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Crafty_Dog
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« Reply #450 on: October 02, 2014, 04:58:43 PM »

As a state legislator, TMcC had my respect for the right values and clear headed analysis.  I am glad that even though he is now a Congressman, he continues to put out his CA ballot recommendations.

McClintock November Ballot Recommendations

Prop 1 – Water Bond: YES.  This is a long way from a perfect measure, but it’s as good as it gets in California these days: a $7.5 billion water bond that spends $2.7 billion for new water storage.  If that sounds breathtakingly underwhelming, remember that’s $2.7 billion more than the multi-billions of dollars of water bonds that we’ve spent in recent years. Sadly, it doesn’t overhaul the environmental laws that vastly inflate costs and it squanders a great deal more that won’t be used for storage, but it is a step away from the lunacy of the green left (that adamantly opposes it) and this alone merits support.       

Prop 2 - Stop Us Before We Screw Up Again: YES.  This repeals Prop 58, a vat of Schwarzenegger snake-oil sold to voters as the panacea to the state’s budget woes.  It wasn’t.  (My I-told-you-so moment).  Prop 58 promised an iron-clad reserve, but in reality, the governor could suspend it any time he wanted.  He did. (Oops, I did it again).  What I like most about Prop 2 is that to raid the required budget reserve, both the governor AND the legislature must agree and then, only for a specifically declared emergency.  In a nutshell, it requires the legislature and governor to do what they did voluntarily during the Deukmejian era.  Still plenty of loopholes, but better than what we have today.

Prop 45 – If You Thought Obamacare Was Bad: NO. This is a trial lawyers measure that give the state insurance commissioner the power to set health care rates.  Sound good?  Doctors and other health care providers are already opting out of Obamacare because of artificially low rates; this compounds the problem for California.  The good news it you’ll have cheap health insurance.  The bad news is you won’t have a lot of providers accepting it.

Prop 46 – If You Thought Prop 45 Was Bad: NO. Another trial lawyers measure that quadruples the amount they can get for pain and suffering awards.  Prop. 45 means lower provider reimbursements and Prop. 46 means higher provider costs.  It also requires drug testing for doctors, which is a stupid idea but I appreciate the poetic justice in making THEM pee into little cups for a change.  Anyway, it won’t matter because your doctor will be out of state.

Prop 47 – Rose Bird’s Revenge: NO. We’ve gone overboard on some drug-related offenses, but this Proposition can only be described as a drug-induced hallucination.  It reduces many grand-theft crimes to misdemeanors and would release an estimated 10,000 incarcerated criminals back on the streets.  Basically, it is a burglar’s get-out-of-jail free card.  Good news for alarm companies and the handful of 60’s radicals nostalgic for Rose Bird – bad news for the rest of us.  Hide the silver.

Prop 48 – Freedom Works: YES.  This ratifies Indian Gaming compacts for two tribes in economically depressed regions of the state that will be an economic boon to the struggling local communities there.  It also cuts through environmental red tape that would otherwise delay these projects for years.
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Crafty_Dog
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« Reply #451 on: October 23, 2014, 10:46:01 PM »

http://www.capoliticalreview.com/capoliticalnewsandviews/how-many-are-covered-hospitals-28-of-calif-hospitals-had-worse-than-expected-infection-rates/

How Many are Covered California Hospitals? 28% of Calif. Hospitals Had Worse-Than-Expected Infection Rates
October 22, 2014 By Stephen Frank
       
More than one out of four hospitals in California have worse than expected infection rates—and government has demanded You be a victim. Connect the dots: Under Covered California you are only allowed to use doctors in a network and hospitals in the network. Neither doctors nor hospitals are chosen on the basis of quality—they are chosen on the basis of cost. The State of California forces you to use the low cost doctor and hospitals that have lots of infections. Feel safe now getting your government approved health care?

“KHN found that 695 U.S. hospitals had reported rates that were higher than expected for one or more of the six infections. Further, researchers found that 25% or more of hospitals had worse-than-expected infection rates in 13 states and Washington, D.C. California was one of the 13 states, with 28% of hospitals reporting at least one worse-than-expected infection rate.

