health costs, that managed care can compromise the quality and integrity of the patient-physician relationship and reduce the quality of care received by patients. "In particular, by creating conflicting loyalties for the physician, some of the techniques of managed care can undermine the physician's fundamental obligation to serve as patient advocate. Moreover, in their zeal to control utilization, managed care plans may withhold appropriate diagnostic procedures or treatment modalities from patients."(32)

     The Hippocratic Oath emphasizes the primacy of trust in the relationship between patient and physician. It obligates the physician to keep his/her patient's information confidential, to avoid mischief and sexual misconduct, and to give no harmful or lethal agents. Over time, patients have come to expect that their physicians might even jeopardize their own health to care for the ill.(33) In short, the physician becomes the advocate for his/her patient, using his knowledge and the patient's trust for the patient's good. Managed care forces physicians to balance the interests of their individual patients with the interests of other patients in the system (rationing of care and constraining cost) and may place the physician in a position where the needs of his patients are in conflict with his own financial interests. His very livelihood may be at risk since many managed care plans drop physicians who incur higher treatment costs than their colleagues, even though they take care of sicker patients. This fear of retribution for providing appropriate but more expensive care can become a powerful force in distorting physicians' clinical judgment. The "ethics of minimums," (i.e., doing as little as possible) as a corporate culture is at variance with the physician's training and basic integrity.

      Many managed care plan executives insist on hiring only recently graduated physicians who are more willing to accept the new corporate managed care culture and who rapidly become dependent upon it. But the "culture of minimums" often conflicts with striving for excellence. An optimal health delivery system must (1) be patient responsive, (2) provide adequate and compassionate care, (3) encourage physician excellence, (4) be accessible, (4) reduce bureaucracy to a minimum, (6) provide humane treatment based on scientific merit and (7) be accountable to the patient. Failure to meet these goals has prompted an increasing number of law-suits which may in fact limit the seemingly capricious decisions that so many fear. Many of these suits spring from the cost containment strategies employed by managed care corporations which include (1) controlling the use of medical services wherever possible, (2) limiting treatment, (3) reducing follow up visits, (4) limiting diagnostic studies, (5) controlling formularies, (6) eliminating the use of costly medications and treatments wherever possible, (7) reducing visits to specialists, (8) reducing or eliminating laboratory procedures, (9) reducing or eliminating expensive measures to preserve life, (10) providing care using the least expensive "professionals", (11) making patients work through gatekeepers, (12) placing healthcare providers at financial risk, (13) rewarding providers for limiting their services through salary increases, bonuses, paybacks, etc, (14) dropping sick patients from panels at the time of contract renewal, (15) forcing providers to follow rigidly defined protocols, (16) limiting physician judgement, (17) using utilization review techniques in an arbitrary manner which may define appropriate treatment as "medically unnecessary,"(18) requiring cumbersome pre-certification, (19) mandating the use of a rigid treatment hierarchy before more expensive care can be offered, (20) insisting on the use of mail-order pharmacies, and (21) limiting the services of ancillary care providers such as nurses, physical therapists, special nursing assistants, sitters, etc.

     Because of injuries and conflicts arising from these cost containment strategies, litigation in the area of managed care has increased considerably during the last several years. Emerging liabilities in managed care litigation stem from issues of (1) patient care management; (2) contracting and (3) joint collective provider activities. Law-suits in the area of patient care management derive from the increased intervention of third and fourth parties into the treatment process. Limitation of a patient's access to medical care by pre-treatment disallowal has become the most fertile area for successful litigation followed by protocol mandated discharges which provide complaints of negligence, malpractice, patient abandonment, neglect, inappropriate provision of care, and premature patient transfer and discharge. Other areas of litigation center around disputes of patient/provider financial obligations under the terms of the patient's contract, and refusal of the managed care company to provide treatment authorization as medically necessary pursuant to specific elements in the patient's contract. New areas of litigation include breaches of confidentiality, lack of protection of the medical record, and misuse of medical information to deny future insurance. Recently the courts have held that corporations can not elude liability for the behavior of their external utilization reviewers when disallowals are medically inappropriate.(34)

     Claims of insurer and reviewer fraud, evidenced by systematic inappropriate application of review criteria or the use of invalid medical criteria instead of accepted community standards to deny care, as well as suits stemming from the faulty qualifications of reviewers who disallow care have also been successfully litigated. Finally, the courts have held that both insurers and reviewers may be liable for a bad outcome and have extended responsibility to employers for the inappropriate application of cost-containment provisions.(34-36)

     Increased corporate liability has been inferred from several recent cases concerning issues that include negligent implementation of utilization review, premature patient discharge, financial risk profiles that change the traditional duties of providers to patients, failure to refer in a timely manner, elimination of post-termination continuation of care responsibilities when illness persists, inappropriate sharing of medical information, and poor quality control of employed physician's practices.(34-43)

     An important area of recent litigation has to do with patient management processes imposed by managed care companies. These break down into suits that involve restriction of patient access, usually prompted by some complaint concerning the utilization review process such as refusal of requests for prior authorization, disallowal of a continued stay request, or refusal of an appeal for payment. Increasingly, suits are being directed at providers who fail to meet their responsibilities under the terms of a contract.

     The legal accountability of HMOs and managed care organizations is in large measure determined by their organizational structure. Staff model HMOs have the greatest responsibility for the behavior of their physicians. IPAs and group model HMOs that have treatment protocols and corporate medical directors also assume responsibility for the physician care they provide. Managed care organizations working through PPO contracts incur less of a medical-legal risk for their providers' behavior.(38)

     Recently the courts have ruled in the Salley and Wilson cases(34,37) that utilization review companies which act as intermediaries between insurance companies and the patient's physician to constrain utilization by disallowing appropriate care as medically unnecessary, are bound by the standard of reasonable community practice. The protocols that these companies develop must be (1) realistic, (2) available to providers, (3) based upon a reasonable interpretation of the medical literature, (4) applied consistently and (5) provide mechanisms and procedures for both appeal and review. Using the scientific data as the benchmark, the court in Wickline has defined, and subsequent courts have reaffirmed the concept that prospective disallowal of treatment has more important medical-legal implications then post-treatment disallowal of costs, and that managed care organizations cannot prospectively disallow care without a firm scientific basis.(36)

     Let us review some of the more important decisions that define the physician's role and duty in this complicated arena. We are indebted to Chittenden(38) for his excellent review of the legal basis by which managed care companies can be sued and the reader is referred to that source document for a more indepth analysis of the issues we are about to consider.(Table 1) As we review these specific cases for guidance as to how physicians should practice vis a vis managed care, it is important that the reader keep in mind that many of these cases apply only in the jurisdiction in which they occur; yet as a group they provide a trend for understanding national judicial thought in this complicated area. They are often cited in ongoing litigation and consequently affect future court decisions.

Elements Necessary To Demonstrate Control of Physician Behavior

     The 1957 case of Bing v Thunig (39) provides one of the important conceptual cornerstones for current managed care litigation. In Bing, the court ruled that a hospital could be held liable for the contractual relationship that it had with a physician, even if that physician was not a full-time employee of the hospital. In defining the hospital-physician relationship, the court ruled that the same factors that determine any other principle-agent relationship could be employed to define the physician-employer relationship and that if the employing entity exercised control over the physician, that it would incur responsibility for the physician's behavior, i.e. his/her treatment decisions and actions.

     The 1981 Georgia case of Stewart v Midani (40) defined what these crucial elements of employment were. In this important case, the court ruled that the factors to be used in determining whether an institution affected a physician's judgement or behavior depended upon the specific elements of the relationship that existed between the physician and the employing institution, specifically whether the institution had (1) the right to directly oversee the physician's work, (2) a contract with the physician to perform a specific service or task, (3) the authority to control the time during which a physician worked, (4) the right to inspect a physician's work product, (5) contracted to provide facilities or supplies to the physician, (6) a right to terminate the physician's contract, (7) the ability to determine the degree of skill necessary for the physician's employment and (8) control of the method by which the physician was paid. The court felt that if a preponderance of these elements were present, that there was a master-servant relationship between the physician and the institution and under such terms that the hospital or corporation would be at least partially accountable for the results of the physician's work.

     Applying Midani (40) subsequent courts have ruled that staff model HMOs which employed physicians on a salaried basis and who directly control the physician's work product are liable for the doctor's behavior because they fulfill all the terms of the "master-servant" relationship. Other cases have expanded Midani to apply to IPA model HMOs and in some cases even PPOs(41,42) where financial arrangements or protocols define practice.

     The 1987 Indiana case of Sloan v. Metropolitan Health Council (42) further defined the relationship between managed care providers and physicians. Metropolitan Health Council employed physicians using a written employment contract in which the physician agreed to "provide treatment to HMO members." In exchange for their medical services the physicians received an annual salary and fringe benefits. During the malpractice suit, metropolitan Health Council argued it should not be sued since the malpractice was caused by the physician who was responsible for his decisions. The court ruled that the Metropolitan Health Council was responsible for the behavior of its physicians since its contract had several elements of a master-servant relationship; specifically it forbade private practice, and employed a medical director who "established medical policy" and whose job description defined him as "ensuring that medical services were properly provided to member-patients."

     The court noted that the HMO had a series of treatment guidelines that it expected its employed physicians to follow and as such, it was able to control how its employed physicians ordered tests

     The 1989 District of Columbia case of Schleier v. Kaiser Foundation Health Plan(42) extended the liability of HMOs to IPAs and potentially to PPO contracts. In Schleier v. Kaiser Foundation Health Plan, the staff model HMO was held vicariously liable for an independent consultant's malpractice even though the contract that the physician had with the HMO emphasized the lack of an employer-employee relationship. The court reasoned that because the HMO had (1) cost control mechanisms common to both IPA model HMOs and PPOs such as diagnosis and treatment protocols, which provided step by step instructions that described how the care of a patient with a given symptomatology should be managed, and because the HMO (2) employed concurrent and prospective utilization review, and because the HMO had (3) preset fee maximums that realistically constrained the treating physicians' options, that there was a level of control suggestive of more than an independent contractor relationship. The court in Schleier evoked the legal philosophy of ostensible/apparent agency which states that when an independent contractor performs services for another party that are accepted in the reasonable belief that the services are being rendered by the employer or his servants, that the employer is liable for any physical harm that is caused by the negligence of the contractor who supplies those services to the same extent as though the employer were supplying them himself or by his servants.

     In addressing the boundaries of the physician-patient relationship in the context of a physician's contractual relationship with a managed care organization, the court suggested the following tests to define if the patient relates to the managed care organization or the physician:

    1. Does the patient look to the institution rather than the individual physician for care?
    2. Does the managed care organization "hold out" the physician as its employee?
    3. Does the patient have a choice of physician?
    4. Is there a direct contractual relationship between the physician and the patient?
     Since the physician in Schleier met those tests, it was the view of the court that the organization incurred liability for his behavior even though the physician was deemed an independent contractor by the HMO. The court referred to the original federal statues that encouraged the development of health maintenance organizations and their definition. "A health care maintenance organization is an entity that provides basic and supplemental health services to its members."(41)     

     Most courts currently employ the following tests to define if a physician has a master-servant relationship with an HMO:

    1. 1. Can the patient choose any physician in the community or only an HMO or managed care defined physician, or some other doctor under "penalty?" 2. Does the managed care organization define itself as a provider of medical care?
      3. Does the managed care organization obligate physicians in its employ to follow a particular set of rules?
      4. Does the managed care organization maintain a quality assurance program that reviews the physician's work product?
      5. Does the patient pay the managed care organization or the physician directly?
      6. Does the managed care organization provide 24-hour coverage or are after hours emergency services the responsibility of the individual physician?
     These principles were tested in the 1988 Pennsylvania case of Boyd v. Albert Einstein Medical Center(43) Mrs. Boyd was a patient of the Albert Einstein Medical Center's HMO. She discovered a lump in her breast during self examination and sought consultation from her physician. A mammogram revealed a suspicious area and she was referred to a surgeon for biopsy. During the biopsy her chest wall was inadvertently punctured and she developed a significant hemothorax. She was hospitalized but subsequently told that further hospitalization was not necessary and that she could recover at home. After discharge her condition deteriorated. Because her family sought further diagnosis and treatment from the HMO, she was seen and evaluated by her primary care physician who diagnosed Tietz's Syndrome. The family requested that she be rehospitalized but the HMO felt this was not necessary. Mrs. Boyd was advised to rest at home; her condition continued to deteriorate; her husband called the HMO and reported that she was doing poorly. This call was received by an HMO physician on call who suggested that she rest. She died.

     The family filed a law-suit but the court awarded a summary judgment to the HMO. The family appealed the decision and it was overturned. The Appelate Court felt that the HMO was responsible for the care that was provided to Mrs. Boyd since the record showed that (1) Mrs. Boyd looked to the HMO for care and that the HMO held itself out as offering care through its employee, her physician. The court noted that the HMO's master contract with its clients agreed to "provide health care services and benefits to members in order to protect and promote their health." The court deemed this to be a specific promise to the patient. It also noted that the plaintiff's contractual relationship was with the HMO, not with any individual physician and that because of the nature of the plan in which she enrolled, that Mrs. Boyd had a limited choice of physicians. In fact, she was obligated to "use the physicians to whom she was referred." The court also noted that because of its policies constraining costs and the quality of care, Mrs. Boyd's hospital stay was prematurely terminated. The court believed that if she had remained in the hospital that it would have been reasonable to assume that some other form of care would have been rendered as she deteriorated and that she might not have died.(43)

NON-DELEGATABLE DUTY AND NEGLIGENT SELECTION


     The concepts of non-delegatable duty and negligent selection are also important. In the 1987 Alaska case of Jackson v Power(44) the court ruled that a hospital was responsible for the quality of care that its physicians rendered to patients in the emergency room. In this case, the hospital employed a physician and placed that physician in public service. The court ruled that the hospital had an obligation to ensure that a reasonable standard of care was met. The court reasoned that the quality of medical care provided to the public was too important to be compromised by lowering standards or delegating authority to some other agency.(37)

     By extension, the courts have also found that there is a direct liability incurred by managed care organizations for the negligent selection or retention of health care providers who place the public at risk. In these situations the courts have ruled that managed care organizations face direct liability for organizational or corporate negligence. The classic case in this area is Darling v. Charleston Community Hospital(45) in which it was ruled that a hospital was negligent for permitting a general practitioner to perform orthopedic surgery. The court ruled that the hospital had a duty to apply reasonable standards to the practice of its physicians, since it was responsible for the privileging of physicians on its staff.

     The 1989 Missouri case of Harrell v. Total Health Care(34) defined the responsibility of a managed care organization for its cost-control implementation policies, particularly when such cost control mechanisms affected physician's decision-making process and lead to negligence. Mrs. Harrell presented to Total Health Care with a urinary problem and was seen by an HMO gatekeeper who referred her to an approved specialist. Surgery was performed and the patient was injured. Total Health Care argued that if malpractice occurred, it was the problem of the physician, not of the managed care organization. The court disagreed. In its review of the facts, it found that Total Health Care's fee structure limited the physician provider to certain procedures by protocol. These procedures were based on cost control measures promulgated by the HMO which affected the doctor's judgment. The court also noted that the HMO gatekeeper was responsible for referring Mrs. Harrell, and in fact, that the HMO's rules made it clear that he was the only person who could refer her for care. The court also noted that all specialists had to work within the HMOs medical guidelines. The court ruled that because its physicians had to accept the HMO's protocols, medical supervision, and fee structure, and because the specialist to whom Mrs. Harrell was referred had been the object of several malpractice suits, (four of which had been concluded in favor of patients), that Total Health Care was culpable. In its decision, the court reasoned that the HMO collected a premium for medical care expenses and limited the subscriber's choice to specific physicians who participated in its plan. In so doing, it had placed the patient at an unreasonable risk of harm if the physicians included in the HMO plan were unqualified or incompetent; or, if based on its price control structure, it forced physicians to choose less than acceptable procedures that had a higher risk of adverse outcome than more costly procedures.

     The court in Harrell opined, "The HMO, in making the plaintiff's choice of physician for her, is required to use due care in making that decision. The duty to exercise care in selecting and maintaining the integrity of its physician panels is non-delegatable to third parties." It further ruled that "if managed care organizations offered themselves as more than health care financiers, they incur a specific duty to supervise the quality of the medical care that their physicians provide to patients and that they are responsible for negligent supervision if they impose treatment guidelines and/or supervision that is below 'acceptable community standards'." Conversely, managed care organizations are not responsible for negligent supervision in PPO models where there are no treatment guidelines or protocols and where their relationship with their physicians is simply based upon a discounted fee structure.

     Another approach to law-suits against managed care organizations is to sue under alternative theories of liability, particularly negligence and breach of contract. These cases require a lower standard of proof and are easier to litigate. Awards often include punitive damages which may be high, consequently, this approach is becoming a popular way to sue managed care companies.(30)

     Breach of contract suits are most frequently employed since the contracts that exist between a managed care organization and its subscribers define the duties of the respective parties. The courts have consistently ruled that a breach of contract exists if a managed care organization fails to provide the quality of health care promised. The landmark case in this area is the 1987 Ohio case of Williams v HealthAmerica.(46) Mrs. Williams saw her physician gatekeeper with a series of physical complaints but was not immediately referred to a specialist. She felt that her delayed referral resulted in a belated diagnosis and subsequent injury. She filed suit against HealthAmerica under the theory that they had failed to deliver the quality health benefits that she had been promised in her managed care contract and that they had deprived her of her right to be referred to an appropriate specialist. The court upheld the breach of contract suit against the physician but recharacterized the action against the managed care organization as a tort claim for breach of duty to handle the patient's claim in "good faith."

     The previously cited case of Boyd v. Albert Einstein Medical Center(44) also had a significant breach of warranty component. The court, in reviewing the marketing brochures for Einstein Medical Center, felt that they contained promises to provide high quality health care. The court felt that the standard of care delivered to Mrs. Boyd was below that promised in Einstein's brochures. It therefore ruled that the standard of care was not met and that the promises were sufficient to impose a ruling for breech of warranty on the HMO.

     Other successful approaches for suit against managed care organizations include litigating under the state consumer fraud statutes, particularly if the plaintiff can show that the HMO has a systematic pattern of denying care. The courts have ruled that a breach of fiduciary duty or fraud exists when plaintiff's have been able to show that managed care organizations routinely deny appropriate care and/or routinely deny appeals for care or when such organizations have denied care based on standards of "medical necessity" that are not related to accepted community standards for care. Increasingly courts are holding managed care companies to the standard of "community practice" for care rendered and are not permitting them to arbitrarily determine that appropriate medical treatments or procedures are "not medically necessary."

