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      "author": "innerhive",
      "body": "https://i.imgur.com/CBqCEo5.png<br><br>Join the community in our migration to Hive, a community built blockchain for the community.  All Steem account holders will receive equivalent stake on the new Hive blockchain.<br><br>Please [follow @innerhive on twitter](https://twitter.com/innerhive) for more information.",
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      "body": "Here is an opportunity for citizens to use quarantine time productively:\nEducate yourselves about local government taxing and spending.\nLearn what the law requires,  and scour local expenditures for instances of violations of these laws.\nExample: \n School  board consent agendas  typically represnt millions of dollars a month that voting board members never bother to check for legality, accuracy,  or legitimacy of need.\n\nIf You have time to twat or Facebook,  then you hsve time to go through the consent agenda of expenditures line by line, determine legitimacy of each payment.\n\nThis goes for every local taxing body.\n\nExtraordinary powers are being seized by small governments all over America.\n\nThe least citizens can do is document and analyze every action and especially expenditure.\n\nWho is getting public money/contracts, who is denied money, what if any relationships exist between grantors and recipients?\n\nDocument, document, document. During this crisis there is nothing we can do,  but afterward there can be analysis of anything improper...so long ss the action was recorded.\n\nVigilance of government behavior can provide a deterrent to governmental bad actions.\n\nIn 2008 crisis nobody was watching.\n\nLet’s not make that mistake again.",
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      "author": "rgz",
      "body": "Rather than wasting days in quarantine twatting about nonsense, make  time productive to medical professionals by spending an hour a day on factual research about the economic hardships burdening nurses and doctors relative to public workers who are guaranteed COLA defined-benefit pensions and taxpayer funded health insurance.\n\nIf America insists on paying government workers like teachers a defined-benefits pension guaranteed for life with 3% annual inflationary increases, America should find money to give the same deal to nurses and doctors.\n\nNo unions necessary, just look at any teachers' contract for template of the deal.\n\nLook up CPS teachers contract. Write down what a 1st, 3rd, and 5th year teacher vs. private sector nurse earns.\n\nCalculate the per-hour salary (that is, nurses working 50 40-hour weeks annually  compared with teachers working 170 6-hour days annually, and don't forget to subtract contractually mandated  days off).\n\nAnother quantifiable benefit: health insurance:\nNurses must pay higher percentages for less coverage and lose coverage when job is lost. Teachers pay a trivial amount toward their health insurance (for better coverage than nurses) and when they early-retire at age 55-58 they pay nothing--that is, free free free.\n\nThe big daddy of them all is 'retirement' pension: \nNurses must have 6.2% deducted from their salary for social security.\nTeachers have 0 deducted for social security.\nIf all a nurse saves for retirement is this, she will make roughly 1/3 of what teachers who must only work 10 years to vest lifetime pension benefits .\nHaving contributed 6.2%, nurses must wait until at least age 62 to start drawing payments from soc.sec..\nTeachers start drawing on their pensions at vesting, which can be typically age 55-58.\nNurses can of course pay additional amounts into retirement savings through at-risk 401k plans and the like.\nQuestion:\nHow much would a nurse have to save each year of a 10 year career to equal retirement benefits of a teacher with pension-spiked entitlement (for which teacher had to pay, at most, 2% of salary for 10 years)?\nYou can use an online annuity calculator to determine the answer. But calculations become complicated when one must factor in the 3% annual pension payment raise.\n\n(If you haven't heard of what pension-spiking is, educate yourself on this method used by school districts to elevate the final years' salaries of teachers on which pension payments are based. Over and above the 6% annual raises (obligatory by contract), there are little tricks used to raise \"creditable earnings\", such as stipend assignments. )\n\nIn the Great Recession of 2008 our local government used the crisis to initiate massive borrowing and spending for insiders--hiring unneeded public employees and issuing un-affordable public debt for  building schools which would predictably remain empty.\n\nNow here we are again, in this coronavirus crisis, our local governments are busy seizing extraordinary powers and suspending OMA and other transparency devices set up for taxpayer protections. \n\nThere is one thing every citizen can do in case we do come out the other side of this crisis: KNOW how these predatory taxing body machinations work, watchdog the deals and spending going on now: who is getting public money and what are the relationships involved?\n\nAnd if you feel any true gratitude toward nurses and doctors who are risking their own families' lives in public service, QUANTIFY your gratitude by becoming knowledgeable about the disparity in economic compensation between  public workers and (mostly) private sector nurses and docs. \nIf society cannot afford similar defined-benefits compensation packages for nurses and doctors, society should re-think demanding nurses and docs bear the additional burden of funding them for others.",