If you are harmed or die, you or your family will not be allowed to sue Covered California for their lack of vetting hospitals for quality or safety. Once again, government is the problem not the solution.

 
28% of Calif. Hospitals Had Worse-Than-Expected Infection Rates
California Healthline, 10/22/14

California is one of 13 states and Washington D.C. where more than 25% of hospitals had higher-than-expected infection rates for at least one of six infections, according to a Kaiser Health News analysis of available CDC data, Kaiser Health News reports.

Background

About one in 25 hospital patients in the U.S. have a health care-associated infection on any given day, and 75,000 U.S. residents die from hospital-related infections annually, according to KHN. The federal government since 2012 has been publishing hospital-related infection rate analyses on Medicare’s Hospital Compare website. In addition, Medicare in the fall will begin factoring hospital-related infection rates into reimbursement payments(Rau, Kaiser Health News, 10/21).

Analysis Details

For the analysis, KHN analyzed CDC data from reports submitted by more than 3,000 hospitals on:

•   Catheter-associated urinary tract infections;
•   Central line-associated blood stream infections;
•   Infections from the antibiotic-resistant germ Clostridium difficile, or C. diff;
•   Infections from the antibiotic-resistant Methicillin-resistant Staphylococcus aureus, or MRSA.
•   Surgical site infections from abdominal hysterectomies; and
•   Surgical site infections from colon surgery.

The hospitals were rated as having infection rates that were better, as expected or worse based on the hospital type and patient mix. The MRSA and C. diff infections were contracted between Jan. 1, 2013, and Sept. 30, 2013, while the other infections were contracted between Oct. 1, 2012, and Sept. 30, 2013 (KHN analysis, 10/21).

Analysis Findings

KHN found that 695 U.S. hospitals had reported rates that were higher than expected for one or more of the six infections. Further, researchers found that 25% or more of hospitals had worse-than-expected infection rates in 13 states and Washington, D.C. California was one of the 13 states, with 28% of hospitals reporting at least one worse-than-expected infection rate.

In addition, KHN found that seven hospitals were determined by CDC to have worse-than-expected infection rates in four of the six categories, including the highly regarded:

•   New York-Presbyterian Hospital;
•   Pennsylvania-based Geisinger Medical Center; and
•   University of Michigan Health System.

Meanwhile, the analysis found that some major teaching hospitals generally had lower-than-expected infection rates, including:

•   Denver Health Medical Center;
•   Duke University Hospital; and
•   Mayo Clinic’s hospitals.

Reaction

Some of the hospitals contested CDC’s data. Some hospitals said their infection rates appeared higher because they worked harder to identify and report the infections or as the result of the hospitals admitting more patients who were prone to contracting infections.

Patient safety expert Kevin Kavanagh said the hospital-related infection rates were the result of many hospitals not strictly following infection disease treatment protocols and a lack of specificity in the government’s protocols. He added, “Right now there are too many recommendations on how to handle infectious diseases” and there is “too much leeway” on adhering to the recommendations.

Don Goldmann — chief medical and science officer at the Institute for Healthcare Improvement and co-author of a 2011 New England Journal of Medicine study on hospital-related infections — said, “The percentage of time that health care providers do all of the things they are supposed to do when caring for a patient with a contagious disease can be pretty low.”

Goldman added that many hospitals are more likely to follow protocols when addressing rarer ailments such as Ebola, but that “[w]hen [an infection risk has] been around for a long time, it kind of becomes part of the background” (Kaiser Health News, 10/21).

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Crafty_Dog
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« Reply #452 on: October 31, 2014, 10:58:01 AM »



https://www.youtube.com/watch?feature=player_profilepage&v=OS7-HuXaREE
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Crafty_Dog
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« Reply #453 on: December 26, 2014, 07:32:19 AM »

OAKLAND, Calif. — When Jerry Brown first served as governor of California, he set out to reshape the powerful California Supreme Court by appointing its first female chief justice. But his pick, Rose Bird, had never served as a judge before and came to be perceived as a liberal ideologue.

Ms. Bird, along with two other judges Mr. Brown named to the court, was recalled by voters in an election in 1986.

