Job killers/Two-tiered America

pms laflame at mindspring.com
Mon Oct 15 21:42:55 PDT 2001


Prior to the implementation of the new system, callers used a touch-tone system for train status information. With this system, 75 percent of callers exited the automated system in favor of an agent. As a result, in order to better meet the needs of their guests, Amtrak worked with SpeechWorks to ensure that the speech system was designed to sound and respond like an agent. With an informal, comfortable voice that is helpful and works with callers, the system provides automation with a human and friendly touch. With simple requests being handled by the new system, agents now have more time to handle complex inquiries, and fewer, if any, callers need to wait on hold.

http://biz.yahoo.com/bw/011015/151094_1.html ********************* But employees at small businesses are suffering more. Steve Youtsey and his wife, Elaine, the sole employees of New Mexico Surveying outside Albuquerque, are facing a doubling of their monthly premium, to $794 from $396, for insurance they buy through a coalition of small businesses. Part of the increase was based on their age - in their early 50's. And Ms. Youtsey has medical problems that would not be covered if the couple transferred to another insurer, so they could not shop around for lower rates, Mr. Youtsey said. "We were just stuck."

In Pueblo County, Colo., where hospital charges have soared, insurance premiums are doubling for many state employees. David Scott Sandoval, a technician in the accounting department at the University of Southern Colorado, said his monthly premium would rise to $549 from $258 in December to cover him, his wife and two children.

"People are going to have to leave their jobs and go bankrupt," he said. "They are going to be putting people in the streets."

http://www.nytimes.com/2001/10/16/business/16HEAL.html

Paul B. Ginsburg, president of Health System Change, a nonpartisan research group in Washington, said premiums were going up faster than the insurance companies' costs. He said the insurers were still playing catchup after four lean years from 1996 to 1999 when premiums did not cover costs.

[So they operated below cost while they drove out the non-profits and otherwise became firmly entrenched. I can't get perscriptions at CVS anymore. Apparently Humana considers their customers traffic to be of value so they expect the drugstores to provide scripts below cost and CVS wouldn't go along . I imagine the process will become centralized in some way. And employ fewer people.] ************* Published on Saturday, August 25, 2001 by the Associated Press

Going Backwards

Doctors Serve Wealthy for a Price

by Allison Linn

SEATTLE –– If David Heerensperger isn't feeling well, he calls Dr.

Howard Maron on the physician's personal cell phone, whether it's 3

a.m. on a weekday or noon on a weekend.

And Maron will happily make a house call to the 65-year-old

executive or send a nurse to his patient's office for tests. And

he'll guarantee same-day results.

The catch? Maron and his partner, Dr. I. Scott Hall, charge patients

up to $20,000 a year in cash for primary care.

Maron compares his Seattle practice to private golf courses or

expensive restaurants.

Dr.Howard Maron, poses for a portrait,Wednesday, Aug. 15,

2001, in Seattle, with his partner Dr. I. Scott Hall in the

background. Maron and his Hall charge patients up to $20,000 a

year in cash for the privilege of opting out of the

overcrowded health-care system. Maron compares his practice to

private golf courses or expensive restaurants; perks, he says,

that come with being wealthy. (AP Photo/Frank Franklin II)

It's a growing trend. Five years after opening his practice MD2

(pronounced MD-squared) in Seattle, Maron is planning to open as

many as 100 franchises across the country. An increasing number of

doctors nationwide are beginning to charge anywhere from $1,500 to

$20,000 to let richer patients opt out of traditional health-care

headaches.

Patients say they are spared the frustration of long waits for

appointments, rushed, impersonal treatment and delayed lab results.

With traditional health care, Heerensperger says, "the prices are

going up so much and the service is so bad, that this is just

great."

"I'm fortunate to be able to pay for it," said Heerensperger, who

runs a chain of lighting stores.

Doctors say it gives them more free time, and lets them spend more

time with patients without budget-conscious insurance companies

looking over their shoulders.

Maron said he got the idea while traveling as the team doctor for

the Seattle SuperSonics. He noticed the athletes got VIP care while

the rich team owners struggled with the frustrations of traditional

health care.

"I thought, 'Isn't it ironic that a player can get a response like

that, while the wealthy and the powerful have to sit in ER waiting

rooms as if they are a nobody – or an everybody?'" Maron says.

Other medical professionals sympathize with the frustrations of the

current health-care system. Lowered insurance reimbursements mean

that many doctors' salaries are decreasing as their patient loads

are increasing.

But they question whether most physicians would be comfortable

practicing "concierge care."

"I don't think they're unethical, but I don't think they take into

account the overall needs of the community," said Frank Riddick, a

New Orleans physician and chairman of the American Medical

Association's council on ethical and judicial affairs.

Critics, including patients dropped by doctors who switched to the

new system, complain that such services hurt those who can't afford

it. In Florida, some politicians have called for an end to such

practices.

Duane Dobrowits, the CEO of MD2, is a former patient of Maron's who

couldn't afford to switch to the $20,000-a-year model. He asks of

critics, "Are you angry because doctors are doing this or are you

angry because you can't have this?"

Maron says he's never run a charitable practice.

"None of these doctors is Mother Theresa," he said. "We're not

saints. We're just practicing medicine."

At his peak, Maron says he was seeing 20 to 30 patients a day from a

roster of 4,000. Now he has fewer than 100 patients and he may see

one or two a day. In addition, his salary has increased

considerably.

"It's allowed me to focus on being a doctor again," says Robert

Colton, who left his private practice in Boca Raton, Fla., last year

to start MDVIP, which charges $1,500 a year above regular insurance

and per-visit fees to keep his patient load down to 600.

"I can spend more time with patients," Colton said. "I can see them

whenever they're ill."

MD2 has only primary care physicians, whom patients can see an

unlimited number of times after paying their annual fee. Specialists

must be paid by the client's personal insurance, but Maron said they

often give MD2 clients preferential treatment.

"It's a point of pride because our patients are a lot of the movers

and shakers in the city," said Maron, who accompanies his patients

when they visit specialists.

William Dowling, chairman of the department of health services at

the University of Washington's School of Public Health, says such

practices are a natural product of the U.S. health-care system.

"Some people can afford to pay more to get prompt service, and so

the marketplace will respond by some physicians providing that

service," Dowling said.

Said Colton, who is looking at opening other MDVIP

(http://www.mdvip.com) branches across the country: "That's what's

great about America, that you have choice, that you don't have

socialized medicine here."

Riddick says very few people can afford to pay for such services,

and there will always be new doctors willing to take on patients

dropped by physicians switching to pricey practices.

Meanwhile, MD2, which opened a second office in Bellevue, is

considering doctors in Portland, Ore., Chicago and Denver. Dobrowits

says he's convinced the model will thrive, even despite the weakened

economy.

"We don't need tons of millionaires," he quips. "We just need enough

millionaires to run our business."

© Copyright 2001 The Associated Press



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