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      "author": "rgz",
      "body": "Convoluted exemptions exist for hospitals and GPOs, exeptions from federal anti monopoly and anti kickback laws which are  strictly enforced against medical doctors. \n\nThis hypocritical policy conceived and enforced by Congress (accepting Big Med lobbyist contributions and consulting jobs after leaving office) is designed to hogtie individual \nmedical  professionals from independent practice,  essentially enslaving the medical professional class as service employees of Political Class Healthcare Industry.\n\nSolution: Indian Reservations are sovereign law. \nHospitals placed there,  offering price-posted medical services, especially elective surgical procedures,  could win back big medical tourism dollars.\n\nPatients even with insurance are beginning to realize they are indeed cash payers, when they grasp the effect of deductibles and co-pays.\n\nWhy not harness the economic power of such demand to create an honorable source of supply? Especially when the largest chunk of the medical transaction dollar is now being taken by third party gatekeepers who add zero value to the trade.\n\nThis is Positron social-economic-political self defense tactics: use the same methods  the self-dealing Political Class uses for narrow self enrichment,  but use the methods for the opposite purpose: equitable distribution. \n\nIn this case, Political Class perversion of the law is their method. Can't beat them in that arena, they Own \"the law\". \nSo find out where they don't own the law, and set up competitive shop.",
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      "body": "We are all de facto cash payers when one considers deductible and copays.\nAnd, people are finally wising up that paying cash for many meds is cheaper than paying the copay for the insurance-negotiated price.\n\n Consider that health insurance is merely an option contract,  expiring monthly,  which implies the rights to purchase unknown medical services at nondisclosed prices from non-obligated third party vendors emdors. \n\nOptions can be offered by a \"cash patient GPO\".\nThese options would include definition of underlying service to be purchased, strike price of that underlying service, and expiry date (before which that service may be purchased).\n\nMedical professionals could sell these options directly to patients,  and keep the premium price of the option themselves.  Why should some third party financier monetize the future performance of doctors,  without paying the docs anything for it?\n\nGPO Patients could be allowed to know who and where are medical professionals who comprise \"open interest\" of short option contracts for any given medical service. \n\nThis would create the first truly borderless network outside of Medicare. \n\nMedical professionals would love to get paid, immediately,  a known price and save 6 figures a year on billing coders and denied claims.\n\n(GPO would need to pay $1 more than any insurance accepted by a given doctor,  the issue being \"most favored nation\" clauses.)\n\nPatients would be big net winners in all scenarios involving typical,  non-catastrophic healthcare. \nCatastrophic care insurance premiums could be quite reasonable, and would plug that hole.\n\nPatients could take over the task of filing claims for reimbursement with their own health insurance companies,  spending their own time (rather than doctors' premium time) dealing with arbitrary claims denials. \n\nPharmaceuticals prices cannot be addressed until laws change.\nIn many cases, medical tourism is indicated.\nA large enough group of affected Americans might seek judicial review of restrictions on purchase of life-saving pharmaceuticals from outside US borders given that many of the components of the pharmaceuticals are produced in other countries.\n\n The whole cash-pay GPO system could run parallel to the current corrupt third party payer system until non-political class gains the understanding and confidence to reject this devil they think they know.",
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      "author": "rgz",
      "body": "Medical provision in America is already socialized, and is non-equitable in its distribution, due to third party gatekeepers dictating (under impenetrable secrecy) who gets what and how much will be reimbursed, if reimbursed at all.\n\nHealth Insurance is simply an Option Contract: \na financial contract expiring monthly (when premiums are due) that enables the buyer to purchase:\nunknown medical goods and services\nat undisclosed prices\nprovided by non-obligated third party providers (hopefully willing and available) \nat some future date.\n\nSellers of this so-called \"insurance\" are not medical providers, they are finance companies which MONETIZE THE PROMISED FUTURE PERFORMANCE OF NON-CONTRACTUALLY OBLIGATED THIRD PARTIES (doctors and nurses).\n\nIf you want medical care, by law, you need a licensed doctor and/or a nurse.\nThese care providers are forced to jump through Gordian-knot-ish hoops to get reimbursements from Third Party Payment system.