     Other practices that have come under scrutiny as representing breach of contract or fraud include the routine disallowal of the last one to three days of hospitalization on retrospective review, use of systems designed to intimidate or harass physicians, cumbersome bureaucracies that make provision of appropriate care difficult or impossible, bureaucratic mechanisms designed to discourage treatment with appropriate drugs and refusal of appropriate referral as promised in the patient's contract. Courts have ruled that complicated provider compensation methods and/or the provision of financial incentives to physicians or intermediaries which encourage them to disallow (1) appropriate hospitalization, (2) medically necessary tests and/or procedures, (3) appropriate length of hospital stay and (4) appropriate consultation with specialists, may represent a tortuous interference with the patient's contract.(30)

     Finally, managed care organizations have increasingly come under criticism for eliminating physicians from their medical panels who treat patients using community standards while retaining other physicians whose practice is based on utilization of cost containment guidelines.

     Negligent implementation of cost control mechanisms has become another important area for litigation. Courts have ruled that when cost control mechanisms are designed which adversely affect a physician's medical judgment and result in injury, that they can be seen as a proximate factor in that injury and that the plaintiff can claim economic and emotional damage from the HMO.(35,36,43) The courts have also ruled that the improper influence of reviewers who systematically disallow appropriate care may represent a breach of fiduciary duty, a breach of contract, or outright fraud.(46) The Wickline decision(35) represents the sentinel case in this regard.




THE WICKLINE DECISION
     When Wickline was first heard, the judge noted that this was "the first attempt to tie a health care payor into the medical malpractice causation chain" and that it "therefore deals with issues of profound importance to the healthcare community and to the general public."(40) The judge noted that the cost containment program at issue centered on prospective utilization review where mandatory preauthorization for care was required before a patient could receive treatment. The court noted that "a mistaken conclusion about medical necessity following retrospective review will result in a wrongful withholding of payment. An erroneous decision in a prospective review process, on the other hand, in practical consequences, results in the withholding of necessary care, potentially leading to a patient's permanent disability or death." In reviewing the facts of Wickline,the court reasoned that when managed care companies deny access to care, they bear a higher burden of responsibility than when they disallow payment after care has been provided.

     A short review of the facts of Wickline may be of assistance in helping clinicians understand the impact of this case. In 1976, Lois Wickline, a married woman in her mid-40s sought consultation for intermittent claudication. Outpatient treatment was unsuccessful and she was admitted to hospital in October, 1976. A consulting peripheral vascular surgeon diagnosed Leriche's syndrome. Although immediate surgery was recommended, the patient had to be discharged home to await approval for the surgery under the California Medi-Cal statute. Appropriate paperwork was submitted and a request for hospitalization was made. On January 6, 1977, Mrs. Wickline was readmitted and underwent a teflon grafting procedure the following day. Her post-operative course was stormy; the graft clotted and Mrs. Wickline required a second procedure. Following this, she continued to experience severe leg pain, arterial, arterial spasms and hallucinations. On January 12, she underwent a lumbar sympathectomy to reduce arterial pain and spasms.

     Mrs. Wickline was not doing well on January 16, the date scheduled for her discharge. Her physicians called Medi-Cal to advise them that it was medically necessary for her to remain in the hospital. Her attending physician requested eight additional hospital days. Her attending surgeon reported that all three physicians involved in her care felt that she required this extra time because she was medically unstable and was at risk for infection and the development of further blood clots which could lead to impaired circulation and possibly an amputation. Court testimony revealed that Medi-Cal was told that her physician felt that they could save both her legs if she were to receive continued hospital treatment.

     More paperwork was submitted to justify Mrs. Wickline's additional hospital stay. The hospital provided Medi-Cal with the patient's complete medical diagnosis, history, clinical status and a detailed treatment plan. After all the paperwork was done, the on-site Medi-Cal nurse, who was authorized to approve the request without any further review, refused it, stating "Nothing in Wickline's case would have warranted eight additional days." She called the Medi-Cal consultant as was required for her to disallow the request. The consultant, a general surgeon, supported the rejection of eight days and authorized "an additional four days based on the nurse's feelings about the case." At the trial, this consultant testified that he had never seen the history, physical or treatment plan that had been submitted until it was forwarded for his disallowal signature. The forms required that a reason for the patient's extended stay denial be provided by the reviewing physician; this section of the form was blank. This Medi-Cal consultant testified he couldn't remember why he disallowed the request or why he gave four days. Neither he nor the nurse remembered the case. When later reviewing forms, he testified that he gave four days because there was no note of Mrs. Wickline's temperature, diet or bowel function in the information provided by the hospital. In addition, he disallowed because she could ambulate with help and was beginning whirlpool treatment. At trial, other surgeons testified that these elements were irrelevant to her circulatory condition and the consultant-surgeon had not concerned himself with the signs and symptoms that a reasonable physician would have typically considered in such a case. The disallowing consultant did not seek the opinion of a peripheral vascular surgeon who was available to him for consultation. At the end of Mrs. Wickline's four day extension, her attending physician wrote a discharge order. When asked at trial why he, as her attending physician, had not asked for an additional extension, he testified that there had been no change in her condition since her initial disallowal. One of her attendings testified that he felt that the Medi-Cal consultant was more concerned about the state's interest than the patient's welfare. He also felt that the Medi-Cal reviewer had the "power" to order him to discharge her. All of Mrs. Wickline's physicians testified that they were within community standards in discharging her.

     At the time of discharge, Mrs. Wickline was unhappy and protested the decision. She asked to remain in the hospital, stating that she did not feel that her husband could care for her at home. Her request was denied and she was discharged despite her protests that she was not in a position to take care of herself. Following discharge she developed pain in her leg. Her leg became "whitish, cold, worse, turned gray" and three days after discharge, her husband called her physician and was advised that she should take more pain medication. The leg became "blue" and the pain "excruciating" to the point that "no pain medication helped whatsoever." On January 30th, eight days after discharge, Mrs. Wickline was readmitted to the hospital in severe pain with an open wound in the right groin, a secondary infection in the right femoral incision, a mottled right foot, and a cold right leg. Because of an infection in her toe, she could not be immediately re-operated. She was started on a medical regimen which proved to be unsuccessful, and on February 8th, a right below-the-knee amputation was performed. Because the wound failed to heal, she underwent a right above the knee amputation nine days later.

     At the trial, her surgeon testified "to a reasonable medical certainty", if Mrs. Wickline had remained in the hospital for the eight additional days as first requested, she would not have suffered the loss of her leg. Her attending physician also testified that the Medi-Cal physicians' rejection did not conform to prevailing medical standards. He felt that the Medi-Cal physician should not have been permitted to make decisions about her care without (1) first seeing the patient, (2) reviewing the patient's chart, or (3) discussing the patient's condition with her treating physicians.

     The state argued that it was not negligent as a matter of law and because the patient's attending physician had discharged her and had testified that his discharge met prevailing community standards. The state argued discretionary immunity and absolute immunity.

     In its judgment of the case, the court cited Rowland v. Christian,(38) "Everyone is responsible not only for the results of his willful acts but also for an injury occasioned to another by his want of ordinary care or skill in the management of his property or person, except insofar as the latter has, willfully or by want of ordinary care, brought the injury upon himself." All persons are required to use ordinary care to prevent others being injured as a result of their conduct."

     The court ruled that the state was not liable because the physician attending Mrs. Wickline had caused her discharge. This was the pivotal fact in the case. The court opined, however, that "What is at issue here is the effect of cost-containment programs upon the professional judgment of physicians to prescribe hospital treatment for patients requiring the same. While we recognize realistically that cost consciousness has become a permanent feature of the health care system, it is essential that cost limitation programs not be permitted to corrupt medical judgment."(35) In Wickline, the court ruled that if a patient needs treatment and is harmed when care that should have been provided is withheld, they can recover from all responsible for the deprivation of care, including where appropriate, health care payors. The Wickline court ruled that third party payors of health care services can be held legally accountable when medically inappropriate decisions result from defects in the design or implementation of cost containment mechanisms, such as when appeals made on the patient's behalf for medical or hospital care are arbitrarily ignored, unnecessarily disregarded, or overridden. Finally, it ruled that the physician's duty to the patient is not mitigated by the patient's insurance and that physicians who comply with treatment limitations imposed by managed care organizations without protest, when such limitations are at variance with their own medical judgement, cannot avoid the ultimate responsibility for any injury that occurs.

     The Wickline decision was revisited, upheld, and clarified in the Wilson Case. The 1990 California case of Wilson vs Blue Cross of California(36) reaffirmed Wickline and clarified the court's interpretation of its principles. In this case, a managed intermediary, Western Medical, disallowed a requested stay in a psychiatric hospital for Mr. Wilson whose attending physician felt that it was necessary to treat his depression. A three to four week stay was requested but further hospitalization was disallowed after a 10 day hospital stay. Twenty days following discharge, Mr. Wilson committed suicide and his estate filed suit. Blue Cross/Blue Shield obtained a summary judgment dismissing the suit because the patient's physician had discharged him. They also argued that aggressive utilization management was necessary to constrain rising health care costs. The Appelate court reversed the decision stating that Wickline did not apply to this private case because it was not a public-policy determined case and that the issues of the Wickline case were not valid in a for profit system where an insurance policy had been issued which defined provider responsibilities. The Wilson court ruled that no clear public policy immunized the utilization review contractor from liability for the patient's suicide after he was discharged from the hospital due to the contractor's alleged decision that hospitalization was unnecessary. Mr. Wilson's estate sued using the theory of tortuous breach of an insurance contract since Mr. Wilson's policy with Blue Cross/Blue Shield stated that he was entitled to 30 days hospitalization during any 12 month period if his attending physician determined that hospitalization was necessary, as was clearly the case.

     In Wilson, Western Medical, the managed care intermediary argued that when a treating physician decides to discharge a patient because an insurance company refuses to pay benefits, that the sole liability rests with the physician. The Wilson court rejected this argument stating that the sole reason for discharge, based on the evidence adduced in connection with the summary judgment motion, was that the decedent had no insurance or money to pay for any further inpatient benefits. Mr. Wilson's treating physician testified that he believed that had Mr. Wilson completed his planned hospitalization, there was a reasonable probability that he would not have killed himself. Western Medical declared that the physician was liable because he had failed to appeal its decision. The court, however, noted that the physician's failure to follow an informal policy allowing for reconsideration did not warrant granting summary judgment.

     Wilson thus became an important case because it (1) defined the limits within which managed intermediaries can disallow care recommended by a patient's treating physician, and (2) clearly defined the liability of physicians working for third party intermediaries who may cause or contribute to an adverse outcome.

     Salley(33) carried corporate liability one step further. In this 1992 Federal case, the court ruled that a managed care company could not disregard part of a physician's recommendations and act on only those elements which were likely to reduce their cost. In Salley, the 5th U.S. Circuit Court of Appeals in New Orleans found DuPont liable for the hospital expenses incurred in treating a 15 year old girl after multiple outpatient treatment failures. The court found that Dupont was liable even though it had contracted the management of individual cases to a third party managed care organization, Preferred Healthcare.

     Danielle Salley, the 15 year old daughter of a DuPont retiree had been hospitalized with suicidal tendencies. During her third hospitalization, her psychiatrist told the intermediary that although her hospital behavior had improved, he was fearful that her condition would deteriorate unless she was discharged to a structured environment. The intermediary then cut off her benefits. Her physician refused to discharge her until a suitable therapeutic environment outside the hospital was obtained. The 5th U.S. Circuit held DuPont liable for her hospital bills from October through January, and noted under it's contract with Preferred Health, that "the employer reserves final authority to authorize or deny any payment for services to beneficiaries of a plan." The court ruled that (1) DuPont abused its discretion when it terminated Danielle's benefits and (2) DuPont was liable for the action or inaction of its third party intermediary; (3) it concluded that Preferred Health did not heed the warnings of Danielle's psychiatrist and that hospital records showed that her inpatient hospitalization was medically necessary until a suitable disposition was found. The court noted that her hospitalization was disallowed without a Preferred psychiatrist examining the patient. In its ruling, the court said that since Preferred health had relied on the treating physician's description that she was no longer suicidal or out of control, that they improperly ignored his other advice that to release her to a non-structured environment could cause a relapse.

     The case of Sarchett v Blue Shield of California(47) established the principle that an insurance company does have a right to challenge a treating physician's determination of medical necessity. The court ruled that retrospective review was an implied right of an insurance relationship but concluded that "doubts and uncertainties in an insurance policy would be construed in favor of coverage for the insured."

     The need for physicians to be cautious in their contractual relations with managed care organizations was highlighted by the Michigan case of Carol v. Blue Cross and Blue Shield.(48) In this case several psychiatrists contracted to participate in a model mental health program developed by General Motors and the United Auto Workers. After 14 months they filed suit complaining that the provisions of the plan affected their medical judgment and asked for revisions in the contract. The court ruled against the physicians, reasoning that they had voluntarily agreed to the requirements and criteria that they now objected to. The court felt that they were obligated to abide by the terms of the contract that they signed, and warned that neither cost-containment nor cost reimbursement provisions mitigated the physician's "ethical and legal obligations to provide appropriate treatment to the patient."

     Marshall and Muszynski(49), attorneys working in this area, caution that providers must carefully evaluate and negotiate any contracts that they enter into with payors imposing managed care techniques that interfere with the treatment process. They recommend that providers seek favorable "out clauses" to allow them to quickly exit an unfavorable contract and counsel that any decision to discharge a patient or modify that patient's treatment should be based solely on the patient's clinical condition.

     The 1988 case of Hughes v. Blue Cross of Northern California(50) demonstrated the court's determination to ensure that providers of managed care services not be permitted to retreat from their obligations to patients, vis a vis the application of overly restrictive, arbitrary or inappropriate criteria, requirements, processes or the like.(38,p2) In this case, Blue Cross which acted as a utilization review organization, retroactively denied a hospitalization and part of another hospitalization for an acutely ill patient. At trial, it became clear that Blue Cross had inadequate information to evaluate the claim. The reviewing physician applied a standard of care which was different from community standards and the treating physician was never told the reason that Blue Cross disallowed the patient's hospitalization. The suit was resolved through the award of $150,000 in compensatory damages and $700,000 in punitive damages because Blue Cross was found to have violated the insured's right to good faith and fair dealing. This case suggests that physicians might benefit from working cooperatively with patients in helping them seek the rights and benefits that are assured them in their contracts.

ETHICAL AND BEHAVIORAL CAVEATS FOR PHYSICIANS DEALING WITH MANAGED CARE
     The foregoing cases suggest that physicians are ultimately responsible for their behavior with patients. As community standards remain the yardstick by which care will be measured, clinicians are well advised, where there is disagreement, to seek consultation with peers, specifically requesting for their opinion about what treatment is needed and whether the recommended treatment meets community standards. Physicians cannot follow protocols which they feel could potentially injure their patients without risk to their licenses.

     How should a physician act then, in dealing with managed care organizations? Here are some practical suggestions:



    1.   First and foremost, as your patient's physician do the right thing and do no harm.

    2.   Keep your patient's rights and interests foremost.

    3.   Treat your patient as you would want your family treated.

    4.   Remember that you are the clinically responsible party. you will be held accountable for your decisions. If there is a conflict between your patient's interest and that of a third party intermediary committed to reducing costs, (for example, about tests, referrals, hospital days, etc.), be sure that the course you choose is medically appropriate and defensible. There is nothing wrong with protecting your patient's rights in the most prudent and cost-efficient manner. The danger lies in distortions of judgment that are caused by financial considerations. Where possible, attempt to work amicably and effecting the managed care companies and if their constraints are reasonable, comply with them. If on the other hand, you feel that they are not reasonable, you should represent your patient's interests.

    5.   If a conflict should occur between you and a managed care organization or its intermediary such that your patient may be put at risk, appeal those decisions vigorously and repetitively. Discuss your dilemma with your patient explaining the pros and cons of each viewpoint and eliciting feedback from him/her. If your patient rejects your advice in favor of the managed care company, ask the managed care organization to provide another physician to care for the patient. Document these facts carefully and send appropriate confirmatory letters to both the patient and the managed care organization. Ask the patient to sign an "Against Medical Advice" form that clearly states your recommendations for continued or other treatment and the possible consequences of failure to obtain the treatment that you recommend. Document the managed care company's role in affecting your patient's decision.
     If, on the other hand, your patient elects to follow your advice and the managed care organization disallows treatment, continue to treat the patient. Carefully document the insurance company's refusal, provide continuing care, and carefully define the clinical facts that are the basis of your recommendation. Contact the managed care company and attempt to reason with another reviewer. Request reconsideration. Try to clarify any areas of disagreement. If no resolution is possible, Federal Express the patient's chart to the insurance company and request that a reconsideration be made in a timely fashion (i.e. 2-3 working days). If the managed care organization fails to reverse its decision, request in writing clarification as to the basis of the disallowal and by whom the disallowal was made. Provide this information to your patient. Obtain a consultation from a respected peer concerning the need for and appropriateness of the treatment you recommended, and specifically ask that peer to comment about whether your treatment decision (1) meets community standards, (2) is necessary to render appropriate care to the patient, and (3) is appropriate to the patient's current level of functioning. Ask the consultant to also specifically define the risks of not providing the treatment you have recommended. Provide the consultant's opinions to the managed care organization and request another reconsideration. If a disallowal again ensues, carefully note the clinical information that was provided to the insurance company or their reviewers, your reasons for requesting the appeal, the number of appeals requested, the reviewer's name and the time and date that you were notified of the company's determination of the appeal. Include a copy of your statement to the insurance company informing them of the risk the patient may experience if treatment is withheld or disallowed. With the patient's permission, provide that information to the patient's attorney and to your hospital administration if appropriate.

     Maintain complete files on all appealed cases. If you see a pattern of arbitrary and capricious disallowal, collect these cases and with the patient's permission, forward them to the insurance commissioner of your state. A copy of that letter should be sent to the insurance company's senior management, the senior administrator of any managed care intermediaries and the patient's attorney, all only after obtaining the patient's permission in writing.

     Have all contracts issued by managed care organizations carefully reviewed by your attorney before signing as the courts have ruled that physicians are responsible for the consequences of their agreements.


0 Comments

July 22nd, 2015

7/22/2015

0 Comments

 
We know that to go back and audit decades of health transactions is too much so we simply install the public system that stops the fraud and profiteering, bring back to the public the buildings and structure that used to be public health but are now Hopkins and corporate health non-profits, and make sure that health institutions installing Affordable Care Act---which make health care profit-driven-----PAY TAXES THAT WILL GO TO SUPPORT EXPANDED AND IMPROVED MEDICARE FOR ALL.

