Tuesday, April 29, 2014

Don't Overreact They Say

Here are some of my favorite comments regarding Cliven Bundy, the Nevada rancher who is fighting the federal government over land use.  Bundy said some pretty racist things.

 His statement is NOT racist. He is explaining how government dependency has destroyed the family compared to even when they were picking cotton. Listen and stop allowing government and media to feed you what to think. No racism in this video. Wake up. Think for yourself. Stop screaming and seeing racism in everything. This administration is dividing us all.
you all should see the video before passing judgement...... ............ i did and it did not seem like he was saying racist comments. Even tho the media has said so.........
 There is no media any more. They're just mouth pieces for political agendas. Pull the race card... try to discredit the man. That's from the first page of the playbook.
When all else fails for the gov, pull out the race card. Most of y'all would be lying if you said you've never at some point criticized people of different race
 The government will do and say anything to have their way. If it takes convincing the country that this man is racist, then that is what they will do. Try to see beyond all the lights and curtains.
Alot of people have pulled out the race card once in a while. You'd be lying to yourself if you believe this wonderful little world of yours is free of racism. Get over it.
 I still support his efforts against our federal government. Obama and Holder are bigots and no one says shit about it.

Not a good showing from several LMT readers.  Of course, they'll say that people like me are overreacting, or sensitive participants in a politically correct world.  They'll do everything to try to detract attention from the fact that Mr. Bundy thinks that the "Negro" is better off being a slave.  I'm the one being divisive, it would be assumed by my would be detractors, and not the Archie Bunker wannabe who is griping over land use fees in Nevada.  

I especially like the comment about Cliven Bundy not being racist because one of his bodyguards is black.  It's like the person close to me that claimed 'Donald Sterling is not racist because he's dating a black woman, case closed.'  

I guess I can agree that Bundy and Sterling are not racists; they just say racist things.  And locals don't see the problem in that.  

Wednesday, April 23, 2014

Big Bucks Medicine

Dr. Luis Benavides takes issue with the Times' story concerning medical reimbursement.  He wrote in to the Op/Ed page today.
Your timing of the sensationalist report about physician earnings on Easter morning is only matched by the lack of comprehensive reporting.There is significantly more data that could help the taxpayers understand.
Start with the fact that the numbers represent gross payment, not “take home” pay.Even the most efficient office has a 50-60% overhead expense. Most of that expense is for employee salaries and benefits.If you take into account all the money the Laredo Doctors are re-investing in our community in staff salaries, the public would understand better.Some of us have invested in technologies that assist our patients and save them and their pay or source (Medicare, etc.) a significant amount of money.
Another issue not discussed is the fact that we are in a healthcare shortage area.This skews the numbers because of the many patients we see, not to make more money but to care for a population with complex problems.
Not taken into account is the amount of training we have gone through, the mountains of paperwork we do and the time we sacrifice from our families to be with our patients, including holidays and weekends.Your front page target was Dr. Ricardo Cigarroa, a well respected hard working physician who chose to return to his hometown and invest a large amount of money in a state of the art medical facility that cares for his cardiology patients.
In my 10 employee office, I spent over $350,000 on salaries and benefits.He has employees with certain expertise.That does not include the overhead for his office, the equipment, insurance and all the other expenses every businessman has to pay.He is at the hospital frequently (I sometimes make rounds in the morning and see him there; I sometimes make rounds in the evening and see him there).
Also he responds to my calls when I have an emergency and promptly sees my patient (as do almost all physicians). One can appreciate the amount of time he devotes to his patients.Another mention was of Dr. Benson Huang, also a hard working, well respected physician, who works tirelessly with critical patients and at times not even appreciated by the health care institution he does it for.
Dr. Eduardo Miranda, previously maligned by your newspaper, provides oncology services and has large overhead to provide appropriate medications for his patients.He has never refused to see my patients regardless of ability to pay.
And when he used a very useful medication and by simple human error ordered it from the wrong place, a location within the U.S., he is placed under scrutiny and made to look like a criminal.I ask anyone who read this article to keep an open mind, read between the lines and look for “the rest of the story.”
Sincerely,Luis M. Benavides, M.D. F.A.A.F.P. PresidentWebb-Zapata-Jim Hogg County Medical Society
My initial take on the news that Dr. Ricardo Cigarroa took in $3.5 million in 2012 was that that is a lot of money; and that just accounts for what he billed Medicare for.  Add to the 3.5 the payments made to him from private insurance plans.  I also took into consideration the fact that he practices a specialty in medicine, (invasive) cardiology.  A lucrative field to immerse oneself in, especially in our culture.  