Nearly 40 years after he made that selection, Mr. Brown is again seeking to remake a court that to this day is viewed by legal scholars as among the most influential in the nation, with one study proclaiming it the state court most followed by other appellate judges. And once more, the ever-unconventional Mr. Brown is roiling the waters with a series of head-snapping, if decidedly more applauded, choices for this tribunal.

“I’ve had 37 or 38 years to reflect on the law and what’s needed,” Mr. Brown said in a freewheeling interview conducted in his hideaway, a barely marked office in downtown Oakland, where he formerly was mayor. “The world is very different. Obviously I know more about how the court works and what the reactions are of people to the court. Hopefully I don’t repeat history.”


Of the three people Mr. Brown has nominated to the seven-member Supreme Court — the latest confirmed on Monday — not one had a day of judicial experience: Two are law professors and the third is an associate attorney general in the Justice Department.

They are all graduates of the same law school — Yale — which also counts among its alumni a California lawyer who made a career in politics, Mr. Brown.

Mr. Brown’s most recent choice, Leondra R. Kruger, the associate attorney general, lives in Washington and has never practiced law in California. “That was kind of a mindblower,” said David S. Ettinger, a lawyer who writes a blog tracking the California Supreme Court.

Her nomination followed Mr. Brown’s selection of Mariano-Florentino Cuéllar, a law professor at Stanford who also spent much of his career in Washington, serving in the Obama and Clinton administrations. Mr. Brown began this process in 2011 when he nominated Goodwin Liu, a law professor at the University of California, Berkeley, three days after a Republican filibuster forced President Obama to withdraw Mr. Liu’s nomination for the United States Court of Appeals for the Ninth Circuit.

All three of the nominees are under 45, young enough to be handing down rulings long after Mr. Brown, who is 76 and about to be sworn in for his fourth and final term, is gone. Ms. Kruger, who was confirmed by the Commission on Judicial Appointments on Monday, is, at 38, the youngest member of the court in nearly a century. Under California law, the governor nominates justices, and, assuming they are approved by the commission, they appear on the ballot every 12 years for an up-or-down vote.

Mr. Brown’s latest selections have also brought a new measure of diversity to the court. Mr. Liu is the child of Taiwanese parents, Ms. Kruger is the first African-American to serve on the court since 2005, and Mr. Cuéllar was born in Mexico.
Continue reading the main story

As Mr. Brown moves into what is likely the final chapter of a 45-year career in public life, the California Supreme Court, where he served as a clerk as a young man, is providing him one more way to put a lasting stamp on his state. And not incidentally, it is providing him an opportunity for a bit of a do-over after the troubled appointment of Ms. Bird, who became not only the first woman to serve as the court’s chief justice, but also, in 1986, the first chief justice to be ousted by voters.

Mr. Brown’s selections were the product of a long search that included consultations with two members of the United States Supreme Court — he would not say which ones — and come at a time when some scholars said the California court, while still widely admired, has lost some of the intellectual luster it once had. He said his nominees were modeled after Yale law professors.

“I was looking for people who you could say were ‘learned in the law’ — a phrase you might not hear too much anymore,” Mr. Brown said. “I put the word out: Are there people who are scholars or of unusual ability?”

Mr. Brown’s choices have caught the eye of other judges and legal scholars, reflecting the regard of a court that, among other things, was first state high court to strike down a law banning interracial marriage, has held that mental health professionals sometimes have a duty to warn people about dangerous patients, and found a constitutional right for same-sex couples to marry in California.

“He is appointing superbly qualified people,” said Margaret H. Marshall, a former chief justice of the Massachusetts Supreme Judicial Court. “There is always a tension between appointing people who have already been judges and appointing people who have not previously been judges, but I think that’s an interesting balance for any court to have.”

Joseph R. Grodin, who was appointed to the court by Mr. Brown in 1982 and swept out in the Bird recall, said the appointments could very well alter the court. “Governor Brown is interested in very high quality, and I think he’s achieved that,” he said. “I have very high expectations and some degree of excitement over where the California Supreme Court may be headed.”

At the same time, Mr. Brown’s selections have ruffled some feathers in a state with an abundance of lawyers, law schools, and sitting judges looking to move up the ladder.