It is ridiculous to think that a health institution can expand from Baltimore across the state all over the US and then overseas using all the money generated as profit and still call itself NON-PROFIT.  All that needs be done is elect progressive labor and justice candidates that will then force a state's comptroller and Secretary of State charged with these illegal non-profit status designations to

DO THE RIGHT THING AND DECLARE CORPORATIONS HIDING AS NON-PROFITS CORPORATIONS THAT PAY TAXES AND THIS INCLUDES MANY RELIGIOUS INSTITUTIONS BEYOND THE CHURCH STRUCTURE.


MedStar in the Baltimore region is taking over every aspect of public health.  They have become our community public health clinics----they are located in every sector of Baltimore----they are senior care-----rehabilitation care centers.  This is an example of consolidated and captured corporate health care.  They want to pretend MedStar is a local health corporation but you can follow MedStar's expansion from the West complete with MediVAC helicopter ambulance service.  Look below to see how revenue in the billions has jumped significantly last year after the installation of the Affordable Care Act allowed MedStar to stop taking patients including uninsured and Medicaid.  It also has installed the kind of patient staging that has patients out fast and not allowed to come back.  This allows for the expensive hospital procedure to be billed and then off you go to all of the home health care services.

MEDSTAR IS A CORPORATION THAT EARNS PROFIT AND NEEDS TO PAY TAXES.


I spoke of my own personal experiences with MedStar and people are made fearful for their lives in this system that does indeed maximize profits.
  Please glance through a long article to get the feel of this consolidation and profiteering.  Having institutions growing to what will be hundreds of billions in revenue vs a public hospital that got only what it needed to provide safe and broad service to a community.  THE AMOUNT OF MONEY SPENT FOR THESE EXPANSIONS IS TREMENDOUS.


MedStar Health and the art of upheaval


Jun 19, 2015, 6:00am EDT Updated Jun 19, 2015, 5:38pm EDT



Tina Reed Staff Reporter Washington Business Journal


The 20-something had tried to schedule a doctor’s appointment over the phone, only to be put on hold for several minutes, a clear faux pas in the world of millennials.

“Dad, I don’t mean disrespect,” Samet recalls her saying, “but do you really run your business that way all the time? Why can’t I go online and make my appointment?”

He had an epiphany.

“I thought, ‘Even I use OpenTable,’” he said, referring to the online restaurant reservation service.

The executive got behind a proposed 18-month exclusive regional deal with ZocDoc in January 2014, allowing patients to book appointments with MedStar online for the first time. It was good for patients. But it also ended up being pretty good for business, too, as last-minute cancellations were filled.

It’s an example of a massive movement at Columbia-based MedStar, which is changing the way patients access care at a magnitude and pace unmatched elsewhere in the region. The system began implementing its MedStar 2020 strategy in 2009, at least a year before Democrats approved President Barack Obama’s Affordable Care Act. Obamacare, as the act is commonly referred to, embraces many of the same elements being instituted at MedStar: incentivizing health systems to push patients from hospital to outpatient care, emphasizing preventative measures and using technology to better coordinate care and improve its costs.

“We are disrupting the largest health care system in the region. This is not a little experiment,” Samet said. “It’s serious enough, we’re willing to disrupt our own business model.”

For MedStar — with $4.6 billion in revenue in its 10 hospitals and more than 250 outpatient access points — the experiment has begun paying off, with the health system reporting its strongest financial results in the last two years even as health systems around the U.S.
have faced serious financial challenges. As it adapts to a new business model itself, MedStar says it could ultimately help the region’s employers rein in ever-escalating health care costs by leading the shifts brought on by health reform.

Getting ahead of Obamacare

Samet began working on the new strategy soon after being appointed CEO of the system in 2008.

He knew health care would undergo radical changes in the coming decade, driven by unsustainable growth in utilization and cost. The system, even with its sizable hospital assets, could no longer focus on episodic acute care in an emergency room.

Key to that 2020 strategy was shaking up what was widely considered a successful regional hospital network, whose holdings include MedStar Washington Hospital Center, which has 769 beds and its cardiovascular institute, and MedStar Georgetown University Hospital, with 396 beds and a National Cancer Institute-designated cancer center. Even as it grew a research agenda and one of the largest medical education programs in the country, MedStar began aggressively pursuing a distributed model of community-based facilities. That included primary and specialty care physician offices, to family care centers, multispecialty care centers, urgent care centers and large-scale “hospitals without beds” — connecting them all electronically.

Another key: Samet recognized he may have to spend — or lose — money in the short term to achieve long-term success. “There’s no question the CFO could come in here and say, ‘Ken, it cost you X dollars for that,’” said Samet, who ran Washington Hospital Center for 13 years before becoming chief operating officer and then CEO of the entire system.

The way Samet tells it, MedStar quietly got way ahead of health reform by swallowing costs and pushing its business outside of traditionally more lucrative hospital care before there was a financial incentive — i.e., Obamacare — to do so. Before health reform, hospitals got more money for admitting a patient to the hospital than for offering a wellness visit to keep them out of one. Health care reform overturns that, paying health systems based on patient outcomes, not volumes.

“It’s a particularly interesting and challenging time from a financial standpoint to run health care organizations like MedStar because it’s running an organization in both a today and a tomorrow world,” Samet said. “We have to believe we’re doing the right thing for the long-term benefit.”


MedStar is already touching more patients, has increased its scale and purchasing power, and is on track to make $5 billion in revenue this year
, a 9 percent increase from $4.6 billion the previous year. That’s significantly better than the national average — Moody’s Investors Service reported last fall that operating revenue growth among nonprofit hospitals dropped from 5.1 percent in 2012 to 3.9 percent in 2013.

Moody’s also has given MedStar an A2 rating, a prime rating that indicates the health system has a strong ability to repay short-term debt obligations. Moody’s said MedStar has positioned itself well in the market with its growing network, allowing it to evolve with the nation’s health care system, praising its leadership for proactive planning for potential future challenges.

That’s not by coincidence. While other hospital systems in the region have promoted major investments in research — see Inova Health System CEO Knox Singleton’s major push into precision medicine in Northern Virginia— Samet has placed more emphasis on the business side.

“Knox wants to be remembered for genomics,” said Jay Shiver, a former D.C.-area health care administrator who now teaches health care administration at George Mason University. “Kenny’s a much more grounded person. He’s thinking the business of health care. And right now, this is where it’s going.”

Follow the Starbucks

In a Mitchellville strip mall with a grocery store and a McDonald’s, a MedStar multispecialty clinic appears packed one recent weekday morning. Patients in the Prince George’s County center are there for everything from X-rays to primary care appointments and follow-ups with cancer or surgical specialists.



Since 2009, MedStar has poured $186 million dollars into building out a network of more than 250 such outpatient access points, many in or near shopping centers, to attract patients across the region. Eight years ago, it had 95.

MedStar looked for established retailers like Starbucks nearby as it chose sites to build what it calls the “distributed care” model. Following the success of CVS’ retail Minute Clinics, MedStar created 10 of its own stand-alone urgent care centers called MedStar PromptCare around Greater Washington. It plans on having about 20 within the next 18 months. All are connected electronically when it comes to patient records.

The outpatient sites tie back to the health system. For instance, a third of all patients who come into urgent care don’t have a primary care physician yet and receive referrals.

“It becomes another front door to the system,” Samet said.

MedStar is going so far as to make some clinics “big-box” or “hospital without beds” multispecialty locations. That includes the planned downtown D.C. location at Lafayette Center, a 92,000-square-foot clinic that will offer six floors of primary care and specialty services, including surgical care and sports medicine. It is meant to be a more accessible way for patients to receive care they might typically receive at multiple locations throughout the city without the inconvenience of having to book multiple appointments. The center, which boasts a large parking structure, is blocks from the George Washington University Medical Faculty Associates, an independent physician group with more than 750 providers and 51 specialties.

Strength in (insured) patients

The health system’s new distributed network has made it a target for criticism, however, that it’s cherry-picked commercially insured patients.

After MedStar opens outpatient centers nearby, the D.C. Primary Care Association has complained that smaller nonprofits get fewer numbers of insured patients who help make their own clinics viable for caring for the uninsured. In August, MedStar looked to shed that reputation as it established a memorandum of understanding with DCPCA to help get uninsured patients improved access to MedStar specialists and improve coordination with primary care providers outside its system, said Jackie Bowens, CEO of the D.C. Primary Care Association.

DCPCA wasn’t the only one. MedStar also entered into a similar MOU with Mary’s Center, a regional network of clinics to help low-income residents.

“Being [that] MedStar is a well-capitalized health center, Mary’s Center didn’t have a choice but to enter into an MOU,” David Tatro, chief operating officer at Mary’s Center, said when it was signed last August. “But we seem to be making progress toward ensuring the community has better access.”

For MedStar, the investments solidified its strength across the region as its outpatient visits dominated its business and drove market growth. Last year, the health system counted 4 million outpatient visits, compared with 160,000 inpatient admissions. For the 10 months of this fiscal year that ends June 30, the system’s outpatient revenue growth, pegged at 7 percent, is outpacing its 1.2 percent rise in inpatient revenue in that time.

Year over year, MedStar steadily increased its market share in D.C., growing 3.7 percentage points from just shy of 18 percent in 2007 to more than 21.7 percent in fiscal 2013, according to D.C. Hospital Association data.

“They are coming together as an increasingly sophisticated health care system,” said Dr. Toby Cosgrove, CEO of Cleveland Clinic, which has partnered with MedStar’s tech transfer program, as well as its cardiovascular program. Cosgrove, himself a 40-year veteran at Cleveland Clinic, calls Samet “aggressive.”

MedStar has a long way to go before it ever has the national reputation of a Johns Hopkins, but Cosgrove praised its growing regional clout even as more nationally renowned institutions struggle with their research-based budgets.

“Increasingly,” he said, “what you’re getting paid for is the efficient delivery of care.”

Investments in innovation

Samet initially planned to pursue a career in medicine at Old Dominion University. He excelled more in business ventures and, in one instance, organized a group of fraternity brothers to help sell souvenirs where he worked as a concessions manager for the local convention center.

After taking a course taught by the chief financial offer at a local hospital, he was hooked on a new plan: the business of health.

After graduate school, he began an administrative residency at the Washington Hospital Center in 1982 and has been connected with the hospital ever since.

“My hands aren’t going to touch a patient, thankfully,” Samet said. “But I feel like my contribution can be in creating and organizing and turning loose the energy and the creativity and the passion of our people.”

His new strategy did just that. In 2009, he set aside $2 million to establish the MedStar Institute for Innovation, called MI2. The institute now has an annual budget of $10 million.

Many health systems say they have innovative cultures, but new ideas can easily get buried in bureaucracy, said Mark Smith, MedStar’s chief innovation officer. That hasn’t happened at MedStar, Smith said, because Samet was clear the institute would report directly to him.

Six years later, Samet is still vague about why he created it. “If I actually knew what it was going to do, it wasn’t very innovative,” he tells anyone who asks.

What we know is this: It was an infrastructure for innovation, Smith said, by offering a safe space for employees to pursue ideas that could impact health care.

The innovation center launched the Global Healthcare Innovations Alliance with Cleveland Clinic in 2011 — essentially outsourcing its work to commercialize ideas.

That partnership has resulted in 255 ideas, including 33 this year. It has also resulted in 13 patent applications, an app on the Apple App Store, five technologies in license negotiation and three proof of concept studies. Most recently, a physician invented an implantable device that could help patients with pulmonary failure live independently. MedStar is moving that product to market.

MI2 eventually led to the formation of the Center for Digital Health & Data Science, which is designed to incubate ideas, for instance, in personal health and telemedicine. The center also serves as a portal to the outside world for both established and early-stage companies, becoming a founding partner of D.C. startup incubator 1776.

MI2 is working with six startups on remote monitoring systems, informatics, telemedicine and other digital health solutions to change health care delivery. In exchange, MedStar has the first rights to use any innovations within its own delivery system.

Most large integrated health systems have begun developing innovation programs, but the overall breadth of MedStar’s program is unique, said Dr. Molly Coye, the entrepreneur-in-residence at the Network for Excellence in Innovation, a health policy institute not affiliated with MedStar.

“MedStar was an early entrant in this,” said Coye, who served on the American Hospital Association board with Samet.

She said MedStar’s focus on combining internal ideas with outside resources makes sense.

“Some health systems insist they want to exclusively do their own innovations or approaches,” she said. “But because MedStar uses this approach, the chances they’ll produce something useful is quite high.”

One of MedStar’s creations was its National Center for Human Factors in Healthcare, which looks to capture safety and quality lessons from such industries as aviation and manufacturing. The name of the center itself is enough to make many health administrators squeamish by virtue of the implicit connection to the mistakes that can happen when humans run a health system. But it put the health system in the company of more established institutions, such as John Hopkins, which has a leading patient safety and quality institute of its own.

Too often, changes in health care are being attempted from the top down, said Dr. Peter Pronovost, a nationally recognized leader in patient safety who heads Johns Hopkins Armstrong Institute for Patient Safety and Quality. “Evidence shows that pay-for-quality has motivated hospital executives, but what about the care provider on the night shift?” Pronovost said. “That’s why innovation is so important because it can inspire and motivate. Fundamentally, you’ve got to engage your employees.”

Indeed, “a lot of innovations are created by medical nerds like scientists,” Coye said. “But human factors engineering means you’re really studying the patients, their families, the nurses at the bedside and really trying to understand them.”

How do you measure success?

Whatever Samet and MedStar are doing, they should brace for some serious competition. Other health systems, such as Tenet Health, are doing this on a much larger scale, said Venson Wallin, a managing director in BDO Consulting LLC’s health care advisory practice.

“From a regional perspective and a general strategy perspective, they are ahead of the game,” Wallin said. “But they won’t be on their own for much longer. That’s where the focus on health care is going.” Instead, Wallin believes MedStar could be more of an example to similarly sized systems that can’t measure up to Tenet’s scale. “If they are able to cut costs by getting people into the community rather than the hospital, as a result, the costs from employers’ and employees’ perspective are hopefully reined in,” Wallin said.

To be sure, the Supreme Court’s decision on whether to uphold the Affordable Care Act, due out by the end of the month, has the potential to create massive ripples across health care if millions of patients across the country were to suddenly lose health insurance. It was the health reform law that helped incentivize much of the momentum happening in the industry.

And while health executives have said it’s unlikely they’ll roll back the steps they’ve taken toward value-based care, it could create some serious financial hurdles and slow progress.

“The region needs us to be successful,” Samet said. “There’s no replacement strategy for the activities and the services that get provided.”

How will Samet and MedStar know if they are successful in the long term?

Samet said he’ll know if MedStar continues to grow even while inpatient revenue makes up less than 40 percent of the health system’s total revenue in five years. But ultimately, he said, success will mean the health system built a value equation recognized nationally as a key to solving the quality, safety and ultimately cost of health care.

“I’m proud of our organization that we had the courage to start this journey before all of that,” Samet said, referring to the health reform legislation. “But I also know it’s a good thing we did.”

____________________________________________
I am highlighting MedStar because it has a growing control in our Baltimore regional market.  This article shows how Medicaid patients are indeed being kept from these profit-driven hospitals and as it says-----MedStar is building the preventative care only clinics in underserved communities to keep patients out.  At the same time, the funding for Medicaid is being fleeced in greater amounts as the access to care for what is becoming most Americans falls.  MedStar is pleased to be at the forefront of tiered access to health care and using Federal funding from our Medicare and Medicaid Trusts to maximize profits---that is Wall Street driven private health care.

Now, if you think it is good news that close to 50% of Americans are moving to these Federal programs as they are being dismantled and privatized----with the coming economic crash taking out private and public pensions and health plans boosting this number above 70%.......you don't know what life without access to any health care but preventative care will look like.  The plan for Medicare will be that it will look just like Medicaid for anyone earning under a few hundred thousand dollars a year.


Single Payer: Centers for Medicare and Medicaid Will Provide 43% of All Health Insurance in 2014


By Terence P. Jeffrey | November 1, 2013 | 9:46 AM EDT 247SharesFacebookTwitterMore President Barack Obama (AP Photo/Carolyn Kaster)

(CNSNews.com) - The Centers for Medicare and Medicaid Services--the federal agency that created and is operating the Obamacare exchanges--says in a budget document provided to the congressional appropriations committees that the Medicare, Medicaid and Children’s Health Insurance Program (CHIP) will cover almost 116,000,000 Americans in 2014.





MedStar Health expands Medicaid business in D.C.



Aug 3, 2012, 6:00am EDT


Ben Fischer Staff Reporter Washington Business Journal Enlarge Wagner

MedStar Health is expanding its Medicaid insurance plan to the Washington region, where executives believe they can make money with a counterintuitive goal: Keep patients out of their growing network of local hospitals.


The Columbia, Md.-based hospital system recently won a D.C. contract to begin competing in the city’s Medicaid program Oct. 1, a victory that comes as it also expands into the Maryland suburbs after a decade in Baltimore. In both jurisdictions, the insurance arm makes money by spending less on beneficiaries’ health care needs than it receives in fees from the government.

For now the plan, dubbed MedStar Family Choice, is a small play, about 3 percent of MedStar’s $4 billion in annual revenue. But the system is positioned to be an even bigger insurance force in D.C., where the current Medicaid contracting market is in flux. Dominant player D.C. Chartered Health Plan Inc. is seeking a buyer, and officials say it likely will not receive a new contract as long as embattled political donor Jeffrey Thompson owns the company. Both Chartered and second-tier UnitedHealthcare Community Plan have reported losses recently, and UnitedHealthcare has not committed to seeking a new contract.


Typically, Medicaid insurance plans build market share slowly, because they are prohibited from directly soliciting business and incumbent plans usually retain members. But the turnover could allow MedStar to be an exception, said Wayne Turnage, director of the D.C. Health Care Finance Department.

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You hear absolutely no discussion as to what these laws in Affordable Care Act mean and below you see what will become the largest culling of American people from accessing Medicare in history-----losing Medigap insurance option as seniors try to pay the 20% of costs Medicare does not cover.  As you see below, a large percentage of seniors use Medigap----you can be upper-middle class and need Medigap to meet that 20%.  What Obama and Clinton neo-liberals did was use this to keep a majority of seniors from accessing much of health care.  This is called----BRINGING DOWN THE COSTS OF MEDICARE.  So, this consolidation and deregulation of health care creating global health corporations will make health costs soar at the same time seniors are made to pay the 20% with no avenue for Medigap to help.  This means one health incident and you are medically bankrupt and no longer able to access ordinary health procedures.

THIS WILL PUSH SENIORS THAT WOULD HAVE GOTTEN MEDICARE ONTO MEDICAID----THAT GUTTED OF FUNDING PREVENTATIVE CARE FOR ALL.

Republicans have always wanted to end Medicare and Medicaid----but they did not force Obama and Clinton neo-liberals----it was what Affordable Care Act had as a goal.