\n\nBuyers of (hoped-for) medical care pay Third Party for a finance contract to purchase something that the Third Party cannot provide and cannot guarantee provision of...AND no prices are disclosed (you didn't think there would be no co-pays, did you? No denied claims? No Out-Of-Network Provider BIG surprise bills?).\n\nSellers of medical care (docs and nurses) hope a Third Party finance company will reimburse them for services rendered, AFTER sellers have spent significant up-front time and money to pre-approve txt's (no-guarantee of payment) and billing-coding (required, but again no guarantee of payment) and risk Rac Audits (Google it). \n\nThis is a corrupted system, where Buyers and Sellers of a critically needed service (medicine) are kept apart from one another by a tortured law designed to benefit only the Third Party Gatekeeper.\n\nSolution? Of Course: \nGPO (group purchasing organizations) formed by patients willing to pay cash for services from licensed medical professionals at disclosed prices.\nYou know how much actual healthcare a human can purchase for the reimbursement rates to actual health care providers? No, how could you know, that information isn't allowed to be disseminated.\nIt is a lot.  \nBuyers and Sellers could share an enormous chunk of the Medical Transaction Cost Savings by eliminating the Third Party Gatekeeper.\n\nWhy GPO? Because GPO enjoys a unique Congressional protected status of safe harbor exemption from Federal Anti-Kickback Laws. GPOs are blamed by many medical professionals for the intractable high cost of pharmaceuticals and the commonly occurring shortages of hospital commodities like saline bags.\nBut here's the thing:  doctors are afraid to post prices or advertise or do anything free-market (which would benefit both doctors and patients) because Anti-Kickback Law is the threat used  to prevent them from doing so!\n\nHence the Positron reference: when corrupt incestuous Political Class actions create untenable circumstances for non-corrupt-non-Political-class humans, the victimized humans must look for novel self-defense mechanisms.\nAppealing to the mercy or honor of malignant narcissists is never a winning strategy.\n\n'Positron' strategy, in the arena of trying to survive the American Healthcare Finance Industry, involves buyers (patients) and sellers (docs&nurses) using the same mechanism (GPO) that bad guys use to enrich themselves at the expense of patients and healthcare professionals, but instead using it for the power of community good rather than narrow insider evil.",
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      "title": "Fight corruption with it's evil-evil-twin: Anti-Evil. Like a Positron."
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      "author": "rgz",
      "body": "Are resources controlled by third party gatekeepers  distributed equitably?\n\nA timely example we should all discuss is this:\ncommonly occurring saline bag shortages at hospitals.\nWhen an epidemic such as coronavirus hits, severe shortages are a deadly certainty.\n\nCommodity supplies in hospitals are purchased through GPOs.\nGPOs are given safe harbor exemption from federal anti-kickback law, and so are permitted shrouds of secrecy surrounding pricing and allocations policy (and this is fiercely protected by Congress).\n\nTherefore:\nHospitals in ‘flyover country’ may or may not receive the same allocations per capita (of saline bags) from huge profitable GPOs as the GPOs allocate to hospitals in districts where their Congressional champions reside.\n\nTaxpayers simply have no way to discover resource allocation policy or whether equitable distribution policy is overlooked for favorable relationships–remember that Anti-Kickback law doesn’t apply to GPOs.\n\nThe following exerpt is from an analysis of medical resource allocations:\n\n“Therefore, although society’s conferral of a service monopoly may have considerable benefit for the monopoly holder, its ultimate aim is not to advantage the monopoly holder but to benefit society and its individual members.\n\nTherefore, the fact that the profession of medicine is a service-provider monopoly means that the profession has a duty to ensure not merely that the quality of medical services is as good as possible, but also that there is equitable access to the services that can be provided only by its members, and that the rules under which the resources that are controlled by the profession are provided are applied equitably. The crucial term here is “equitably”. “\n\nResource Allocation in Healthcare: Implications of Models of Medicine as a Profession\nEike-Henner W. Kluge, PhD\nMedGenMed. 2007; 9(1): 57.\nPublished online 2007 Mar 21.\nPMCID: PMC1925021\nPMID: 17435657\nhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1925021/",
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      "body": "GPOs enjoy unique exemption from Federal Anti-Kickback Law.\nGPOs are not required to disclose pricing information, kickback specifics, or other information relevant to Americans whose taxes fund the lion's share of healthcare spending. \n\nGPOs direct the flow of hospital commodity supplies.\nShortages of normal saline bags and other common hospital supplies frequently occur even in ordinary circumstances. \n\nWhat happens in an epidemic such as coronavirus?\n\nWhat will be the allocations priority for those who literally hold American lives in their hands?\n\nAmericans seem to be prohibited from knowing this information.\n\nThis shroud of secrecy indicates that allocations of crucial supplies in a national emergency will be anything but equitable.",