“This has been pointed out to me by a number of African-American lawyers, law school professors and judges in recent days, all of whom wonder why the governor had to go all the way to the East Coast to find a justice,” Willie Brown, a Democrat and former speaker for the State Assembly, wrote in a column for The San Francisco Chronicle. “Were there no qualified African-Americans in California?”

Erwin Chemerinsky, dean of the School of Law at the University of California, Irvine, called Ms. Kruger “a very unconventional choice — she’s never practiced in California. She’s a Washington lawyer. So why didn’t he pick someone from California?”

Still, he added, he was impressed with Mr. Brown’s ambitions. “The three nominees share certain characteristics: They are quite young, they have impeccable qualifications, and they are by all accounts brilliant,” he said.

Legal scholars said that aside from Mr. Brown’s effort to inject more intellectual heft to the court, they expected that these appointments would move the court to the left. All of Mr. Brown’s original choices from his first two terms were replaced with judges chosen by a conservative Republican governor, George Deukmejian. Mr. Brown has now replaced all of them with his own appointees.

Of the seven members now on the court, four were chosen by Republican governors, and three by Mr. Brown.

As for the Yale connection, the governor said that he would certainly consider graduates of other law schools for future nominations. But he added, “Yale is pretty good — it’s a small school, so it’s very selective.”

The court has long been known as influential. A study published in 2007 by the University of California, Davis, Law Review said that California Supreme Court was the most influential in the nation, based on the number of times that the court’s findings were cited by other courts going back for 65 years.

“Judges are inherently conservative, and one of the most frequent things we do is look to precedent: How do other courts talk about the issues?” Ms. Marshall said. "California is certainly one of the places to which I looked when I was at the court.”

Mr. Ettinger said that with these appointments, “the court is well poised to really make a mark.”

“And I think that is what Governor Brown is looking for: leaving a legacy that will restore the luster of the Supreme Court he knew when he clerked for the court.”
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Crafty_Dog
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« Reply #454 on: January 02, 2015, 07:23:52 AM »

http://www.capoliticalreview.com/capoliticalnewsandviews/stunning-data-on-average-compensation-for-municipal-employees-in-california-120000-a-year/
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Crafty_Dog
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« Reply #455 on: January 07, 2015, 09:51:28 AM »

http://www.capoliticalreview.com/capoliticalnewsandviews/sacramento-forces-elderlysick-into-confusing-health-care-program-with-little-service/
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Crafty_Dog
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« Reply #456 on: January 11, 2015, 03:59:09 AM »

https://www.youtube.com/watch?v=EHJpNhGUP5Q#t=89
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Crafty_Dog
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« Reply #457 on: January 12, 2015, 05:19:17 PM »

Be sure to check Steve Frank's California News & Views throughout the day for breaking news and commentary!
Visit http://www.capoliticalreview.com/capoliticalnewsandviews/
 
Please follow on Twitter  @capoliticalnews

Please forward to your friends: FORWARD


Can An Independent Win Boxer’s Seat? Yes, But Republican or Democrat Won’t
By Stephen Frank on Jan 11, 2015 06:02 pm
Thanks to Prop. 14, neither the Republican, nor Democrat party, or any Third Party be allowed to nominate a candidate to replace Barbara Boxer in the U.S. Senate. Under the terms of Prop.14, ALL candidates are Independent, though they are allowed to express a “preference” for a political party, which does not mean they are […]

Read More and Comment: Can An Independent Win Boxer’s Seat? Yes, But Republican or Democrat Won’t

 
Rider: In California ALL Your Insurance Policies Premiums are Taxed—Did You Know?
By Stephen Frank on Jan 11, 2015 05:59 pm
There are so many taxes, direct and indirect, that it is impossible to keep up with them. Years ago an economist found that more than 50% of the cost of a loaf of bread was taxes. Now, even I am shocked. Did you know that you pay tax on your premium when you buy insurance […]

Read More and Comment: Rider: In California ALL Your Insurance Policies Premiums are Taxed—Did You Know?