You see how installing Expanded and Improved Medicare for All takes care of all this.  It covers the 20% seniors had to pay----as a result bringing some of that massive fraud against all of our wealth assets back with full coverage for life.  It does not matter if the poor have this access folks----simply ending corporate fraud and profiteering leaves plenty of revenue -----along with taxing corporations.


Medigap Most Medicare enrollees have some type of coverage that limits the program's cost-sharing requirements. According to the Kaiser Family Foundation (KFF), 23% of all Medicare enrollees buy private Medigap policies; 35% have employer- or union-sponsored supplemental coverage; and Medicaid augments Medicare coverage for low-income seniors (19% of all enrollees).

Under the doc-fix law, Medigap plans will no longer cover the annual Part B deductible for new enrollees ($147 this year). That will mean changes for Medigap "C" and "F" plans, the two most popular plan choices and the only ones that cover Part B deductibles. Starting in 2020, seniors would have to pay it themselves. Current Medigap policyholders and new enrollees up to 2020 would be protected. First-dollar coverage from employers and Medicaid are unaffected.


With the average income in Baltimore at $45,000====everyone will be on Medicaid. See how you make the single-payer Medicaid for All!


Pressure for Entitlement Cuts Is on Medicare, Medicaid



by Jim RowleyHeidi Przybyla November 28, 2012 — 12:17 PM EST 

Democrats willingness to change Medicare and Medicaid will determine how far Republicans can go to meet President Obama’s demand for $1.6 trillion in more revenue. (Bloomberg)


-- Democrats say Social Security is off the table. So if Republicans are successful in pushing for changes to entitlement programs in U.S. budget talks, the pressure for cuts will be on Medicare and Medicaid.

Republicans propose raising the Medicare eligibility age. Other options for squeezing money out of the health care program for the elderly include additional co-payments and an increase in premiums paid by high-income recipients. In February, President Barack Obama proposed saving about $70 billion over 10 years by revising the formula for federal matching of state Medicaid expenditures, along with other changes.

“There are things that we can do with entitlements that don’t hurt beneficiaries,” Senate Majority Leader Harry Reid, a Nevada Democrat, told reporters in Washington yesterday without giving specifics.

Democrats, buoyed by victories in the Nov. 6 election, say they won’t touch Social Security during talks over averting the so-called fiscal cliff. Their willingness to make changes to Medicare and Medicaid -- which together cost $720 billion a year, about one-fifth of the U.S. budget -- may determine how far Republicans will go to meet Obama’s demand for $1.6 trillion in new revenue over the next decade.

Financial Structure House Speaker John Boehner, an Ohio Republican, has said he wants “real changes to the financial structure” of entitlements before he’ll agree to more tax revenue.

Lawmakers are trying to avert $607 billion in tax increases and automatic spending cuts scheduled to begin in January. They are also aiming for a longer-term plan to reduce the U.S. budget deficit, which has topped $1 trillion for four consecutive years.

Today, Boehner said he was “optimistic” all sides will continue to work toward an agreement. A day earlier, Reid said the parties had made “little progress” in budget talks since a Nov. 16 meeting at the White House.

Stocks were little changed today. The Standard & Poor’s 500 Index rose less than 0.1 percent to 1,399.03 at 11:27 a.m. in New York, erasing a decline of as much as 1 percent. The Dow Jones Industrial Average added 28.15 points, or 0.2 percent, to 12,906.28.

One alternative sought by Republicans is increasing the eligibility age for Medicare, now 65. Gradually raising that to 67 for future recipients would save $148 billion through 2021, the Congressional Budget Office has estimated.

Starting Point The Democrats’ starting point for Medicare and Medicaid cuts is what Obama proposed to trim from the programs in his 2013 budget. CBO estimated those cuts would total $351 billion over 10 years.

Republican Representative Tom Cole of Oklahoma dismissed Obama’s proposals for entitlement cuts as “mostly nips and tucks around the edges.” To curb the projected long-term growth of entitlement spending “you’ve got to go deeper,” he told reporters. “I haven’t seen anything that suggests” that Obama “is willing to do real structural reform.”

Obama and his advisers “surely look at the same numbers we do and they know they can’t” cut deficits without dealing with entitlements, Cole said. After endorsing a plan to partially privatize Medicare, House Republicans survived the “fire of an election,” he said. “That tells me the American people are willing to accept some honest talk and some tough decisions.”

Drug Rebates The biggest savings in Obama’s budget proposal would be $137 billion from requiring drugmakers to give Medicare the same rebates for medicines for low-income recipients that are allowed for Medicaid’s purchase of prescription drugs, according to the CBO estimate.

More than $45 billion in savings would come from cutting reimbursements for providers of some post-acute care, such as rehabilitation services and home-health care. Almost $24 billion would be saved by reducing the government’s coverage of bad debts that hospitals incur from patients who don’t pay their bills. 

For Medicaid, the health-care system for low-income Americans, Obama’s budget would revise the formula for payments to states and make other changes for a 10-year savings of about $70 billion, according to CBO. Republicans have proposed making Medicaid a block grant-style program and turning it over to the states.

Some Democrats say they favor an increase in the payroll withholding tax for Medicare. It would hit lower-income wage earners harder because it’s based on a percentage of income.

‘Tiny Fraction’ Still, an increase of just “a tiny fraction would generate a fair amount of money,” said Democratic Representative Earl Blumenauer of Oregon.

These sorts of changes probably won’t provide enough savings for Republicans to accept in return for increasing taxes for high earners, said G. William Hoagland, a former Republican staff director for the Senate Budget Committee. He’s now a vice president at the Bipartisan Policy Center in Washington, which studies ways to cut the deficit.

Even if Democrats are willing to make fundamental changes to Medicare they “don’t generate savings very quickly,” Hoagland said. Republicans want to “see spending savings quickly,” he said.

The election effectively killed the Republican proposal to offer future Medicare recipients a chance to buy private health insurance with money provided by the government, Hoagland said.

A Democratic proposal to raise premiums paid by higher-income Medicare beneficiaries is potentially “the big one for real savings quickly,” Hoagland said.

Higher Premiums Individuals with annual incomes of more than $85,000 and married couples with incomes of more than $170,000 already pay higher premiums. That amounts to 5 percent of all Medicare recipients.


As an alternative to raising taxes, “this is a back-door way, particularly for the elderly rich,” Hoagland said. Higher premiums for individuals with incomes of more than $200,000 or married couples with incomes of more than $250,000 would be “fair game” for “soaking the rich,” he said.


Obama’s plan would freeze the income thresholds until 25 percent of Medicare recipients pay premiums based on income testing. That provision would save $30 billion over the next decade, according to the CBO.

Means-testing is “much more controversial” among Democrats who don’t want Medicare and Social Security to be equated with welfare programs, said Paul Van de Water, a health-care economist at the Center for Budget and Policy Priorities, a Democratic-aligned budget policy research group.

‘A Stake’ “It’s important that everyone feel they have a stake,” Van de Water said. “Income-tested premiums represent a breach in that principle.”

With sluggish progress in budget negotiations, Democratic-aligned interest groups are starting a media and grassroots campaign to urge Obama not to accept benefit cuts. Congressional Republicans are seeking to rally public support for their positions on taxes and entitlements.

Goldman Sachs Group Inc. Chief Executive Officer Lloyd Blankfein is among executives scheduled to meet today with Obama, and later with Boehner, to press for a solution to the fiscal-cliff standoff.

About 200 local labor union members led by the AFL-CIO and the Service Employees International Union plan to visit Washington today to lobby lawmakers.

The disagreement over entitlements may be a bigger hurdle to a budget deal than Republicans’ opposition to higher taxes, said Steve Bell, a former Republican Senate Budget Committee aide.

“I do not believe that taxes will be the main stumbling block to these negotiations,” Bell said. “Any fundamental change in Medicare and Medicaid will be the stumbling block.”
______________________________________


When thinking of all these reforms with the Affordable Care Act we need to know that these politicians know a massive bond market crash will implode the government with so much debt as to have them saying----SORRY---NO MONEY FOR PUBLIC TRUSTS.  That was the goal of super-heating the bond market.  So, all of this is about creating the structures to move almost all of Americans into what will be a gutted Medicaid for All----this is the single-payer model Maryland has been developing these few decades.....and it is what will play out very quickly for baby boomers losing all pensions, retirements, and now health insurance.  This would happen as soon as 2020----and that is why Obama and Clinton neo-liberals chose 2020 to end MediGap.



The Coming Bond Market Collapse: 3 Ways To Escape The Damage


Apr. 27, 2013 8:29 AM ET 



Just when you've finally gotten over the stock market crash from four years ago, there's a new threat that could potentially hit your portfolio. Even worse, it's in an area that many people think of as being safer than stocks: the bond market.

We're on a collision course with the worst bond market collapse in decades and the warning signs are as clear as day. There's still time to dodge the damage - and even to profit - if you know what to look for.

But the time to make your move is now…

Three Facilitators for a "Total Bond Market Collapse"U.S. Treasury bond yields have been falling steadily since the beginning of 2011, with the 10-year Treasury yield falling from 3.54% to its current yield of 1.78%.



Investors have piled into bond investments over the past several years, accepting lousy guaranteed returns in exchange for the near-certainty that they won't lose any principal. Various levered (NYSEARCA:UBT) and inverse levered long Treasury bond funds (TBT,TMV, TTT), will continue to generate activity and interest. With Treasury bond volatility now roughly equivalent to the trailing volatility of the S&P 500 (NYSEARCA:SPY), this market will continue to be a place for traders to tactically position with the hopes of short-term gains, but for how long?

While this example only represents a moderate decline in bond prices, take heed: That gentle slope leads directly to the precipice of a bottomless pit - a total bond market collapse.

There are three key factors that will cause - and even hasten - the coming bond market collapse. These catalysts are easy to spot - indeed, they're in the headlines virtually every day.

I'm talking, of course, about monetary policy, inflation and the federal deficit. Let's take a detailed look at each of these potential bond-market-collapse catalysts:

The Monetary Policy BluesU.S. Federal Reserve Chairman Ben S. Bernanke has kept interest rates virtually at zero (0.00%) for 54 months, with inflation jumping .4% in March. At the latest FOMC meeting, Bernanke has announced the Fed's plan to continue buying $85 billion per month of U.S. Treasury debt and mortgage-backed securities. He's not going to raise interest rates anytime soon, which means inflation could potentially accelerate, mostly through commodity prices. And when he stops buying Treasuries, where will that leave the investors?

The Inflation ConflagrationInflation had been running very low ever since the recession, but in the last six months, the producer price index (PPI) has risen at an annual rate of 12%. That will feed into the consumer price index (CPI) over the next few months, which already experienced the largest over-the-year increase in February - the largest increase since the 2.9-percent advance in March 2012.

(click to enlarge)

At some point, bond buyers will realize inflation is back and panic. After all, even though inflation never got above 14% in the 1970s and 1980s, long-term bond yields got to 15%. For bond yields to move that high from here, bond prices would have to fall an awfully long way.

The Federal-Deficit Follies:The real cost of the $787 billion "stimulus" of 2009 is the $1.12 trillion deficit we are now struggling with. The United States has never run a deficit of anywhere near this magnitude, and it's becoming obvious that near- trillion-dollar-plus deficits are here until 2015. That's another reason for the bond markets to panic - and is another reason to fear a bond market collapse.

Worse Than the 70sCombine those three factors, and you're looking at the potential for a truly epic bond market collapse, worse than anything that we saw in the 1970s. If you ask me to bet, I would say the bond market disaster will start in the third quarter - even CPI inflation figures are likely to be looking pretty creepy by then. Before then, you will probably see a continuing creep upwards in bond yields, perhaps reaching 4% on 10-year Treasuries by early June.

How to protect yourself? Well, obviously gold and silver are part of the solution, at least until the Fed starts fighting inflation properly, which I don't expect to happen before next year.

In fact, I would recommend you have at least 15% to 20% of your portfolio in gold and silver, the traditional inflation hedges.

Of course, the short story is that both metals have exchange-traded funds that track their price fluctuations - namely the SPDR Gold Trust (NYSEARCA:GLD) and the iShares Silver Trust (NYSEARCA:SLV).

The other solution is to bet on the bond market collapse itself. To do that, I'd recommend a look at the ProShares UltraShort Barclays 20+ Year Treasury Exchange Traded Fund (NYSEARCA:TBT), which aims to rise by twice the amount that long-term Treasuries decline. Like all leveraged inverse funds, this accumulates tracking error if you hold it too long. However, I don't think we'll have to hold it for more than a few months this time, so the tracking error should be modest.

People have been predicting a sharp rise in bond yields for a few years now, and they have been wrong. However, I think those predictions of a bond market collapse are likely to come true within the next few months, and when they do, they'll come true with a bang.

Investors are looking at a bond market collapse, and it could start in the third quarter. But don't wait until then to adopt defensive investments. Start positioning yourself now.


The U.S. Federal Reserve's loose monetary policy and the inability of our elected representatives in Congress to rein in the U.S. debt load have undermined both the U.S. dollar and the nation's economic recovery.

There is no safe place to hide, but owning gold and other precious metals such as silver could go a long way toward preserving your wealth - at least until the Fed starts fighting inflation properly, which I don't expect to happen before next year.

Disclosure: I have no positions in any stocks mentioned, and no plans to initiate any positions within the next 72 hours. I wrote this article myself, and it expresses my own opinions. I am not receiving compensation for it (other than from Seeking Alpha). I have no business relationship with any company whose stock is mentioned in this article.


_________________________________________________
Below you see a well-researched paper on health fraud.  Notice that the amount of fraud back in 1998 was $250 billion a year.....THAT WAS BEFORE CORPORATE FRAUD WENT ON STEROIDS.  This is an example of what was probably one of the last of university research that held power accountable and told the truth about this massive fraud of our Medicare and Medicaid Trusts.  I have this paper on my website under Healthcare.

Today you see estimates of $90 billion ------I contacted the Center for Public Integrity reporter who used this number and he qualified it as the sum of just one kind of fraud-----billing fraud and all media, pols, and pundits use that low-ball number.  We know if in 1998 before the complete dismantling of FEderal oversight and accountability allowed the Bush and Obama years to go wild with fraud----that health care frauds were already in the hundreds of billions.

My point is recovery of this money to our trusts are never mentioned and will never be mentioned by Clinton neo-liberals-----they will simply use 'austerity' to pay for that corporate fraud.

STOP ALLOWING THEM TO DO THIS-----WE PAID FOR DECADES A HIGH PAYROLL TAX JUST TO RECEIVE FIRST WORLD QUALITY CARE AS SENIORS.

Expanded and Improved Medicare for All not only keeps our Federal Medicare strong----it gives all Americans the opportunity when they need it most to walk in to get any healthcare they need.


'It is clear to see why Americans consider this the biggest cause, when health care fraud was estimated to cost approximately $100 billion to $250 billion per year in 1998, or 10 percent to 25 percent of total health care spending'

An Undergraduate Honors Thesis by
Emily Fisher
V449
Professor Nicole C. Quon
April 2008



Wednesday, April 20, 2011

******************************************************************


Mass "For Profit" Medicine Creates Economic Incentives for Medicare Fraud and Medicaid Fraud

Medicare Fraud Lawsuit, Systematic Medicare Fraud Lawsuit, Medicare Recipient Whistleblower Lawsuit, Medicare Fraud Whistleblower Lawsuit, Systematic Medicaid Fraud Lawsuit, and Medicare Compliance Fraud Lawsuit Information
by Texas Medicare Fraud Lawyer Jason S. Coomer

Medicare fraud and Medicaid fraud are becoming one of the fastest growing and most lucrative crimes in the United States.  It is estimated that Medicare fraud and Medicaid fraud costs tax payers between $70 Billion and $230 Billion each year.  One of the reasons for the rapid growth of Medicare Fraud and Medicaid Fraud is that many large "for profit" medical services including hospitals and medical systems have moved to assembly line mass production of medical services that value maximizing profits over the individual needs of the patients. This maximization of profits can easily turn into systematic Medicare fraud or systematic Medicaid fraud. 


Many Large "For Profit" Health Care Providers Become Medical Assembly Lines for Patients, Provide Mass One Size Fits All Medical Services for Patients Regardless of Individual Medical Need, and Commit Systematic Medicare Fraud and/or Medicaid Fraud
by Texas Medicare Fraud Lawyer Jason S. Coomer

In the modern age of medicine, large "for profit" health care providers have turned traditional medical practices where doctors knew their patients and were able to spend significant time with their patients into large "for profit" billing machines where many patients are run through an assembly line and the patient is lucky to spend 10 or 15 minutes with a doctor.  These "for profit" patient mills often tend to provide one size fits all services despite the individual needs of the patient.  In many of these large "for profit" medical systems, patients are nothing more than a number or a Medicare number that can be billed.  
The large "for profit" hospitals and health care systems, often view patients through their billing departments as ways to make a profit by billing for expensive and unnecessary services as long as the services can be billed to the person's Medicare number.  Regardless of the patient's actual needs, the ability to bill Medicare for services becomes a driving force as to how the person is treated in the medical system.  By maximizing the amount that can be billed to Medicare or other third party payers, the large health care provider is able to maximize their revenue and profits regardless of what the patient actually needs.  The patient's needs often become secondary to the need to maximize profits. 
The need to overcome economic incentives that could turn medical providers away from the best interests of patients was understood and the basis in passing the Stark Laws and Anti-kickback Laws.  Hopefully, new whistleblower protections and expanded False Claims Act laws may also help curb negative economic incentives and profit driven health care providers that are placing profits over the needs of patients.  
In situations where the health care provider is driven by profit instead of a patient's needs, the traditional doctor patient relationship is violated.  The patient's trust in the health care provider can then often be misplaced.  Where the traditional expert advice of a medical doctor was once in the patient's best interest, the "for profit" health care provider can now be working against a patient's best interest and to only be maximizing profits.
Further, many "for profit" health care providers have separate billing departments, accountants, and administrators whose jobs are to maximize the hospital or health care system's profits.  These billing departments, accountants, and administrators, can sometimes determine that by making systematic changes including upcoding, phantom billing, or other Medicare fraud, that the hospital's or health care system's monthly, quarterly, or annual profits can be increased.  By slowly and continually making these systematic Medicare fraud changes, the hospital can continue to increase profits and the incremental changes can be extremely hard to detect. 
Hospital Medicare Fraud Whistleblower Lawyer, Nursing Home Medicare Fraud Whistleblower Lawyer, Physician Medicare Fraud Whistleblower Lawyer, Hospice Fraud Whistleblower Lawyer, and Home Health Care Medicare Fraud Whistleblower Lawyer
(Medicare Fraud Whistleblower Law Suits)

If you are a hospital administrator, nursing home administrator, physician, nurse, respiratory therapist, coder, accountant, dentist, health care coordinator, coding specialist, or other health care professional that is aware of Medicare fraud, it is important that you report the Medicare fraud.  As a Medicare fraud whistleblower you not only can recover a portion of the recovery if the fraud is properly reported, but it can help avoid potential criminal liability.  Medicare fraud lawyer, Jason S. Coomer helps whistleblowers that are aware of systematic Medicare fraud including health care providers that are committing upcoding, illegal kickbacks, charging for unnecessary services and procedures, charging for services not provided, double billing, or bill padding.
Through Health Care System Medicare Fraud Whistleblower Lawsuits, Hospital Medicare Fraud Whistleblower Lawsuits, and other Health Care Fraud Lawsuits, billions of dollars have been recovered from individuals and organizations that have committed health care fraud and stolen large amounts of money from the government. It is extremely important that Hospital Administrator Whistleblowers, Health Care System Whistleblowers, and other Medicare Fraud Whistleblowers continue to expose fraud schemes including off-label marketing schemes, illegal kickbacks, fraudulent billing practices, hospice fraud, nursing home fraud, dentist Medicaid fraud, and other Medicare Fraud that cost hundreds of billions of dollars.   
Feel free to clicking on the following link for more information on Hospital Systematic Medicare Fraud Lawsuits and Health Care System Medicare Fraud Lawsuits: Hospital Systematic Medicare Fraud Lawsuit and Health Care System Medicare Fraud Lawsuit Information.
Medicare Fraud Lawsuit, Systematic Medicare Fraud Lawsuit, Medicare Recipient Whistleblower Lawsuit, Medicare Fraud Whistleblower Lawsuit, Systematic Medicaid Fraud Lawsuit, and Medicare Compliance Fraud Lawsuit Information
by Texas Medicare Fraud Lawyer Jason S. Coomer

Medicare fraud and Medicaid fraud scams are costing the United States hundreds of billions of dollars and are threatening the Medicare benefits and Medicaid benefits of millions of Americans.  The cost of systematic Medicare fraud and systematic Medicaid fraud includes nursing home Medicare fraud, home health care service Medicare fraud, hospital Medicare fraud, therapist Medicare fraud, dentist Medicare fraud , and other health care provider Medicare fraud that systematically and knowingly commits upcoding Medicare fraud schemes, double billing Medicare fraud schemes, unnecessary service Medicare Fraud schemes, and other fraudulent Medicare billing schemes.  By billing for services not provided or needed, many fraudulent health care providers have found it extremely profitable to exploit the current Medicare and Medicaid system. 