I agree with Dr. Benavides' assessment, that doctors sacrifice a lot to care for their patients.  I can especially vouch for Dr. Cigarroa as being a workhorse in and around Webb County.  He puts in the long hours, partly because that's what his job demands, and because that's what he has put on himself.  He has a drive and ambition that few could match.  But prestige also plays a big part.  In his office lobby you'll find a picture of Dr. Cigarroa posing with then-Governor George W. Bush.  The elite hobnobbing with the elite.  Hell, the name of his practice alone, the Cigarroa Heart and Vascular Institute, commands compensation in the millions of dollars.  

Many years ago Dr. Roberto Cantu, an orthopedic surgeon, commented to a young man that the manipulation of bones was an easy task; the point was knowing when and how to utilize the expertise competently.  (Paraphrasing)  He was referring to the significance of his years of training and experience.  Doctors go through extensive training, and with that, rack up a lot of debt as they learn their craft.  And their practices are businesses.  Like Dr. Benavides said, they have to worry about their overhead.  But I have to wonder sometimes if medical charges aren't set arbitrarily.  

Does setting a wrist bone from an uncomplicated fracture really cost $4,000.00?  Is that reasonable for the 20 minutes it takes to accomplish the procedure?  Is it considered surgery when an opthalmologist swabs your eye with a Q-tip to remove a small piece of debris?       

The point of the Medicare numbers being made public (and the LMT story) was to offer a hint of transparency to consumers.  Dr. Benavides does well in trying to add some perspective to the story, but it's not like Dr. Cigarroa, Mr. Highroller (that's his name from now on), didn't have a chance to explain himself.  The cost of doing business is an issue worthy of discussion.  One article won't paint the full picture.  But I think we can give LMT readers more credit and think they can process a story critically and fairly.  Oh fuck, what am I thinking?  I've seen the public comments on LMT social media feeds.  Nevermind.

Related stories that shed light on billing practices are how different hospitals charge different fees for the same diagnosis.  And a recent story in the Texas Tribune speaks of one Laredo doctor who bills the patient directly to avoid the red tape.       

Thursday, April 17, 2014

Proposed Tire Ordinance

Kudos to any person who addresses Laredo's problem with dumped tires.  We see them all over the place:  discarded on curbs, on abandoned locales, and even piling up on private property.  At the very minimum they are a blight on the landscape; but they have the potential to become a health hazard given the right conditions.  Naturally the city wants to act. Their efforts, however, seem a little naive.



The proposal is to charge people money when they take their old tires home. Nationally known auto shops provide disposal services and impose a fee.  At the Sears Automotive department, I was charged a $3.50 disposal fee per tire recently.  I could've saved seven dollars if I hauled them off myself and later dumped them at the city landfill for free, but that would've cost me time and gas money.

At locally-owned tire shops (vulcanizadoras), attendants have typically handed over responsibility of the old tires to the customer.  The less clutter they can amass at their shops, the better.  (I haven't frequented all tire shops in town so I can't speak to their practices as a whole)  With the new ordinance, if it takes effect, those shop owners would charge a fee on top of their regular cost.  This makes no sense to me, because, first of all, the business of buying tires is between the client and the salesman, and both are looking for the most beneficial outcome -- the business owner is not going to risk losing his clientele by adding a cost to his customers, and the patron does not want to lose the option of saving a little money.

And then comes the issue of enforcement.  Perhaps it's not impossible to check up on tire retailers to see if they're following the ordinance, but I would assume they'd have a lot of room to sidestep the rule.

The proposed ordinance could make a dent in the tire trash problem.  We could measure its effectiveness over time.  I just don't see it working from where I'm sitting now.  Ya veremos.