 
Employment Is Up. Paychecks, Not So Much
By Stephen Frank on Jan 11, 2015 05:56 pm
The legacy media and the Democrats are crowing about the jobs number—it is now “down to 5.6%. What they are not telling is that 70% or more of the jobs created under Obama are part time/low pay jobs. And, it can be proved that they are not full time jobs—as the unemployment rate goes down […]

Read More and Comment: Employment Is Up. Paychecks, Not So Much

 
California Environmental Protection Act Does NOT Cover Local Stores Dispensing Marijuana
By Stephen Frank on Jan 11, 2015 05:52 pm
When the Left doesn’t like something they try every possible technicality to kill a project, either through use of regulations or lawsuits. In both cases they want to make sure they financially break those they do not like. Years ago, Californians voted for medicinal marijuana. I voted against it, but it is the law. Now […]

Read More and Comment: California Environmental Protection Act Does NOT Cover Local Stores Dispensing Marijuana

 
As Expected: Brown Spends NO $$ From $7.5 Billion Water Bond on Dams
By Stephen Frank on Jan 11, 2015 05:49 pm
Brown lied and California jobs and farms died. The California Political News and Views told its’ readers during the recent election campaign that our confused Guv Brown was LYING about using part of the $7.5 billion water bond would be used for water storage. We said the money was really a payoff for special interests […]

Read More and Comment: As Expected: Brown Spends NO $$ From $7.5 Billion Water Bond on Dams

 
Government Take Over of Utilities Begin—Putin/Castro laughing
By Stephen Frank on Jan 11, 2015 05:42 pm
Who says California not a Socialist State, as much as Cuba or Russia? Putin and Castro have to be laughing at us. Thanks to government regulations, several cities are going to force PG&E to sell it poles and equipment to a government agency—at a price the agency is willing to pay. If they cannot agree, […]

Read More and Comment: Government Take Over of Utilities Begin—Putin/Castro laughing

 
Farmworkers and the New Civil Rights Struggle – Decertification of Bad Unions
By Stephen Frank on Jan 11, 2015 05:39 pm
Unions have become the enemy of workers, black, white, Hispanic and Asian. Hispanic workers in the Central Valley are being harassed for money by a union that has not spoken with them for twenty tears—and they want back “dues” (bribes is the correct term). An election was held, to see if the workers wanted the […]

Read More and Comment: Farmworkers and the New Civil Rights Struggle – Decertification of Bad Unions

 
States Urge SCOTUS to Strike Down S.F. Gun Law
By Stephen Frank on Jan 11, 2015 05:37 pm
Over the past few days, four people were killed in the Bay Area. Yet, they are proud of laws that allow criminals (by definition criminals do not abide by laws) to have guns and make honest citizens defenseless. In this case San Fran wants those that invade homes to be safe from homeowners that have […]

Read More and Comment: States Urge SCOTUS to Strike Down S.F. Gun Law

 
Illegal Alien Activists in California One Step Away from French Newspaper Terrorists
By Stephen Frank on Jan 11, 2015 05:33 pm
In Paris, terrorists shot up a magazine because they did not like a cartoon. In Santa Barbara, terrorists have begun the process of destroying a newspaper—for the crime of using proper language in a headline. They do not like “illegal aliens” (people that come into this nation, knowingly) being called illegal aliens. They are NOT […]

Read More and Comment: Illegal Alien Activists in California One Step Away from French Newspaper Terrorists

 
NSF Funds $18,952 Dissertation on Mating Habits of Syrian Hamsters
By Stephen Frank on Jan 11, 2015 05:30 pm
Did you know that there are Syrian hamsters? I wonder if there are Turkish hamsters, Israeli or Chinese hamsters? I did not know and really do not care. But Obama and the Federal government do care. While Obama allows the Syrian government to kill hundreds of thousands of Syrians, while Syria is the home base […]

Read More and Comment: NSF Funds $18,952 Dissertation on Mating Habits of Syrian Hamsters

 



 
In Case You Missed It:
California flush with cash—and massive debts and liabilities not spoken about
2016 California Senate Race MIGHT NOT Have GOP on November Ballot
California Medi-Cal Doctors Reimbursement CUT 60%–How Many Will Continue Losing Money
Union Leader: Beating Up Recalcitrant Union Members Part of Job
Brown: No State Funding Increase If UC Raises Tuition