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July 21st, 2015

7/21/2015

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Before looking at the individual elements of Maryland's 'single-payer' being played as a progressive inclusive model for health care......I will take another day to look locally at Baltimore and its health care environment to show where the goal of Maryland's health model will go.

I have posted before that citizens in Baltimore are actually fearful of Johns Hopkins because of a belief that Hopkins is treating people as human capital-----profiteering from bodies.  Now, since we have no oversight and accountability of health care in Baltimore-----and since the level of abuse and exploitation of the poor in Baltimore is extreme----I tend to believe Baltimore citizens that say they experience this attack on their physical bodies.  Hopkins has operated in Baltimore as it would overseas because it has been living the Trans Pacific Trade Pact version of another US Constitution----one that is rewritten with no rights for people as citizens.  That is why it fleeces, exploits, and jukes the stats at will.  It is because Clinton embraced the Federalism Act as Executive Order as does Obama as any good Republican would----that Hopkins can do this with no Federal oversight. 

THIS FEAR OF HEALTH INDUSTRY ABUSE WILL EXPLODE IF WE ALLOW TPP AND THE DISMANTLING OF OUR FEDERAL PUBLIC HEALTH TO CONTINUE.  THIS IS NOT HYPERBOLE----IT IS TRUTH TO POWER.


As we see below the problem with health care costs IS HEALTH INDUSTRY FRAUD AND PROFITEERING----and as we see the Affordable Care Act unfold we see it simply creates the environment for fraud and profiteering to soar with the dismantlement of the one policy tool meant to keep health costs controlled-----A FEDERAL PUBLIC HEALTH PROGRAM MEDICARE AND MEDICAID.  These programs were not only about helping the poor and seniors stay healthy----these programs keep private health industry prices and profit in check and this is why Republicans and Clinton neo-liberals want it gone----unchecked global profit-----whatever the market will bear.

So, Expanded and Improved Medicare for All----IT IS NOT SOCIALIST MY REPUBLICAN AND CONSERVATIVE DEMOCRATIC FRIENDS ----is the only way to keep costs in check and have the American people having access to common medical treatments.  We are not talking concierge personal medicine---we are talking about the same basic care Americans have had for most of the 20th century.

Published on Monday, July 20, 2015 by Common Dreams
Private Health Care as an Act of Terrorism

byPaul Buchheit

Americans are being cheated by a medical system that favors profits over health and wellbeing. But things are even worse than that. (Photo: MilitaryHealth/flickr/cc)

The FBI defines terrorism as "Acts dangerous to human life...intended to intimidate or coerce a civilian population." Much of the behavior of our current health care system meets that definition. The facts show intention on the part of corporations to intimidate the population by using market strategies to charge whatever they like for their medical products and services, and an effort to coerce the public into accepting the current system as the only option.

The Average American Family Pays $4,000 for Medical Fraud and Subsidies 

Medical billing fraud is estimated at 10 percent of all health care, or about $270 billion, while patent monopolies raise the price of prescription drugs by another $270 billion a year. Combined, this represents an astonishing annual cost of over $4,000 to an average American household. As The Atlantic puts it, "The people most likely to bilk the system are doctors and medical providers, not 'welfare queens.'" 

Intimidation by Outrageous Markups 

In a recent analysis of 50 hospitals (49 for-profit) with the highest charge-to-cost ratios in 2012, the average markup was 1,000 percent, which means that a procedure costing a hospital $100 is marked up to $1,000 for us. 

Some of the markups test the limits of sanity: an 80-cent needle for $143.25 (a 17,000 percent markup). A 25-cent IUD device for $1,000. A blood test that costs $10 in one hospital and $10,000 in another. 

A Johns Hopkins professor explained, "They are marking up the prices because no one is telling them they can’t."

Cheating and Coercion 

Pharmaceutical companies have successfully lobbied Congress to keep Medicare from bargaining for lower drug prices. Americans are further cheated when corporations pay off generic drug manufacturers to delay entry of their products into the market, thereby forcing consumers to pay the highest prices for medicine. 

We're cheated again by certificate-of-need laws, which force many patients to accept established money-making procedures while denying access to modern technologies such as virtual colonoscopies. 

And cheated yet again when the doctors we trust accept payoffs from pharmaceutical companies to promote the most expensive products. 

And, like the hospitals, corporations are fleecing the public with unfathomable markups. After Gilead Sciences was criticized for charging $1,000 for a hepatitis pill that costs $10 in Egypt, the company responded by introducing a new pill that costs $1,350. 

The Terror of Poverty Without Health Care 

Uninsurance can be deadly. Low-income minorities are least likely to have coverage, and the resulting financial stress, as documented by over 200 studies, leads to sickness and early death. Over 40 percent of uninsured adults of color would be eligible for Medicaid if the program were adopted by all states. 

But it's not just the uninsured who feel the terror of unattainable health care. About half of privately insured Americans report experiencing financial hardship as a result of health care costs, and nearly half (43 percent) of sick Americans skipped doctor's visits and/or medication purchases in 2012 because of excessive costs. Even though with Obamacare the uninsured rate has dropped by nearly a third since 2013, the average deductible has more than doubled in just eight years, from under $600 to over $1,200, in large part due to corporate austerity measures. Many Americans can't afford this. A recent Bankrate poll found that almost two-thirds of Americans didn't have savings available to cover a$1,000 emergency room visit. 

The Best Medical Care in the World -- For the Wealthy 

Wealth promotes health. Super wealth buys an emergency room for the mansion or yacht or private plane, equipped with scanners, ultrasounds, x-ray machines, and blood analyzers. Or, if a hospital stay is needed, one fine option is a$2,400 suite with a butler in the hospital's penthouse. 

Not all of "concierge medicine" is so extravagant. Basic signup fees range from $1,500 to $25,000 per year, with premium memberships offering unrestricted online access to a doctor, although with extra charges for face-to-face services. It's out of the question for almost all of us. 

Yet with a farcical display of self-congratulatory capitalist trickle-down rationalization, Forbes proclaims that "these elite concierge medical practices are trailblazing methodologies and technologies that will, in time, be available to everyone." 

Little chance with a privatized system. The reality is that being sick and having nowhere to turn is terrorizing far too many Americans.

This work is licensed under a Creative Commons Attribution-Share Alike 3.0 License Paul Buchheit is a college teacher, an active member of US Uncut Chicago, founder and developer of social justice and educational websites (UsAgainstGreed.org, PayUpNow.org, RappingHistory.org), and the editor and main author of "American Wars: Illusions and Realities" (Clarity Press). He can be reached at paul@UsAgainstGreed.org.

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Maryland is so geared to assure that all public health dies----we even have a separate health system that would be public only it is corporate non-profit and Hopkins with Beilenson as its director runs these non-profits that will become Medicaid for All. 


EVERGREEN REPLACES OUR FEDERAL HEALTH PROGRAMS AND WILL MAKE SURE THAT ANY MEDICARE AND MEDICAID FUNDS WILL BE SPENT FOR PROFIT AND NOT PEOPLE.

Below you see why Maryland was first out the door to sign up for these Medicaid funds and believe me-----other Republican states doing the same for the same reason-----THEY TAKE THESE FEDERAL FUNDS AND THEN MISALLOCATE THEM.  There is no state that misallocates Federal, state, and local funds better than Maryland.  So, this drive of Obama's and Congressional neo-liberals to sound progressive in allocating these funds to Medicaid -----which we all know the Federal subsidy will end with this coming bond market economic crash-----are funds that will be directed in building the structures for global health systems----and not for Medicaid patient access.

Now, think about how in Maryland most of the current health system signup comes from people signing on as Medicaid plan and think how all those funds have almost no oversight and accountability-----Maryland does not even know how to build this because it does not require any oversight in any government function.  This is why when Baltimore or Maryland is tied to a Federal funding that may actually be audited----IT ALWAYS FAILS.


What Maryland does with those Medicaid funds is place them in that health care pool and VOILA-----they disappear.  Same with Medicare as Maryland was allowed to be the only state in the nation exempted from Federal Medicare oversight these few decades and as we all know-----there is no oversight of Medicare funds.  This is why Maryland will be found one of the biggest FRAUDSTERS OF OUR FEDERAL MEDICARE AND MEDICAID PROGRAMS and as such we can go to Baltimore City to recover billions of dollars for Expanded and Improved Medicare for All.




Maryland Misallocated Millions to Establishment Grants for a Health Insurance Marketplace

The Maryland Department of Health and Mental Hygiene (State agency) did not allocate costs to its establishment grants and Medicaid in accordance with Federal requirements, the terms and conditions of the establishment grants, and its Cost Allocation Plan (CAP). The State agency allocated a total of $76.6 million to its establishment grants on the basis of a cost allocation methodology that (1) did not prospectively use updated or better data when available and (2) included a "material defect." As a result, the State agency misallocated $28.4 million in costs to the establishment grants instead of the Medicaid program.

The State agency misallocated these costs because it did not have adequate internal controls to ensure the proper allocation of costs.

We recommend that the State agency (1) refund $15.9 million to the Centers for Medicare & Medicaid Services (CMS) that was misallocated to the cooperative agreements because it did not prospectively use updated actual enrollment data; (2) refund $12.5 million to CMS that was misallocated to the establishment grants using a methodology that included a material defect; (3) immediately amend the CAP and the Advance Planning Document for the period July 1 through December 31, 2014, so that allocated costs correspond to the relative benefits received; (4) develop a written policy that explains how to calculate cost allocations and that emphasizes the necessity to use updated and actual data; and (5) oversee operations to ensure the identification and correction of enrollment projection errors, the use of better or updated enrollment data, and the application of these data to allocate costs.

In written comments on our draft report, the State agency concurred with recommendations four and five and said it will develop a written cost allocation policy and implement steps to oversee operations effectively. The State agency did not concur with the first three of our recommendations.

Copies can also be obtained by contacting the Office of Public Affairs at Public.Affairs@oig.hhs.gov.


*******************************************************************

Below you see what is widespread in Baltimore-----citizens having benefits but not knowing it because there is no system of notifying a public especially with frequent housing changes.  So, we have a low-income tax break in Baltimore where most of the funds remain unclaimed because citizens do not know they have the tax break.  This is true of health care in Baltimore.  Citizens simply go to a clinic and get what care they can and never know what they are supposed to receive according to Federal guidelines.  They may not even know they are on Medicaid.  Undercounting Medicaid enrollment is important because----if a citizen was determined to be uninsured before this health care reform-----the Federal government sent in more Federal funds to hospitals to cover this uninsured status.  Juking the stats means that Maryland hospitals were claiming to be treating citizens as uninsured when in fact they qualified as Medicaid patients.

So, the Federal government sees a Maryland citizen as eligible for Medicaid and sends Maryland those funds-----but the Maryland citizen does not know this and is reported as uninsured-----giving double Federal money.  Think how this was done especially in southern Republican states that do not see giving Federal public health care to citizens a priority and you see how these Federal programs were milked for funding.  The mentality of milking Federal agencies with fraud in this case mirrors the milking of the FHA during the subprime mortgage frauds----if you have politicians steeped in criminal behavior------they juke the stats and steal Federal funding and then distribute it to corporate profit----in Baltimore's case this would have come to Johns Hopkins Medical system and UMMS
.

These frauds have operated since Reagan/Clinton when dismantling of Federal agencies of oversight opened the gate to systemic corporate frauds from our Federal Treasury and Public Trusts.



Undercounting Medicaid Enrollment in Maryland:
Testing the Accuracy of the Current Population Survey




Todd Eberly Mary Beth Pohl Stacey Davis
Received: 29 May 2007/Accepted: 27 December 2007/Published online: 30 April 2008
? Springer Science+Business Media B.V. 2008


Abstract

The U.S. Census Bureau's Current Population Survey is the most commonly cited source for estimates of the insurance status of Americans, but there are concerns that the data may undercount participation in public programs such as Medicaid. Such a Medicaid undercount may result from survey respondents not acknowledging Medicaid coverage because they are unaware that they are enrolled in Medicaid, because they have not recently received health services, due to the stigma associated with receiving public assistance programs, or due to simple recall bias. This paper estimates the extent to which the Current Population Survey undercounts Medicaid participation in a single mid-Atlantic state, Maryland. We administered the Current Population Survey questionnaire to a random selection of known Medicaid participants. We find evidence that the Current Population Survey significantly undercounts Medicaid participation in Maryland and that much of the undercount could be corrected if the survey better identified the Maryland Medicaid program. We also find that recall bias may contribute to the undercount as well.

There was no indication that stigma contributed to any undercount. Though not an aim of this study,w e find that the Medicaid undercount may contribute to an over count of the number of uninsured.

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The push to get people onto Medicaid these few years has nothing to do with helping people----it is again the Federal funding that is being sent to states for each Medicaid patient.  Since the Federal government has ended the War on Poverty public health subsidy for uninsured citizens with austerity------that uninsured payment to hospitals shown above-----it no longer is beneficial to skew Medicaid data.  Hospitals in Maryland mostly do not allow uninsured patients to enter even through an emergency room anymore.  If you read any article on the availability of doctors you will see there are very few Medicaid doctors-----and in Baltimore where Medicaid would need to cover most citizens-----the number of doctors taking Medicaid is super-small.  So these Medicaid patients are insured with nowhere to go. 

THAT IS HOW A CORPORATE STATE MILKS FEDERAL PROGRAMS AND MAKES SURE THOSE NEEDING IT DON'T RECEIVE IT.  THAT MONEY IS SUCKED UP BY THE LIKES OF JOHNS HOPKINS WHICH CONTROLS MUCH OF THE HEALTH CARE FOR THE POOR IN BALTIMORE AND THIS IS WHY----NOT BECAUSE IT CARES FOR THE POOR.




The Maryland health system has most of its new enrollees so far listed as Medicaid probably because Maryland has one of the most expensive premium/co-pay/deductible costs in the nation.  At the same time, those Medicaid patients are sent to a non-profit health insurance plan which they intend to take over the Federal Medicaid and Medicare when they end these programs after this coming economic crash.....it looks like Obama is setting 2020 for the closing of these Federal programs as that will coincide with Trans Pacific Trade Pact being installed.

MEANWHILE, CLINTON NEO-LIBERALS ARE ALL PRETENDING THE AFFORDABLE CARE ACT IS ABOUT HEALTH CARE FOR ALL-----


SEE WHY HAVING A BALTIMORE CITY MEDICARE AND MEDICAID OVERSIGHT AND ACCOUNTABILITY OFFICE IS CRITICAL?????  THE AMOUNT OF MONEY SAVED FROM JUST FRAUD AND PROFITEERING WILL ALLOW ACCESS FOR ALL TO ALL THE HEALTH CARE THEY NEED.




Maryland Medicaid enrollment surges past projections


Jan 30, 2014, 10:17am EST

Sarah Gantz ReporterBaltimore Business Journal Sarah Gantz ReporterBaltimore Business Journal

Crates filled with Medicaid packets line the walls at Health Care for the Homeless in… more

While the state is struggling to get Marylanders enrolled in private health plans through the new health exchange, Medicaid enrollment has already surpassed fiscal year-end projections.

As of this week, a total of 121,000 Marylanders have enrolled in Medicaid, beating out projected enrollment of 110,000 people by the end of June. Charles Milligan, the state’s deputy health secretary for Medicaid, credits the high enrollment totals to early preparation. A majority of the new Medicaid enrollees did not have to navigate the troubled state exchange to sign up because they were part of a program that automatically transferred members to Medicaid Jan. 1.

“It’s significant for Medicaid participants themselves because it gives them not only insurance and access to health care, but peace of mind about potential economic stress for people worried about paying for care out of pocket,” Milligan said.
Meanwhile, the state will likely fall short of its goal to enroll 150,000 Marylanders in private health plans through the exchange. Roughly 25,000 people have enrolled so far, according to a Jan. 24 report by the exchange.

About 95,000 of the new Medicaid enrollees were transferred automatically from the state’s Primary Adult Care (PAC) program — a limited coverage Medicaid plan for adults.

Unlike anyone looking to sign up for Medicaid or federally subsidized private insurance now, the 95,000 people who came to Medicaid through PAC did not have to navigate the exchange. Their PAC policies were automatically upgraded to full Medicaid plans.

