It shouldn’t be, but it seems that geography is one of the variables that effect how much you will pay for your hospital stay. A procedure at a hospital in one state may be much more expensive than the same procedure in another state, or even within the same state.
California is a prime example of the effect geography has on determining hospital costs. Recent research shows that patients in Southern California pay markedly higher rates than do those in Northern California. According to the Los Angeles Times, 15 of the most expensive hospitals in California are in the Southern California area. These hospitals charge insurance carriers 5 times as much as do the least expensive hospitals. Depending on who is interpreting the results, this either speaks to the vibrancy of the Southern California market, or it shows how insurers using predatory practices have been more effective in leveraging the Southern California market.
I side with those who fault the insurers. Critics of the insurers point to the fact that in the Southern California market, 17 hospitals have closed in the last 10 years. Many more are in financial distress. While about 42% of hospitals in California are operating at a loss, 50% of Southern California hospitals are losing money.
As I wrote in an earlier post, hospitals in general are facing tough times. I believe that insurers are not making it any easier for them or for us.
People of my generation are familiar with the old Sears. It was a one-stop shopping retail store that in addition to providing a pleasant shopping experience was associated with quality, dependability and reliability – old fashioned traits.
The Sears of today is an example of what’s taking place in many of our cherished institutions. It was transformed into Sears Holdings by Edward S. Lampert, the billionaire hedge fund manager in 2005. Since that time, Mr. Lampert’s cost cutting methods have caused Sears stores to look shabby. In one example reported by the New York Times, a visitor to a Sears store found mismatched floor tiles in the lobby, old shelves and ragged carpet. They found a pail designed to catch the water that dripped from a broken pipe from the ceiling. The pail had been in place for two weeks. To make matters worse, prices are higher at Sears than at comparable, better managed stores. The explanation is that investors such as Mr. Lambert are exclusively interested in wringing every dollar from their investments even if it means hurting the institution and people’s lives.
This same phenomenon is occurring at nursing homes as investors have begun acquiring nursing homes as an investment. Unfortunately, unlike the Sears example, where people can choose to shop elsewhere (and they are), if investors take over too large of a share of the nursing home market, customers, who want adequate care, may not have many other options.
It offers rebates for all but the wealthiest individuals. This was the result of a compromise between Democrat and Republican lawmakers. Republicans wanted to limit rebate payments to taxpayers only with those earning more receiving the highest rebates. Republican recommendations were criticized both on fairness (since this is a government give away, it’s not fair to shut out the poor who needs it more?) and effectiveness (most economists believe the government will get more bang for its buck by getting most of the money into the hands of low income people).
It does not extend unemployment and food stamp benefits. Although economists know that these are more effective for stimulating the economy, the Democrats dropped their demand for this type of stimulus. In exchange for Democrats caving on food stamps and unemployment, Republicans dropped their demand that previous tax cuts enacted by Bush that benefited the wealthy be made permanent.
Nobel Prize economist Joseph Stiglitz wrote a great article in today’s New York Times. In it he offers solutions to our current economic crisis. He believes the best approach is one that includes both short term and long term solutions. He decries Bush’s tax cut solution to every problem. He believes that type of approach has served to perpetuate excessive consumption in American society. Despite marketers claim otherwise, excessive consumption is bad for the economy. The large tax cuts that have been enacted over the past years are linked to lower family income for middle and lower class Americans.
Like many other economists Stiglitz believes that in order to get more bang for the buck, income in the form of tax rebates and increased unemployment benefits should go to lower income individuals. He also believes money should go to local governments. According to him, in response to shrinking income, local government will automatically cut services and that acts as a destabilizer. He believes the feds should put money into building the physical and social infrastructure. Without a strong infrastructure, America cannot maintain its economic competitveness.
I agree wholeheartedly with Stiglitz. For too long, any economic problem has been greeted with the idea of tax cuts that in the long run benefited the rich at the expense of the middle and lower classes. One result of our leaders’ penchant for tax cuts has been the disinvestment in America. The result has been a gradual decaying of America’s physical and social infrastructure,. The recent booms have only served to camouflage the decay.
That’s what Republican lawmakers are proposing. The proposed tax rebate is to be between $800 and $1600. If Republicans have their way only those who paid taxes last year will receive it. That means that a family of 4 who earned $24,000 last year would not be eligible, or that a family that earned $40,000 last year would only be eligible for a partial refund.