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      "body": "Patient  Joe\n\nI went to obtain an informed consent,\nAnd convey to the patient what that meant,\nI spent the next several moments explaining \nConcepts I'd learned over eight years of training. \n\nNow, Patient Joe was frugal, didn't live beyond his means,\nAnd was dead-set on keeping his own body free of liens,\nJoe said fine, he'd be glad to sign, \n\nif I told him what the procedure would cost.\nThen I knew in my heart I was lost.\n\nI can go on and on on stents until my face turns cyanotic,\nAssure him we treat flatlines like they're merely asymptotic,\nBut billing codes and DRGs are topics Gordian-knot-ic.\n\nSaid I to Joe, I do not know, but if I knew I couldn't say, \nbecause third party payers insist it be that way.\n\nJoe asks '\"how can he give infomed consent if he hasn't been informed of price?\"\nAnd I answered, who knows, but sign it, or leave here 'against medical advice '.\n\nPatient Joe starts talking lawsuits, then he stops and says \"aw shucks.\n Lets get this done, what do you say, how's cash, five hundred bucks?\"\n\nI drew on all my experience and training and ethics and...and...\n(...meet me in the alley out back at nine. Here's cefazolin and some betadine).",
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      "author": "rgz",
      "body": "Illinois is governed by the people, for the people... if you can even  call them people...who are enriched by the Illinois political industry. \n\nIt is the perfect business model, so long as there are sufficient fresh supplies of  sucker money invested in the State. But these predatory savages of the Illinois Political Industry are running out of suckers. \n\nSelf cannibalization of Illinois taxpayers renders homeownership a losing  investment by any comparison standards. \nTaxpayers find that 20-30 years of home ownership does not create a retirement nestegg; Illinois homes carry annual tax rate capitalization devaluation of 1.5%-5% relative  to homes all over America.\n Illinois homes carry an additional ever-increasing shadow mortgage of public debt burden for  extraordinarily high public defined-benefit entitlements. \nAnd every year spent living in Illinois represents thousands of dollars taken in superfluous property taxes which steal at least double the national percentage of household income typically spent for p-tax.\n\nIllinois households have to give up some form of expenditures in order to pay property taxes which households all over America are spared.\nThis means going without family pets, children's college savings accounts, and personal retirement savings for many Illinois homeowners (or renters, because property taxes are a factor in higher rents).\n\nAlt-Illinois could free itself from the incestuous corruption that is the Illinois Political Industry , by using the same mechanisms used by self-dealing crony capitalists in government. \nAlt-Illinois would incorporate areas outside current municipalities, and create Village-wide TIF coverage. Every property would, by charter, receive pro rata annual rebate of TIF taxes paid.\n\nOver 23 years of inflation,  the Illinois political industry would be deprived of its customary diet of disenfranchised taxpayers. \nNewly created  Alt-Illinois  would be in a stronger position to demand rights to create new, fiscally responsible local  school districts,  fire&rescue districts, and local governments within its own borders.\n\nIllinois property is selling at a deep discount,  as is proper for a region captive to  incestuously corrupt governance .\nAlt-Illinois could create a firewall between that destructive governance and a region with a great deal of  potential  value.",
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      "author": "rgz",
      "body": "Most people do not realize how much property tax is taken from them, details of how it is spent,  or whether communities in other States are getting the same quality social services provided, but for significantly lower costs.\n\nIn Illinois collar counties, most taxing body are governed by a board of  persons elected from the community. The Board is typically not paid.\n\nThose who run for such Boards--library, parks, conservation districts,  etc.-- are people who are passionate about that cause.\nThat becomes a big problem when zealotry meets hard cold economic reality. \n\nWhen the Board of, say, the conservation district decides that nothing is more important than the environment, and no amount of money is too much in pursuit of that holy cause, you get a taxation policy of enormous overspending the means of the taxed community. \nOther Boards feel just as passionate about their own sacred missions to spend as much as possible on ( library, schools, local government, fill in the blank).\n\nThis has happened in our northern Illinois region  over the past dozen years. Our home values were devastated and cannot recover.  Our property taxes are ~4% of fair market values.\n\nLearn from us; the canary in the coal mine.",
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