Milligan said his department started in January 2013 to beef up outreach and enrollment for that program, knowing that those individuals could automatically be moved to a full Medicaid plan at the beginning of 2014.


“Part of the reality is that the recession has dragged on the economy longer than some of us anticipated,” Milligan said. “That’s resulted in the fact that there might be more Medicaid-eligible people than forecast.”

Milligan said the state has not yet updated its year-end projections for Medicaid enrollment.

Higher-than-expected Medicaid enrollment could have an impact on the state’s Medicaid budget.
 Most of the new enrollees will be covered by federal funds that were made available to state that agreed to expand eligibility for the publicly funded health program. But a small portion of enrollees will be paid for by the state, though Milligan said he did not know yet what additional cost this would be for the state.

The growth in Medicaid is also meaningful for hospitals and insurers.
In Maryland, money to cover the hospital costs of uninsured residents is worked into the rates insurers pay (insurers pass on the cost to consumers). With fewer uninsured residents, the amount worked into rates for so-called uncompensated care will likely decrease.

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The reason some states were allowed to opt out of Medicaid expansion was that Obama embraced by Executive Order the Federalism Act -----that means Obama will not enforce Federal laws that cost states money----and that is all progressive Constitutional laws.  So, as Clinton neo-liberals try to shame Republican states for failing to sign on to Medicaid-----it was Clinton and Obama who signed on to this Republican refusal to enforce Federal laws that would have required Medicaid expansion be allowed.

Remember, the goal of ACA is to end all Federal public health because Trans Pacific Trade Pact does not allow public subsidy that takes away from global corporate profits.  So, just think what this game is-----people once fully insured in good private corporate plans or public sector health plans that are being axed are now being moved onto Medicaid with this Federal funding for a few years and then VOILA----

ALL THAT FEDERAL FUNDING FOR MEDICAID ENDS BECAUSE OF THE ECONOMIC CRASH FROM THE COLLAPSING BOND MARKET.

So, Medicaid having already been slashed of funding back in 2010 will be slashed again as Medicaid no longer looks like Medicaid and while more and more Americans are being pushed to Medicaid. 

THIS IS HOW YOU END A FEDERAL PUBLIC HEALTH PLAN THAT IS A CONSTITUTIONAL RIGHT----IT IS SO DEFUNDED AND OUTSOURCED AS TO HAVE NO ONE WANTING TO USE IT.

That is the goal-----and that is a Clinton neo-liberal for you!!!!


Keep in mind as you read this the level of health industry fraud over just a few decades against Medicaid ----trillions of dollars that should be coming back and all that fraud ignored because we have Clinton neo-liberals instead of Democrats in office.




As Number of Medicaid Patients Goes Up, Their Benefits Are About to Drop


By ROBERT PEARJUNE 15, 2011

WASHINGTON — The Obama administration injected billions of dollars into Medicaid, the nation’s low-income health program, as the recession deepened two years ago. The money runs out at the end of this month, and benefits are being cut for millions of people, even though unemployment has increased.

From New Jersey to California, state officials are bracing for the end to more than $90 billion in federal largess specifically designated for Medicaid. To hold down costs, states are cutting Medicaid payments to doctors and hospitals, limiting benefits for Medicaid recipients, reducing the scope of covered services, requiring beneficiaries to pay larger co-payments and expanding the use of managed care.

As a result, costs can be expected to rise in other parts of the health care system. Cuts in Medicaid payments to doctors, for example, make it less likely that they will accept Medicaid patients and more likely that people will turn to hospital emergency rooms for care. Hospitals and other health care providers often try to make up for the loss of Medicaid revenue by increasing charges to other patients, including those with private insurance, experts say.

Neither the White House nor Congress has tried to extend the extra federal financing for Medicaid, even though the number of beneficiaries is higher now than when Congress approved the aid as part of an economic recovery package in February 2009.

The Congressional Budget Office estimates that federal Medicaid spending will decline in 2012 for only the second time in the 46-year history of the program. But states say they will have to have to spend more on Medicaid as they struggle to make up for the loss of federal money.

State officials say they are resigned to the loss of the extra federal matching payments, given the climate in Congress, where deficit reduction is a paramount goal.


“We all see the reality of what’s going on in Congress,” said Mark W. Rupp, director of the Washington office of Gov. Christine Gregoire of Washington State, a Democrat who is chairwoman of the National Governors Association. “It’s more about cutting than spending. Why put a lot of effort into something that did not seem likely to have a positive outcome? It would have been fairly futile.”

Although Medicaid provides health insurance to one in five Americans at some point in a year, it is more vulnerable to cuts than Medicare and Social Security, which have broader political support.

“Medicaid is very much on the chopping block,” said Senator John D. Rockefeller IV, Democrat of West Virginia and chairman of the Senate Finance Subcommittee on Health Care. “Seniors vote. But if you are poor and disabled, you might not vote, and if you are a child, you do not vote — that’s a lot of Medicaid’s population. They don’t have money to do lobbying.”

Medicaid is financed jointly by the federal government and the states, with the federal government paying a larger share in poorer states like Mississippi and West Virginia and a smaller share in higher-income states like New York and Connecticut.

The aid ending next month increased the federal share of Medicaid spending in all states, with additional help for states where unemployment rates had risen sharply. The extra aid was scheduled to expire last December, but Congress extended it for six months at the urging of the White House and state officials.

The additional money pushed the average federal share of Medicaid spending nationwide to 67 percent. It will revert to 57 percent next month. The cutback in federal Medicaid money has put pressure on states to cut the budget for other programs, including education and social services.

Toby J. Douglas, director of the California Department of Health Care Services, said the federal Medicaid cut was causing “very consequential reductions in health care and other public programs.”


California is cutting Medicaid payments to doctors and many other providers by 10 percent; has established new co-payments for drugs, doctors’ services and hospital care; and will limit beneficiaries to seven doctor’s office visits a year unless a doctor certifies a need for more.

With 7.6 million Medicaid beneficiaries — 50 percent more than any other state — California faces bigger problems, but its response has been typical. A survey issued this month by the National Association of State Budget Officers found that 24 states were reducing Medicaid payments to providers, while 20 were limiting benefits in some way.

R. Andrew Allison, who is executive director of the Kansas Health Policy Authority and president of the National Association of Medicaid Directors, said Medicaid was gobbling up new revenues as states recovered slowly from the recession.

Kansas illustrates the predicament most states are facing. Federal Medicaid payments in Kansas are expected to decline by more than $250 million, or 13 percent, in the state’s new fiscal year, which starts July 1, Mr. Allison said. But the amount of state revenue spent on Medicaid is expected to increase by more than $300 million, or 39 percent.

New York has just imposed a cap on state Medicaid spending, with a separate limit for each sector like hospitals, nursing homes and managed care plans. Under a new state law, if it appears that the state share of Medicaid spending will exceed the cap, New York officials must devise and carry out a plan to reduce spending, by modifying benefits, provider payment rates or other features of the program.

“This is an enormous sea change for Medicaid,” said Jeffrey Gordon, a spokesman for the New York State Health Department.

Continue reading the main story Write A Comment In New Jersey, Gov. Chris Christie, a Republican, said, “Medicaid’s growth is out of control,” and he has proposed numerous changes “to fill in the hole created by the loss of over a billion dollars of federal stimulus money” for the program. He would tighten eligibility, reduce Medicaid payment rates for nursing homes, move older and disabled Medicaid recipients into managed care, and charge co-payments for medical day care services.

The New Jersey Legislature appears likely to accept some of the changes in a budget to be adopted this month.

Connecticut has avoided major cuts in Medicaid, but the State Legislature has set new limits on vision and dental coverage for adults.


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Below you see what will replace Medicare and Medicaid in Maryland and it is no coincidence that the head of this health exchange non-profit is a Johns Hopkins partner.  As you see below they are moving Maryland's Veterans to this non-profit because the Veteran's Administration is being privatized and closed and Veteran's benefits are being defunded-----ergo all of the charity ads on TV.

The VA is a Federal health program that veterans paid for with service and as a Federal program will fall into these non-profit health insurance plans along with Medicaid and Medicare.  Since Hopkins controls most of the health care in the Baltimore region it will use this format of non-profits to control all government funding to care for the poor, seniors, disabled, and veterans.

This non-profit format will replace all public health programs at the same time private insurance corporations go global and become so expensive that most Americans will not be able to afford them and be pushed into these non-profit plans.  What will this ghettoized health insurance look like?  As I said years ago-----it will be the same kind of preventative clinic care that people in third world nations receive..


THIS IS TO WHERE OVER 80% OF MARYLANDERS WILL GO UNDER MARYLAND'S PRIVATIZED SINGLE-PAYER-----

See why Expanded and Improved Medicare for All is better and we need to start building the platform in Baltimore right now----the 2016 election should have all Democratic primary candidates shouting how they are going to install Medicare for All.  In Maryland, Clinton neo-liberals and Baltimore's neo-conservatives running as Democrats are still trying to pretend the Affordable Care Act was progressive.

Beilenson was at Hopkins as all of Baltimore's VA functions were dismantled and doctors with the VA courted to Hopkins health tourism.

Improving access for Veterans by giving them access to preventative care only!!!!!  HOW SPECIAL!!!


Maryland Politics

Maryland veterans waiting for primary care have a new option: Evergreen Health Care




Peter Beilenson of Evergreen Health Care. (Ricky Carioti/The Washington Post) By Jenna Johnson September 1, 2014 Veterans who have been waiting for months to see a primary-care doctor through the Veterans Affairs Maryland Health Care System can visit one of the four Evergreen Health Care facilities that are affiliated with the state’s new health insurance co-op.

Maryland VA officials signed a contract with Evergreen in August to spend up to $485,000 for ongoing primary care for as many as 1,000 veterans.
The contract could change based on need.

Adam M. Robinson Jr., VA Maryland Health Care System chief of staff, said in a statement Thursday that the “partnership is a major component of our aggressive action plan to improve patient access.”

#pmad-01-frame { display: inline-block; width: 300px; height: 90px; } VA medical systems are required to see new patients within 14 days after their paperwork is accepted and returning patients within 14 to 30 days of an appointment request. Some states have been accused of tampering with their scheduling to hide backlogs.

An audit of the Maryland VA system this year found no improper scheduling, according to the statement, but discovered that the system was not seeing new patients quickly enough.

Maryland veterans will have the choice of continuing to wait to see a primary-care doctor through VA or seeing a doctor at one of Evergreen’s health facilities in Baltimore, Columbia, White Marsh or Greenbelt.

“It’s totally up to the veteran,” said Peter Beilenson, chairman of the board of Evergreen Health Care and founder of its affiliated insurance company.

Veterans can return for up to six visits a year, Beilenson said, and will be referred back to VA for more serious problems that require a specialist. In addition to general primary care, Evergreen can provide screenings, wellness programs and counseling.

The partnership means a rush of new patients for the Evergreen clinics, where business has been much slower than expected because not enough people have signed up for health insurance through Evergreen Health Co-op, a start-up made possible by the Affordable Care Act.

About two dozen such nonprofit co-ops are operating across the country, with varying degrees of success. They aim to shake up the insurance market by offering low-priced, high-perks plans that can bring down health-care costs.

#pmad-02-frame { display: inline-block; width: 300px; height: 90px; } Unlike other co-ops, Evergreen has affiliated health-care centers for members that focus on preventive care and general wellness.

Evergreen planned to find its customers on Maryland’s online health-insurance marketplace, at which plans from four carriers would be clearly detailed. Beilenson thought Evergreen easily could enroll 10,000 people in the first year.

But the state Web site crashed the day it debuted last year, struggled through the six-month-long enrollment period and is being rebuilt before the next open-enrollment period starts Nov. 15.

Maryland enrolled 72,000 people in private plans, roughly half of the state’s original estimate. Of those, 94 percent chose a plan from CareFirst, a major Maryland-based insurance carrier that often had plans with the lowest premiums.

For the second open enrollment, CareFirst will increase its premiums by about 10 percent to 16 percent, while the other three carriers will decrease premiums. Evergreen’s rates will be about 10 percent lower.

“They grossly underpriced the market on purpose,” Beilenson said of CareFirst in its first year on the exchange. “We’re going to be much more competitive.”

Evergreen has found success in selling coverage to small groups and businesses, offering lower prices and promising to keep those prices for two years. The co-op has 3,600 members and hopes to have 6,000 by the end of the year, Beilenson said.

When reports of long waits for veterans surfaced this year, Beilenson reached out to Maryland officials and offered to treat their patients in his health centers. He said more than 700 veterans in Maryland have been waiting for at least 90 days for appointments.


Evergreen saw its first veteran Friday morning in Columbia, he said, and plans to see many more on Tuesday.






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July 20th, 2015

7/20/2015

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I will continue this week the discussion of the dismantling of Federal public health agencies which are the FDA, Department of AG, EPA, and Centers for Disease Control---CDC----and look at the same dismantling of public health locally through the dismantling of Medicare and block granting of Medicaid.  As I said last week----Expanded and Improved Medicare for All will take care of all of these attempts at dismantling public safety and health programs.  We know hundreds of billions of dollars were stolen by corporate fraud each year for a few decades from our Medicare and Medicaid Trusts so simply ending those frauds will cut half of the spending----add to that ending of profiteering----and VOILA----everyone can be fully covered.  Hopkins has built a global corporation from redirecting Medicare and Medicaid funding in Baltimore and UMMS has done so as well.  We will use Baltimore to build the platform for Expanded Medicare to replace the Maryland state private health system.  I have already shown where Hopkins and UMMS will be made free for all medical training from lab, to aid, to nurse and doctor.  It is simply reclaiming as public operations made private and non-profit.

Since rebuilding oversight and accountability of Medicare and Medicaid is the first step towards a healthy system---we need a strong public sector dedicated to our Federal Trusts.  If we take Johns Hopkins East building in Waverly and make it public oversight for health care ---we are on the way to funding resourced doing what it is meant to.


Baltimore has always refused to provide health services to Medicaid and Medicare patients that states all over the nation did---it exempted itself out of Medicare oversight and then declared it part of a pool of money.  Of course when Federal funds hit a pool of state money----it means it will be dispersed elsewhere.  Baltimore City is now dismantling all of disability and senior services tied to Social Security Disability and Medicare/Medicaid by ending these public sector jobs and outsourcing----with the goal of ending them.

MTA in Baltimore is deliberately left defunded and a mess because poor people use it.  O'Malley cut $10 million from only Baltimore's MTA and now Rawlings-Blake is outsourcing funding from the Transportation Fund to pay for temporary employment for services for seniors and disabled.
  So, the MTA Disability service was given to VEOLA and now seniors and disabled feel they cannot trust being picked up on time and or fear being left not able to get home while the MTA disability rides fall because the space in MTA buses are packed as buses fail to follow schedules.  The disabled do not want to wait for a bus and find there is no space for them. Keep in mind, Baltimore has great numbers of disabled and seniors so these policies are causing people to stay home and become more dependent.  Don't worry about being trapped at home---all of your health care will be done online and with unregulated and with no oversight home health care

THIS IS HOW YOU END SERVICE FOR THE PUBLIC---YOU MAKE IT TOO UNDEPENDABLE TO USE.


WOW!  I cannot wait to age into all of that.

The shock you see below is being noticed because the new residents of Baltimore are seeing what the long-term have experienced for decades.  All while Baltimore is completely Democratic......operating as Hopkins' neo-conservative.
  You see the Congressional, state, and Baltimore City Hall pols all working to make transportation for most difficult.


New to MTA bus commuting, shocked by the poor service A resident who depends on a regular MTA bus line wants to draw attention to the "severe dysfunction" of mass transit beyond the Charm City Circulator





Brian Levy October 27, 2014 at 10:03 am  Baltimore Brew

EDITOR’s NOTE: This essay is adapted from an email written by an irate city resident to a list of public officials regarding the 13 bus line that runs the length of North Avenue. One of the city’s busiest routes, service is scheduled every 10 minutes on weekdays and Saturdays, every 15 minutes on Sundays.

I began taking the #13 bus line in September of this year. I take the route every day to and from work except those days where I have been forced to give up and walk or attempt to summon a cab.

The service has been consistently terrible since the very first day I took the line.

In general, the #13 bus is often late and is always overcrowded. I will point to two incidents, both occurring this week, which illustrate my concerns.

These instances are representative of the types of rides I encounter a few days every week since starting to ride this bus.

Doors Shut, Left Without Us

Last Wednesday, October 22nd, I arrived at the #13 bus stop on the corner of North Avenue and Charles Street heading east at 7:00 a.m. I waited till 7:40 a.m. before a bus finally came.

By the time it did arrive, a crowd of about 25 people had gathered to get on. However, the bus that had arrived was so full that the driver only allowed one person who was waiting on.

She then shut the doors and continued on her route without the rest of us.

Let me emphasize, this is not the first time that this has occurred to me. I was lucky enough to have the money to walk down three blocks and grab a cab. I was over an hour late for work that day.

Dodging Would-be Riders

Last Friday, October 24th, I waited for the #13 at 4:30 p.m. at the corner of Harford Road and North Avenue, heading west. About 12 people waited with me.

When the bus arrived all 12 of us packed on. The bus was so crowded that five of us had to stand in front of the yellow line next to the driver. (In plain view of the sign that states it is against federal law to stand in front of the yellow line).

Every seat on this bus was taken. Every inch of standing room was filled. The driver proceeded to skip the next three bus stops.

At each stop we passed dozens of people who were waiting. There was not a bus close behind us for them to grab.

When a passenger wanted to get off, the driver would pull over 100 yards before the bus stops to let passengers off, to ensure none of the anxious riders waiting at their stops for our overcrowded bus would attempt to get on. This is a common occurrence.

Hurting the Hurting Parts of Town

The city’s free Charm City Circulator buses, which run near the waterfront and in a few upscale areas, have been in the news lately over a possible fee charge as well as plans to expand service.

I’m trying to call attention to the severe dysfunction in the part of the city’s transit system that – unlike the Circulator – charges riders money and is supposed to serve the rest of Baltimore.

North Avenue, where the east-west #13 runs, connects some of the poorest parts of Baltimore. It cuts across our city’s midsection like an infected scar, with struggling neighborhoods to the north and south in quite poor shape along nearly the entire length.

There are abandoned houses and storefronts along most of the route I take. Many houses’ roofs are visibly caving in. Some, slightly less dilapidated homes have their boarded up windows and doors stamped with advertisements for the city’s Vacants to Value program.

I know the factors that caused this area of the city to fall into disrepair are numerous and complex. But surely, one factor that adds to this area’s woes is the poor state of the public transportation.

When the bus is late, or overcrowded,
I and other riders like me are made late for our jobs, our appointments, our families and our lives.

A late bus is not simply an inconvenience, but a burden on the lives of those who rely on it. It is certainly a reason many lose employment, and it is certainly a reason many decide to leave the city if they can.