Give me a break. If the government wants to give a handout (and that’s what it is), why should they only give it to high earners? In fact the proposal by Republican lawmakers has been critiqued based on fairness and effectiveness. Critics argue that it is the low income individuals, who are the ones most likely to need the extra cash.
Even if you’re not interested in fairness, the advantage in getting money into their hands is that you’ll get more bang for your bucks. The goal of the rebate is to stimulate the economy by getting extra money into people’s hands in the hope that they will spend it. Out of necessity, low income people are likely to spend the money quickly, while higher income individuals may choose to hold on to it or place it in investments.
I lived through the Reagan years and witnessed first hand the rise in poverty and homelessness. That’s why I’m always happy to read an economist who gives a dash of reality to that era. Paul Krugman in today’s New York Times did just that. According to him, during the Reagan era, although the rich got richer, there was little sustained overall economic growth. By the late 1980s middle class income had barely risen from what it was a decade before, and poverty in America was actually higher.
As for me, I witnessed a large numbers of people joining the ranks of the homeless. Whereas, before the homeless seemed limited to only a small number of mostly males, who were obviously mentally ill, suddenly I started to see large numbers of women and children living on the streets. It seemed a betrayal of everything I believed about my country, and it shook me to the core.
Despite the fact that three of the five major Wall Street investment firms posted quarterly losses as the result of the subprime mortgage fiasco, they paid their sales forces and middle managers over $65.5 billion in compensation and benefits. This was up about 8 percent from last year.
It goes to show you that although Wall Street played an active role in creating the mess, it was able to shift the costs to investors, many of whom were retirees and nonprofits. Retirement funds and other nonprofit investors expected their investments to be in relatively safe products, but were duped into buying securities that were backed by risky subprime mortgages that are now practically worthless. In the meantime the sales people who sold them this junk are laughing their way to the bank.
It seems Congress, the president and the federal reserve chairman all believe a tax rebate should be one of the measures used to help head off the recession that some economists believe we are already in. The rebate should be between $300 and $600, and should come quickly. The rebate is expected to be temporary, that is it should be a one time deal. Otherwise, it can create greater economic problems like adding to government deficits and other financial burdens.
The litany of reasons for the expected recession have to do with the easy credit that caused housing prices to rise to unsustainable levels. As a result of the bursting of the bubble, new home sales are down 24.8 percent, and home foreclosures are up. Credit has tightened, and the financial markets have been hit by a wave of debt it has been forced to write down.
- Even if you are reluctant to ask for a pay increase, you can ask for perks like a better title, flex-time, gadgets, or a bigger office if the company had a poor year.
- Expect a merit-based wage increase. Since pay is the primary way employers have for attracting and keeping good employees, companies rarely eliminate merit-based wage increases.
- The longer you work for a company the more money you should make. If you are not living up to the job requirements, it’s hard to make a case for an increase.
- You don’t have to be an outstanding employee to ask for an increase.
- Let your boss bring up specific amounts or percentages. If your boss intended to give you one amount and you suggest a lower, it’s hard to take back.
- Don’t make your case based on your living expenses. The raise is about your performance.
- Prepare yourself psychologically. You must have a clear sense that it is something you have earned, not what you deserve.
With the recession either already here, or predicted to come, experts recommend taking a conservative approach to finance. Below are investment strategies that can help you manage your investments in these economically shaky times.
- Rent don’t buy. Prices haven’t bottomed out nearly enough to make buying a good investment option. Even with tax benefits, because of mortgage and upkeep, it’s more expensive to rent.
- Invest in high dividend stocks. High dividend stocks pay like bonds. It’s best to invest in blue chip stocks, pharmaceuticals or utilities. Health care is also a good option.
- Invest in ETFs. ETFs are traded like stocks. They are a bundle of stocks that represent an index. ETFs typically try to duplicate a portfolio, or a market sector like energy or technology, or a commodity like gold or petroleum. But unlike Mutual Funds, with ETFs you don’t have to pay someone to pick for you. With Mutual Funds you may pay as much as 1.5% to have someone pick your stocks and the returns are no different from that obtained from ETFs.
- Invest in short-term CD’s offered by banks. They pay around 5% and there is no risk involved. Short term CD periods are typically 3 to 4 months in duration. The advantage of short term CDs is that if interest rates go up, you have the flexibility to take advantage of this change. CDs require a minimum investment of $5000 or $10,000.
- Invest in long-term CDs. Keep in mind it’s not a good idea for your CD investments to be for more than 5 years. One of the advantages of long-term CDs is that banks may pay you a higher interest rate.