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Crafty_Dog
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« Reply #458 on: January 17, 2015, 04:58:16 PM »

http://www.capoliticalreview.com/capoliticalnewsandviews/
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Crafty_Dog
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« Reply #459 on: January 19, 2015, 10:58:43 AM »

http://www.capoliticalreview.com/capoliticalnewsandviews/
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Crafty_Dog
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« Reply #460 on: February 09, 2015, 03:11:00 PM »

Calpers Gets Schooled
A judge says public pensions can be impaired as part of bankruptcy.
Feb. 8, 2015 6:43 p.m. ET
51 COMMENTS

Federal judges tend to be impatient with bullies. Behold judge Christopher Klein ’s opinion last week confirming the city of Stockton’s bankruptcy exit plan, which is as incisive in its rebuke of the California Public Employees’ Retirement System (Calpers) as it is instructive about U.S. bankruptcy law.
Stockton, California's City Hall ENLARGE
Stockton, California's City Hall Photo: Reuters

Stockton declared Chapter 9 bankruptcy in 2012, and it has since rewritten labor contracts and asked creditors for writedowns. Yet after being browbeaten by Calpers, the giant public-pension fund, the city held pensions harmless. Calpers argued that the California constitution’s guarantee of contracts shielded pensions from cuts in bankruptcy. The fund also asserted sovereign immunity and police powers as an “arm of the state,” including a lien on municipal assets.

Judge Klein upheld Stockton’s bankruptcy plan but not before effectively throwing Calpers out of court. “It is doubtful that CalPERS even has standing,” he writes. “It does not bear financial risk from reductions by the City in its funding payments because state law requires CalPERS to pass along the reductions to pensioners in the form of reduced pensions.”

As the judge explains, “CalPERS has bullied its way about in this case with an iron fist.” Calpers’s arguments are “constitutionally infirm in the face of the exclusive power of Congress to enact uniform laws on the subject of bankruptcy under Article I, Section 8, of the U.S. Constitution—the essence of which laws is the impairment of contracts—and of the Supremacy Clause.”

The Supremacy Clause holds federal law superior to state statutes as long as the feds don’t violate state powers under the Constitution. The judge notes that states act merely as “gatekeepers” to Chapter 9 bankruptcy. Once states authorize municipalities to file for bankruptcy, they hand over custody to federal courts. Thus, as “a matter of law, the City’s pension administration contract with CalPERS, as well as the City-sponsored pensions themselves, may be adjusted as part of a chapter 9 plan.”

What all this means is that Calpers can’t stop cities from modifying pensions in bankruptcy. This has ramifications across the U.S. because unions are trying to make public pension benefits inviolable as a matter of constitutional law. If that view prevails, then politicians can make irresponsible deals to get elected that no future politicians can rescind even if they become unaffordable. Illinois is currently ground zero in this showdown.

Judge Klein also noted that California’s Supreme Court has recognized an “unusually inflexible ‘vested right’ in public employee pension benefits” that stands in contrast to the U.S. Supreme Court’s “less rigid view of the extent of a ‘vested right’ in retiree benefits,” as delivered in last month’s M&G Polymers v. Tackett ruling. Judge Klein adds that California courts’ interpretation of vested rights “encourages dysfunctional strategies to circumvent limitation and peculiarities in California public finance.”

You can say that again. The judge seems to be inviting a legal challenge to California’s vested-rights doctrine, and someone should take him up on it. Meantime, Calpers would do better by raising its investment returns rather than going to court to raid taxpayers.
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Crafty_Dog
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« Reply #461 on: February 16, 2015, 05:42:38 PM »

http://www.capoliticalreview.com/capoliticalnewsandviews/
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« Reply #462 on: February 18, 2015, 10:53:38 AM »

http://www.foxnews.com/politics/2015/02/17/gun-rights-groups-await-judge-ruling-on-california-microstamping-law/
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« Reply #463 on: February 21, 2015, 10:23:52 AM »

One-Third of Californians Provided FREE Health Care—How Long Can We Afford This?
February 20, 2015 By Stephen Frank Leave a Comment
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    If Obama has his way, his amnesty would add one million illegal aliens to the role of Medi-Cal in California. In the past 120 days, Covered California has brought 750,000 people “free health care cards”. It should be noted that these folks have No doctors or hospitals that were created to treat them—they got cards, nothing else.