Rx for Troubled Route

The troubled bus route damages the quality of life for those with cars as well. It is also a deterrent to invest in the area.

Traveling along North Avenue, one sees crowds of people waiting for the bus. These crowds attract people trying to sell drugs, and are breeding grounds for conflicts and trouble of all sort. I can’t tell you how many times people have come up to me and the people I wait with for the bus attempting to sell narcotics.

Whether waiting for the bus yourself or just driving by, this atmosphere causes people to stay clear of the area.

For my sake, for my fellow passengers sake, for the sake of those who live and work on North Avenue and for the sake of our city – please heed my plea and do whatever is in your power to improve the service of the #13 line.

Making the route safer and more reliable for transit users could have a healing effect that would spread further into the community.
________________________________________

Brian Levy, a legal fellow with the Public Defender’s Office, recently moved with his fiance to the Midtown-Belvedere neighborhood. He says he sent this email to the Maryland Transit Administration; Mayor Stephanie Rawlings-Blake; City Councilmen Eric Costello, Nick Mosby and Carl Stokes; Maryland 40th District Delegates Frank M. Conway, Jr., Shawn Tarrant and Barbara Robinson; State Senator Catherine Pugh; U.S. Representative Elijah Cummings; and U.S. Senator Benjamin Cardin and Barbara Mikulski.

______________________________________________

I wanted to show how Baltimore pols are committed to these dismantlings of our Federal Medicare and Medcaid programs.  Now, people at first glance will say----ahhhh, look jobs for youth shoveling snow.  If you look closer you see that a public sector service having always been covered by Medicare./SS Disability and covered by public sector employees is now being outsourced----and this time it falls under the temporary category of being funded from Transportation Funding to a program for temporary youth work.

Now, the disabled and seniors arlready have trouble with a defunded transportation funding for public transit as we saw above.  So, Baltimore City Hall and Rawlings-Blake is taking more of the Transportation money to fund what should have been an existing public programs for seniors and disabled----shoveling snow.

If I were those Baltimore citizens I would wonder who will come when this temporary youth program ends and from where will the money come. 

EXPANDED AND IMPROVED MEDICARE FOR ALL TAKES CARE OF ALL THESE EXTENSIONS OF HEALTH CARE AND PUBLIC SAFETY AND THERE IS PLENTY OF MONEY AVAILABLE FOR MEDICARE AND MEDICAID.


Baltimore will pay kids to shovel snow next winter


Jul 15, 2015, 3:03pm EDT Updated Jul 17, 2015, 3:23pm EDT  Baltimore Business Journal.


Baltimore will extend its efforts to boost youth employment through the winter with a new… more

Children won't have to ring the doorbell to ask grandma if she wants her sidewalk shoveled this winter in Baltimore City.

The city Department of Transportation is starting a new youth snow program that will have young people clearing public sidewalks for older residents and those with disabilities. It will hire 200 to 400 youths between the ages of 14 and 21.

Young people participating will have the choice of receiving a stipend of at least $500 — depending on how much it snows — or credit hours that can be applied toward high school graduation. They will be assigned specific locations to shovel during snow emergencies, said said Richard Hooper, operations bureau chief for the department of transportation.


The snow removal program is an extension of recent efforts to boost youth employment in Baltimore, said Mayor Stephanie Rawlings-Blake, who announced it Wednesday. The city increased this year the number of summer jobs it offers through its YouthWorks program by nearly 3,000 to 8,000.

"We know that Baltimore's younger people are looking for employment beyond the summer," Rawlings-Blake said.

Funding for the program comes from the Department of Transportation snow budget. Participants will be issued shovels, gloves and safety vests. They will also go through orientation and training.

_______________________________________________


Here you see where this same service comes out of Medicaid funding------so in Baltimore where is that Medicaid funding going at the expense of transportation?

This is the problem for Maryland and especially Baltimore.  Because the state places these funds in the state treasury as a pool-----they become so fungible that the needs and services of seniors and Medicaid-eligible are left unmet.  We also see where the public sector structure in Baltimore for doing these things is gone.....

If an agency in Baltimore actually kept track of how many Medicaid and Medicare citizens and their needs and make sure all of those funds come to Baltimore from the State of Maryland----we would have plenty of funding for Expanded and Improved Medicare for All.

I attended a Maryland Assembly meeting where a very nice man with a non-profit for the aging asked that such a system be put into place-----as if it was not a NECESSARY REQUIREMENT FOR TRACKING FUNDS FOR MEDICARE AND MEDICAID.     We may not be able to force the Maryland Assembly to build these tracking systems for our revenue---but we can build them in Baltimore where much of Medicare and Medicaid is spent.




Seniors, disabled residents can get help with snow removal

Published: Wednesday, January 12, 2011

  By MATT DECEMBER


Romeo, Washington and Bruce residents may be eligible for assistance with snow removal this winter through the CHORE program. Call 752-9601 for more information.


As Michigan enters the heart of winter, northern Macomb County residents are reminded that they may qualify for assistance in removing snow from their residence.

The CHORE program provides free or low-cost snow removal services in the winter to seniors or residents with disabilities who live in Romeo, Washington Township or Bruce Township. The cost of the program is also income-based.

"If you are on Medicaid, there is no charge," said Debbie Webber, director of the senior centers in Romeo and Washington Township. "If we know someone is financially hurting it can be adjusted. It is very, very low-cost, even when we do charge."

The program is funded through several means, including Community Development Block Grant funds given on behalf of the communities.

__________________________________________________
If you hear people calling for single-payer without calling for Expanded and Improved Medicare for All they are working for this highly privatized Maryland version that basically allows for people's access to Medicare and Medicaid be different from that required by the Federal programs and what people access nationally.  This is why Baltimore has the worst health and life expectancy in the US-----the pools of Federal funds were distributed all around Maryland to make sure hospitals giving expensive care did not lose money.  This is what Maryland Health Care for All was created to support----it is the Johns Hopkins non-profits whose job is to make it seem like this is a good way to use Federal funds meant to give everyone equal coverage.  If you think---that's OK----it's just the working class and poor getting screwed out of health care they were legally entitled to---WAKE UP----

AS YOU SEE BELOW MARYLAND IS GEARING UP TO MAKE SURE THAT MOST OF BABY BOOMERS DO NOT ACCESS THESE FEDERAL FUNDS AS THEY SHOULD.
I will talk more tomorrow on the details of these changes that came with Affordable Care Act and almost a $1 trillion cut from Medicare and Medicaid to pay down the debt created by massive corporate fraud.  I would like people to think what happens when these health funds are allowed to be pooled and then distributed by arbitrary means by health corporations only interested in maximizing profits.


IF A POLITICIAN IS SUPPORTING ALL-PAYER THEY ARE WORKING TO END MEDICARE AND MEDICAID AND PUSHING OVER 80% OF AMERICANS ONTO PREVENTATIVE CARE ONLY AS DISABLED AND SENIORS.  ALL-PAYER IS THE OPPOSITE OF EXPANDED AND IMPROVED MEDICARE FOR ALL.

Of course Donna Edwards is very proud to support All-Payers as does Chris Van Hollen because----they haven't said a word about a trillion dollars stolen from our health trusts over a few decades! 

THAT'S HOW YOU KNOW A CLINTON NEO-LIBERAL!  WHO IS RUNNING IN THIS DEMOCRATIC SENATE PRIMARY AGAINST THESE TWO NEO-LIBERALS?


Maryland All-Payer Model



The Centers for Medicare & Medicaid Services (CMS) and the state of Maryland are partnering to modernize Maryland’s unique all-payer rate-setting system for hospital services that will improve patients' health and reduce costs. This initiative will update Maryland’s 36-year-old Medicare waiver to allow the state to adopt new policies that reduce per capita hospital expenditures and improve health outcomes as encouraged by the Affordable Care Act.



Background

Maryland operates the nation’s only all-payer hospital rate regulation system. This system is made possible, in part, by a 36-year-old Medicare waiver (codified in Section 1814(b) of the Social Security Act) that exempts Maryland from the Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS) and allows Maryland to set rates for these services. Under the waiver, all third parties pay the same rate. The State of Maryland and CMS expect that the All-Payer Model will be successful in improving the quality of care and reducing program expenditures for Maryland residents, including Medicare, Medicaid, and CHIP beneficiaries.  Moreover, the Maryland system may serve as a model for other states interested in developing all-payer payment systems.

Initiative Details

Maryland’s all-payer rate setting system for hospital services presents an opportunity for Maryland and CMS to test whether an all-payer system for hospital payment that is accountable for the total hospital cost of care on a per capita basis is an effective model for advancing better care, better health and reduced costs. Under the new model, Maryland hospitals will commit to achieving significant quality improvements, including reductions in Maryland hospitals’ 30-day hospital readmissions rate and hospital acquired conditions rate. Maryland will limit all-payer per capita hospital growth, including inpatient and outpatient care, to 3.58 percent. Maryland will also limit annual Medicare per capita hospital cost growth to a rate lower than the national annual per capita growth rate per year for 2015-2018. Moreover, the Maryland system may serve as a model for other states interested in developing all-payer payment systems. Under this model, Medicare is estimated to save at least $330 million over the next five years. This opportunity is available through the authority of the Innovation Center, which was created by the Affordable Care Act to test to payment and service delivery models.

Under the terms of the Maryland All-Payer Model:

  • Maryland will agree to permanently shift away from its current statutory waiver, which is based on Medicare payment per inpatient admission, in exchange for the new Innovation Center model based on Medicare per capita total hospital cost growth.
  • This model will require Maryland to generate $330 million in Medicare savings over a five year performance period, measured by comparing Maryland’s Medicare per capita total hospital cost growth to the national Medicare per capita total hospital cost growth.
  • This model will require Maryland to limit its annual all-payer per capita total hospital cost growth to 3.58%, the 10-year compound annual growth rate in per capita gross state product.
  • Maryland will shift virtually all of its hospital revenue over the five year performance period into global payment models.
  • Maryland will achieve a number of quality targets designed to promote better care, better health and lower costs. Under the model, the quality of care for Maryland residents, including Medicare, Medicaid, and CHIP beneficiaries will improve as measured by hospital quality and population health measures.
    • Readmissions:  Maryland will commit to reducing its aggregate Medicare 30-day unadjusted all-cause, all-site hospital readmission rate in Maryland to the national Medicare 30-day unadjusted all-cause, all-site readmissions rate over five years.
    • Hospital Acquired Conditions:  Maryland currently operates a program that measures 3M’s 65 Potentially Preventable Conditions. Under this model, Maryland will achieve an annual aggregate reduction of 6.89% in the 65 PPCs over five years for a cumulative reduction of 30%.
    • Population Health:  Maryland will submit an annual report demonstrating its performance along various population health measures.
  • If Maryland fails during the five-year performance period of the model, Maryland hospitals will transition over two years to the national Medicare payment systems.
  • Before the start of the fourth year of the model, Maryland will develop a proposal for a new model based on a Medicare total per capita cost of care test to begin no later than after the end of the five year performance period.

    _____________________________________
    If you look below you see what has been happening in Maryland is now being extended across the US under the Affordable Care Act.  The idea of handing a lump sum to a health system corporation and then tell them to make it work will create this block granting that has been happening for Medicaid unofficially for years but now it will happen to Medicare.

    The example above where funds for Medicaid were used to shovel a disabled or seniors walk because it is a safety and health issue is a block grant for Medicaid.  In that case it was a good use of funds.  What Maryland All-Payer does is allow these same conditions except a bunch of corporations are going to decide how those Medicare and Medicaid funds can be spent so the money comes back to them in profit.  Shoveling sidewalks does not create profit for health corporations.
     

    Obama appointed Bill Gate's Burwell to dismantle Federal Medicare and Medicaid and create these block grants because----

    THAT IS WHAT REPUBLICANS HAVE TRIED FOR DECADES TO DO TO END MEDICARE AND MEDICAID......AND CLINTON NEO-LIBERALS ARE DOING IT FOR THEM BECAUSE-----THEY ARE REPUBLICANS.


    Corporations are getting all of their wish lists in privatization because Clinton neo-liberals lie to Democratic voters about what policies mean----that paint them progressive no matter how repressive and regressive they are.

  • Medicaid Block Grants: A Zombie Idea With Lipstick in Texas
  •  Posted: 04/09/2013 5:02 pm EDT Updated: 06/09/2013 5:12 am EDT  Huffington Post

    • The latest proposal to block grant Medicaid in Texas is a terrible one for the state, its children, people with disabilities, and the elderly. Unfortunately, this bad idea, which just never seems to die, is once again being trotted out by Texas governor Rick Perry and his friends at the Texas Public Policy

    Federal block grants are, by definition, an arbitrarily capped amount of federal funding that go to states in the form of a lump sum payment and fail to adjust for population growth, economic changes, public health crises, or natural disasters such as hurricanes, tornadoes, etc.

    Thus, states with growing populations, such as Texas, or states often in the pathway of natural disasters, such as Texas, or states with a disproportionate share of low wage jobs, such as Texas, would be most negatively impacted by a federally-imposed block grant. As need increases due to any of these factors, block grants and federal assistance are, by definition, unresponsive and unhelpful. States would be left facing the full brunt of any calamity or crisis.

    Looking to protect the states from the problems inherent in their block grant proposal, former Congressman Dick Armey and former State Rep. Arlene Wohlgemuth argued in a Politico op-ed on April Fools' Day, "Once a block grant is in place, Texas should fundamentally transform Medicaid from a defined benefit program to a defined contribution program for most eligibility groups. This would undoubtedly lead to cost savings and a more sustainable system over the long term. With skin in the game, and without an unlimited guarantee of state and federal funds, Medicaid enrollees would be more efficient in their use of health care and more engaged as consumers."

    Put another way, states would not have to worry because any costs above the per-determined and federally-imposed arbitrary limit in the block grant would simply be shifted to low-income children, the disabled, and the elderly -- the very people that Medicaid is intended to protect. Asking low-income children, the disabled, and the elderly to put "skin the game" when need is increasing and support is capped will lead to one outcome: health care rationing.

    Since block grants are arbitrarily capped,
    federal support would no longer adjust for changes in need or population and this would particularly be a disaster to Texas because it is one of the fastest growing states in the country. In fact, between 2000 and 2010, the number of children across the entire country increased by 1.9 million. But, in Texas alone, the number of children increased by 979,000 -- which is more than half of all the growth in the combined 50 states and the District of Columbia.

    Moreover, since block grants fail to adjust appropriately for changes in need, current inequities and disparities are permanently locked into place and often expand. For Texas, which already starts with the 2nd highest uninsured rate for children in the country, the situation would get worse with the federal government cutting back and capping its support to Texas despite its rapidly growing population.

    Underscoring this very problem, proponents of Medicaid block grants, such as the Texas-based National Center for Policy Analysis (NCPA), often cite the Temporary Assistance for Needy Families (TANF) block grant as a model for Medicaid "reform."

    However, when TANF was converted to a block grant structure in 1996, Texas initially received just 31 percent of the national average in the amount of federal support per child in poverty. Rightfully so, the state was deeply concerned the block grant would lock in this inequity forever. Consequently, Texas Senator Kay Bailey Hutchison attempted to negotiate a more favorable formula change to help Texas. However, since block grants are set at an arbitrarily capped amount, any increase for Texas would led to reductions to other states so she was unsuccessful. Instead, to get her support, small Supplemental Grants were approved with the intent of reducing the inequities among states.

    However, population growth quickly outstripped the small adjustment for Texas. Even worse, the Supplemental Grants were allowed to expire in 2011. As a result, today the states receive the same level of federal TANF funding they initially received in 1996 without any adjustments for population or economic changes. As a result, inequities have increased and Texas now receives less than 26 percent of the average level of federal spending per child in poverty. In fact, in 2012, Texas received just $294 per child in poverty from the federal TANF block grant compared to the $2,782 per child in poverty that New York received.

    For Texas, block grants only make sense if you think that the children of New York deserve 9.5 times more federal support per child than what Texas receives for its children and think that disparity should also increase over time, as it has in TANF. Although I doubt that any Texan would approve of that incredible and growing disparity in federal funding, that would be the "pig in the poke" that Texas would be buying into if it agreed to a Medicaid block grant as touted by TPPF and NCPA.

    Incredibly, TPPF clearly recognizes the inherent unfairness in such block grant formulas. As they acknowledge in their ironically-named report Save Texas Medicaid: A Proposal for Reform, "Determining the amount of the block grant based on historical funding presents a number of inequalities. Medicaid programs vary between the states, such that states with higher health care costs get more federal funding. In addition, some states have negotiated more favorable waiver arrangements than others, and Disproportionate Share Hospital (DSH) payments reflect historical use rather than rational policy choices."

    Again, for Texas, a block grant would lock in and exacerbate those inequities. So, how would TPPF address this issue that they recognize is a problem? They would not. As the report reads, "Nonetheless, basing the initial block grant amount on historical spending is the most acceptable method because it represents the political status quo."

    Interestingly, the solution to this inequity in their "reform proposal" is to adhere to the "political status quo" even if this "solution" is detrimental to Texans and reflects "historical use rather than rational policy choices." At least TPPF admits it is not rational.

    However, in addition to being really poor policy, it is also poor politics. In fact, with respect to the politics of cutting and capping health coverage to children, former State Rep. Arlene Wohlgemuth should know better after having led the effort in the Texas Legislature to cut 147,000 children off of coverage in the Children's Health Insurance Program (CHIP). Despite beginning her subsequent 2004 political race for Congress with a lead in the polls, Wohlgemuth was defeated by Rep. Chet Edwards after he ran a devastating ad about the impact of Wohlgemuth's efforts to slash children's health coverage.

    In a country as wealthy as ours, with the best medical care in the world if you can afford it, the American people do not think we should be not be threatening and rationing the health care of our children, seniors, and people with disabilities. Medicaid provides long-term care to millions of seniors, helps Americans with disabilities live independently, and enables millions of children to see a doctor. In fact, a Bloomberg national poll found that over three-quarters of the American public oppose cutting Medicaid and that it is the least popular option of all for deficit reduction.

    In short, block granting Medicaid is a poorly conceived and arbitrary form of health rationing that in opposed by the American people and has been defeated on a bipartisan basis time-and-time again. Putting a new picture on the cover of this latest proposal does not change that fact. As former Texas governor Ann Richards would say, "You can put lipstick on a pig, but it is still a pig."

    Rather than, once again, trotting this zombie idea to ration the health care of others: politicians (both current and former) should test the idea on themselves. Medicaid block grant proponents should first agree to cap and limit their own government insurance coverage. After such an experiment, they can then let us know whether they still consider health insurance for seniors, children, and people with disabilities should be rationed.

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July 18th, 2015

7/18/2015

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I will talk elections this weekend


I SEE A GREAT DEAL OF 'PURGING'.


I attended a Johns Hopkins gathering of professionals and heard the discussion of needing more sheep----getting rid of those people with individual personalities. That is what a corporatized K-12 with testing and evaluation will do.

THIS IS HOW BALTIMORE BECAME A COMPANY TOWN----HOPKINS CULTIVATES SHEEP FOR GOVERNMENT AND ORGANIZATION LEADERSHIP.

Just think about the move in the US by Libertarian/neo-conservatives like Johns Hopkins to pose left-leaning with Marxism -----while privatizing all Baltimore City schools into vocational apprenticeship K-12 with testing and evaluation of children tracking them as they go----prison factories-----and you have the same process as Mao's Chinese reforms that used labor to build a nation of sheep. Asian nations have citizens who do not rebel----who do not see themselves as individuals, but as a collective. Trying to build a socialist culture in the midst of an American takeover by an autocratic, criminal plutocracy is setting the stage for anything people build collectively simply being seized as is happening right now. All of the citizen volunteering replacing our public sector-----all of our tax revenue simply being sent directly to corporate subsidy and corporate non-profits----people having individual personalities being culled from the ability to find jobs. Today in the US citizens are being made afraid of speaking out against what is happening for fear of not being able to get a job. THAT IS WHAT AUTOCRATIC CORPORATE CONTROL DOES. THAT IS WHY NEO-CONS WANT TO CONTROL LABOR UNIONS BY POSING MARXIST.

WE THE PEOPLE SIMPLY NEED TO MOVE BACK TO SOCIAL CAPITALISM----LABOR AND JUSTICE PROGRESSIVISM---BY REINSTATING RULE OF LAW AND EQUAL PROTECTION ===WE DO NOT NEED TO GO DOWN THIS ROAD TO AUTOCRACY!


This is what Trans Pacific Trade Pact and global corporate tribunal rule wants to install after the coming bond market crash brought to you by Clinton neo-liberals and Bush neo-cons----ALL OF MARYLAND POLS ARE GLOBAL CORPORATE POLS.



Laogai: "Reform Through Labor" in China

by Ramin Pejan*

Introduction

Laogai, which translates from Mandarin to mean "reform through labor," is the Chinese system of labor prison factories, detention centers, and re-education camps. Mao Zedong created the system in the early 1950s, modeling it after the Soviet Gulag, as a way to punish and reform criminals in a manner useful to the state, producing thought reform and economic gain. The Laogai system is still in place today and continues to deprive individuals of basic human rights. An individual's mere association with groups unpopular with the Peoples Republic of China (PRC) government can result in the individual being sent to a reform institution in the Laogai system, through a process that deprives the person of due process rights. Once inside the Laogai, prisoners are subject to cruel and degrading treatment and oftentimes torture. These human rights abuses violate both Chinese and international human rights norms.


_____________________________________________


We want to be clear------whether Stalism or Maoism----this is not socialism, it is autocratic corporatism. Mao was simply transforming Chinese culture into laborers for the industrialization of China----China has been Wall Street naked capitalist neo-liberals for decades and not Communist.

This is what far-right politics in the UK and US is trying to do to our first world progressive Democratic societies-----re-educate all of the individual rights and freedoms out of America...ns and English----and engineer back the labor class for the rebuilding of industry in the US under Trans Pacific Trade Pact.

Now, your national leaders know this goal as do your state leaders. Local leaders may simply be doing what they are told. National union leaders like Trumka and Weingarten know this is where TPP and right-wing Clinton neo-liberals and Bush neo-cons are taking unions. This is why they are backing Clinton neo-liberals to the end----- We must restructure our US labor unions to domestic social Democratic and not International Marxist.

Below you see UK's Cameron who is the same as Bush neo-cons doing in UK what Clinton neo-liberal Obama is doing in the US. THEY ARE THE SAME. In the US, the Republicans are calling Obama Socialists while it is the far-right that is building these Marxist political structures to move the US to a corporate autocratic control.

So, the rich will have sucked all of the wealth from UK and US with this coming bond market collapse and economic crash and they are ready to create a sheep society under the guise of Marxism keeping the rest of people impoverished workers. Look below to see the comment about how Cameron in the UK and Obama in the US both look to 2015 for the dismantling of Federal agencies and passing the Trans Pacific and Trans Atlantic Trade Pacts. It is this schedule of massive economic collapse tied to these treaties that move the US---MOVING FORWARD----to this MAOIST purge of all democratic and freedoms of America.

What is great about this article is it brings the political philosopher HAYEK in as the source of the LITTLE RED BOOK---Hayek being the neo-liberal philosopher embraced by Clinton and Obama and as this article shows-----Thatcher and Cameron. None of this has anything to do with Socialism or Communism----it is simply a political structure to dismantle all signs of Democracy----Rule of Law---and all economic gains of the American people


 Is the coalition really 'Maoist'?



By Brian Wheeler
Political reporter, BBC News
  • 21 December 2010
  • From the section UK Politics
It might seem faintly ridiculous to compare Britain's coalition government to the brutal regime of former Chinese Communist leader Mao Zedong. But that is precisely what one of its leading members, Vince Cable, has done. When questioned about Mr Cable's comments, David Cameron confessed he was not an expert on Maoism but unlike the former Chinese leader was not "going to insist on being called The Great Helmsman". So what could the business secretary possibly mean?

1. LOCALISM? - Mao wanted to smash the elites that ran pre-communist China, believing they had become corrupted by power. He wanted the peasants to rise up and effectively take charge of services in their own communities. Sound familiar? With its plans for elected police chiefs and local council tax referendums - not to mention its war on the highly-paid elites who run Town Halls and its call for an army of "armchair auditors" to hold civil servants to account for the money they spend - the coalition has, arguably, attempted to unleash its own cultural revolution in Britain's public services.

2. INFORMERS? - You had to be very careful what you said - and who you said it to - in Mao's China. Informers were everywhere - and citizens were forever being exposed for expressing "counter revolutionary" views. Vince Cable must know how they feel. He was having a private conversation with constituents when he described the coalition as "Maoist", and revealed dark thoughts about overthrowing the regime, only to find his words splashed across the pages of a national newspaper. For the analogy to work, of course, The Daily Telegraph would have to be seen as a party newspaper which, despite being affectionately known as The Torygraph, would be stretching it.

3. CHAOS? - Mao's cultural revolution unleashed chaos in Chinese society. Nothing was sacred. At the weekend, Tory MP Nick Boles, one of the coalition's leading thinkers, described the "chaos" that will follow the ripping up of central government planning as a "good thing". Political pundits have marvelled at the speed and ruthlessness of coalition ministers as they set about reforming monolithic institutions such as the NHS and the benefit system. One senior minister, commenting on the devolution of power from Whitehall, has reportedly used one of Mao's favourite slogans: "Let a thousand flowers bloom."

4. PERMANENT REVOLUTION? - Mao was a firm believer in the theory of permanent revolution, which he believed should be in the hearts of all Chinese Communists. The coalition is also partial to ideological purity (Before they adopted Mao as their role model, Tory high command urged activists to take a leaf out of Gandhi's book and "be the change")
. Like Mao, the coalition is working to a strict Stalin-esque five year timetable. David Cameron's chief strategy adviser, Steve Hilton, described by Observer columnist Andrew Rawnsley as "the most Maoist person in the government", has reportedly been heard to tell colleagues: "Everything must have changed by 2015. Everything."

5. GANG OF FOUR? - The later stages of the cultural revolution were guided by an inner circle of powerful Communist party officials known as the Gang of Four. The coalition is, similarly, guided by what insiders call the "quad" - David Cameron, George Osborne, Nick Clegg and Danny Alexander, Nothing important happens without their say so apparently. They will be hoping to avoid the fate of their Chinese counterparts, who included Mao's wife, Jiang Qing, who were eventually tried for treason. 

6. BRUTALITY? - The violence unleashed by Mao's cultural revolution, with students in the forefront, was responsible for many deaths. There may have been injuries and criminal damage caused in London during the recent student protests but even the most ardent opponents of the coalition would not claim it was going down a similar route to China in 1966.

7. DEFENCE AND FOREIGN POLICY? - Chairman Mao's China built up an impressive military might with a legacy of having the largest army in the world. The People's Republic also sought to avoid dependence on, and economic ties with, Western Europe and the capitalist world. By contrast Cameron's coalition has been slashing spending on defence and despite Eurosceptics urging the government to cut ties with the European Union, there are few signs of it happening.

8. IDEOLOGY? - Mao was driven by a belief in violent class struggle. As a devout Marxist, he would have had little time for the wealthy, public school educated plutocrats at the top of the coalition government. Everyone would be equal in theory in the communist state. He set the rules for all political, cultural, economic and intellectual activity. In other words, it was the exact opposite of the "small state" philosophy espoused by coalition ministers. Most Conservatives in the coalition government grew up in the Thatcher years, sharing a belief that there should be equality of opportunity for all, whatever the circumstances of their birth. As they put it in their 2010 slogan: "We're all in this together".   One Baltimore!

9. PROPAGANDA? - Their parties may have been keen on pasting giant posters or paintings of them in prominent city centre locations, but Mr Cameron has yet to come up with his own version of Mao's Little Red Book - a handy pocket book collection of quotations from his speeches Chinese citizens were encouraged to carry with them. The Conservative Party manifesto - a hardback entitled "an invitation to join the government of Great Britain" - in deepest Tory blue - may have become its nearest equivalent, if it had not been rendered obsolete by the coalition agreement.

10. RE-EDUCATION? - If Vince Cable had lived in Mao's China he would probably be packing his suitcase for a trip to a re-education camp by now. This was where "troublemakers" were sent to be persuaded of the error of their ways and to experience and reconnect with the life of the humble peasant. In London in 2010 Mr Cable may well be facing some tricky meetings with colleagues and strategists, but it's unlikely he's going to be sent off for a spot of farming.


Here is a selection of your comments:

What a load of populist tosh. One Minister says somethign in private and it happens to be his private opinion, and all hell breaks loose. This is a coialition for gods sake! There are bound to be differences (some of them big) between the coalition partys, and making an elephant out of a mouse is not really doing the country any good at this point in time. I believe the coalition as it is is making a really good job out of a very bad situation, and the more we let them get on with their job rather than mudsling both parties and their coalition, the better. I dread to think how labour would have spent us into oblivion over the next few years. NIk C, knebworth

One thing the Maoists and the current UK administration have in common: no sense of obligation to the people that they serve. Megan, Cheshire UK

Perhaps the thing that most strikes me about the coalition government and Mao's China is the way they are both driven by idealistic philosophical world views.
For Mao it was his form of marxism, for the coalition it is an extreme form of neo-liberalism. Mao's ideas were a dismal failure - the neo-liberal ideology of the 80s was likewise a failure. It led to a massive gap between the rich and poor. Pity this government can't learn from the mistakes of the past. Jennifer, Barnoldswick

Spot on - this is something I saw early on in Thatcher's reign, whom I described then to colleagues as a Right-wing Maoist. One of the crucial indices of Maoism was its hostility to elites (ironic, in view of the elitist nature Communism in practice) the chief elite being that of experts. For Mao pure communism would replace the experts, whereas for Thatcher market forces would perform that function. Remember the attack on consultants and their power in John Moore's "reforms (= deforms) of the NHS, and Kenneth Bakers attack on teachers in GerBIll which became the 1988 Education Act? Cameron is only playing the same tune, under the guise of devolving power to the localities = smashing the power of the highly trained & qualified Civil Service, which might act as a fetter on the Con-Dems aim of deconstructing the Welfare State, Destructive chaos is what they are after, and by golly, they are in danger of finding that they will get just that. The sttudents are only the harbingers of more to come. Andrew, Norwich

I find the premise you suggest has some merit. Points 1 to 5 have fair correlations with MAOISM in its purest form. This may have become inevitable with such a forced coalition attempting to merge two opposing political philosophies. However, as recent events demonstrate, idealism yields to necessary contingency driven behaviour and reactive policy follows. Malcolm, Devon


Mao started the "Cultural Revolution" in the 1960s, which was an anti-intellectual, grassroots purge of authority at all levels. It was based on the ancient Chinese concept of "hegemony" - the complete domination of society's political and social agenda by a single model of how the world is - and the role of the state - in this case, as defined in Mao's little "Red Book". Maoism therefore had a strong anarchic vision based on direct local action by indoctrinated cadres of activists, who would infiltrate local organisations and structures, then act in concert to pull down the "corrupt" system from within, backed up by central control of the mass media. Sound familiar? If you trace Libertarian entryism into the Tory Party in the late 70s, their rise to power under Mrs Thatcher and the way that certain local authorities like Wandsworth, Westminster and Bradford become test beds for privatisation, service cuts and workfare experiments, there are striking parallels to the way the Libertarians and Maosits operate politically - and they even have Hayek's little book too: "the Road to Serfdom", in which he argued that warned of the danger of tyranny that inevitably results from government control of economic decision-making through central planning, and in which he argues that the abandonment of individualism, liberalism, and freedom inevitably leads to socialist or fascist oppression and tyranny and the serfdom of the individual. Interestingly, Goeorge Orwell, that great whistleblower on the risks of tyranny comments:"A return to 'free' competition means for the great mass of people a tyranny probably worse, because it is even more irresponsible, than that of the state." I find the ideology of the Cameron government is pure Hayek - and their policies for local government and the "Big Society" display an ideological fundamentalism that Mao would immediately recognise as a deliberate attempt to gain control of the way we see ourselves and our communities - the rhetoric of "setting people free" is straight out of Hayek and the combination of deregulation and massive spending cuts are ideologocal choices, not pragmatic or practical decisions about what will deliver the best services at the local level. To say that the Tories are ideologically motivated and that they use the levers of power to implement their ideology is merely a statement of fact. To question the validity of such an ideology as a statement of FAITH - not a reflection of social and economic REALITY - is to begin to address the reason why we find the criticism of "Maoist" worrying, because if this faith is just a dangerous delusion based on the obessive ravings of another old man, it takes us to precisely the same place as every other dogma has done down the ages - up a blind alley - and as with every other zealot-inspired witchhunt, a hell of a lot of innocent and vulnerable people will get hurt in the process. Richard, Devon

__________________________________________


Now, if Americans have lost the ability to 'have fun' it is because Reagan/Clinton neo-liberalism attacked and dismantled all of what made the US a first world Democracy with a strong middle-class. The Clinton's and the Bush's are the source of the decline to America and Americans into third world poverty. They worked hard to bring this coming bond market crash designed to send the US into a Great Depression and worked hard on Trans Pacific Trade Pact to end national sovereignty and our rights as citizens----

SO WHAT IS HILLARY REALLY TALKING ABOUT??????

Well, since neo-liberals and neo-cons are embracing
Marxist Stalinism-----I would go with re-education camps.


Hillary Clinton Says to Fix The 'Fun-Deficit' in America, 'We Really Need Camps for Adults'


Hillary Clinton Says to Fix The 'Fun-Deficit' in America, 'We Really Need Camps for Adults' (March 19, 2015)
  NBC News
----You Tube

I have spoken about the neo-liberal national charter chains like KIPP where students are given 'no excuses' and are culled from the charter through behavior and achievement shortfalls. Meanwhile, the stats that say KIPP is improving achievement have often been found to juke the stats---they are not really achieving. What they are doing is re-educating and changing behavior. Now, people may say underserved children need discipline but this is not where all this is leading. ... These national charter chains and Common Core are all attached to what will become an autocratic control of all information the American people receive. It was written by Wall Street and Bush neo-cons and Clinton neo-liberals as global corporate tribunal pols.

IT IS CRITICAL THAT WE GET RID OF ALL GLOBAL CORPORATE POLS IN THESE COMING ELECTIONS. BECOME ENGAGED AND BE THE CANDIDATE IN ALL PRIMARY ELECTIONS. ALL MARYLAND POLS ARE CLINTON NEO-LIBERAL OR BUSH NEO-CON.


The urgency of every minute to learn----is straight from the neo-liberal education handbook from Asian schools.


Achievement First: Boot Camp for Kiddies




By dianeravitch
July 10, 2013 //


Achievement First prides itself on its high test scores, but recent stories report that these charters are also distinguished for startlingly high suspension rates. Half the 5-year-olds were suspended last year.

Dacia Toll, the Ivy League-educated leader of the charter chain, promised to cut the suspension rate in half. Instead of suspending the kids, apparently they will get even tougher on them in school.

I have always wondered how privileged white college graduates learned to be so hard on impoverished black children. It is highly unlikely that what they do in these boot camps reflects their own home life or schooling.

Here is the drill in the AF charters that gets higher test scores:

“There is an urgency in the tenor of the classrooms at Achievement First schools; a sense that every second must be used for learning. Even on the last day of school at the Hartford middle school, a history teacher has a tightly structured lesson that students are clearly enjoying. She uses a timer to ensure that small tasks — like moving the desks into a U-shape for discussion — don’t take longer then necessary.

“The schools also have a language of their own that expedites communication and students, for the most part, respond like a precision team. A teacher at Bridgeport elementary schools tells her students to: “SLANT, fold your hands and make a bubble.” Translation: Sit up straight, listen, ask and answer questions, nod to signal engagement and track the teacher with your eyes. And the bubble? Purse your lips and fill your cheeks with air — a move that ensures quiet.

“For years, the Achievement First students in Hartford, New Haven and Bridgeport, have outperformed their peers on state tests in almost all grades and subjects. On a recent visit to Achievement First’s middle school in Hartford, a strict disciplinary code was evident.

“In a large lecture hall with stadium seating — the “reflection room” — two or three students who had been removed from class for behavioral reasons sit quietly under the supervision of a staff member.

“At the front of the room, the consequences of breaking the rules and the rewards of not doing so are spelled out on large posters that proclaim, “You’re not a born winner, you’re not a born loser. You’re a born chooser. Make the Right Choice!”

“And in most classrooms, two or three students wear a white shirt over their blue school uniform, signaling that they are in “re-orientation”
— a disciplinary measure that permits them to stay in academic classes but forbids interaction with peers and removes them from special classes like music or physical education.”

There is something Orwellian about that “Reflection Room.” I wouldn’t let my children or grandchildren go to such a school. Would you?

A comment posted on the article by Carol Burris, the principal of South Side High School in New York:

“As a public school principal, if I engaged in such practices, I would be fired. No middle class suburban parent would put up with the systematic humiliation of their children. The “culture” is more aligned with a communist nation than our nation.

“As for the “reflection room”–that is in-school suspension and for state accounting purposes, it should be counted as such. These practices may develop compliant children controlled by fear, but they will not develop leaders who have learned self-control.”

____________________________________________





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    Cindy Walsh is a lifelong political activist and academic living in Baltimore, Maryland.

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