    Can the people of California afford the new freebies? Who pays? How many will die for lack of health care—and then the families sue for fraud? California is digging its Depression deeper in the economic landfill.

    ““It’s been relieving to have Medi-Cal and know that if something happened — I needed an ambulance or there was an emergency — I wouldn’t have to worry about being in debt thousands of dollars,” she said.

    Hopkins says before she would not have gone to the doctor. “It’s nice to have this option, although it’s been taking a long time to be able to get an appointment.”

    Hopkins says she had to wait five weeks for her first doctor’s visit.”

    Wait till next year when many fewer doctors will participate, while millions more are card holders.

    NHS-nurse-hospital_2519626b

 

More Pressure on Providers in Face of Medi-Cal Expansion

KQED, 2/19/15

Medi-Cal — the public health insurance program for low-income Californians — is growing faster under federal health care reform than the state expected. Twelve million residents — nearly a third of the state’s population — now rely on Medi-Cal, and that’s increased pressure to find more doctors willing and able to treat patients for what has historically been low reimbursement rates.

At the LifeLong Clinic in West Berkeley most of the patients waiting to see a doctor are on Medi-Cal. Among them, 26-year-old Amanda Hopkins, says she enrolled half a year ago when the state expanded the benefits program.

“It’s been relieving to have Medi-Cal and know that if something happened — I needed an ambulance or there was an emergency — I wouldn’t have to worry about being in debt thousands of dollars,” she said.

Hopkins says before she would not have gone to the doctor. “It’s nice to have this option, although it’s been taking a long time to be able to get an appointment.”

Hopkins says she had to wait five weeks for her first doctor’s visit.

Clinic medical director Dr. Davi Pakter says the long wait is one side effect of adding nearly three million people to Medi-Cal since January, 2014. At his clinic, the patients with the greatest need are seen first.

“We try very hard to arrange our schedules so that we can accommodate folks that are in urgent need,” he said, “and try to avoid sending folks to the emergency room — which is a much higher cost and usually not in the best interest of the patient.”

Pakter says that means people who need a check-up or treatment for a less urgent condition can end up waiting one to two months.

A lot of Medi-Cal patients are turning to federally subsidized clinics like LifeLong because private practice doctors won’t accept Medi-Cal insurance.

“They’re not able to afford it,” says Dr. Del Morris, the president of the California Academy of Family Physicians. Morris says the state’s notoriously low reimbursement rate — one of the lowest in the nation — won’t cover the cost of caring for Medi-Cal patients.

“These patients, because of their social circumstance have a higher acuity level than an average patient of the same age,” he says. “These are complicated patients with complex problems and take up a lot of a physician’s time. To be taking on patients like this and lose money in the process is just not something most private practices are willing to do.”

Morris who’s also the medical director of the Stanislaus County Health Services Agency — says Medi-Cal patients are often forced to get care at emergency rooms.

Morris expects the situation to worsen, unless state lawmakers take action.

A provision of the Affordable Care Act that temporarily boosted Medi-Cal reimbursement rates expired on December 31. Also, state lawmakers passed a ten percent cut to California’s reimbursement rates during the depths of the state’s recession took effect last month for primary care doctors.

State lawmakers Sen. Ed Hernandez (D-La Puente) and Asm. Rob Bonta (D-Alameda) introduced a bill this week that would restore the higher reimbursement rates. But even if it passes, they’ll have to persuade Gov. Jerry Brown to sign it.

H.D. Palmer with the state’s finance department says the governor’s not budgeting for higher provider rates because California faces numerous fiscal uncertainties.

“So we have to be very careful and prudent about adopting any new major spending commitments or dealing with some of the difficult but necessary reductions that had to be made in recent years,” he said.

California’s spending on Medi-Cal will jump by $1.7 billion in a just a few years. Right now and through 2016, the federal government pays 100 percent of the cost of covering people who are eligible under the Medicaid expansion. From 2016 to 2020, the contribution will gradually decline to 90 percent, meaning California must pick up the rest.
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