I.R.S.

 
 

Is Obamacare Going to Be Assisting In This Atrocity To Americans


 

How to Stop Hospitals From Killing Us

The Wall Street Journal
By Marty Makary | The Wall Street Journal
Fri, Sep 21, 2012

When there is a plane crash in the U.S., even a minor one, it makes headlines. There is a thorough federal investigation, and the tragedy often yields important lessons for the aviation industry. Pilots and airlines thus learn how to do their jobs more safely.

The world of American medicine is far deadlier: Medical mistakes kill enough people each week to fill four jumbo jets. But these mistakes go largely unnoticed by the world at large, and the medical community rarely learns from them. The same preventable mistakes are made over and over again, and patients are left in the dark about which hospitals have significantly better (or worse) safety records than their peers.

As doctors, we swear to do no harm. But on the job we soon absorb another unspoken rule: to overlook the mistakes of our colleagues. The problem is vast. U.S. surgeons operate on the wrong body part as often as 40 times a week. Roughly a quarter of all hospitalized patients will be harmed by a medical error of some kind. If medical errors were a disease, they would be the sixth leading cause of death in America—just behind accidents and ahead of Alzheimer’s. The human toll aside, medical errors cost the U.S. health-care system tens of billions a year. Some 20% to 30% of all medications, tests and procedures are unnecessary, according to research done by medical specialists, surveying their own fields. What other industry misses the mark this often?

It does not have to be this way. A new generation of doctors and patients is trying to achieve greater transparency in the health-care system, and new technology makes it more achievable than ever before.

I encountered the disturbing closed-door culture of American medicine on my very first day as a student at one of Harvard Medical School’s prestigious affiliated teaching hospitals. Wearing a new white medical coat that was still creased from its packaging, I walked the halls marveling at the portraits of doctors past and present. On rounds that day, members of my resident team repeatedly referred to one well-known surgeon as “Dr. Hodad.” I hadn’t heard of a surgeon by that name. Finally, I inquired. “Hodad,” it turned out, was a nickname. A fellow student whispered: “It stands for Hands of Death and Destruction.”

Stunned, I soon saw just how scary the works of his hands were. His operating skills were hasty and slipshod, and his patients frequently suffered complications. This was a man who simply should not have been allowed to touch patients. But his bedside manner was impeccable (in fact, I try to emulate it to this day). He was charming. Celebrities requested him for operations. His patients worshiped him. When faced with excessive surgery time and extended hospitalizations, they just chalked up their misfortunes to fate.

Dr. Hodad’s popularity was no aberration. As I rotated through other hospitals during my training, I learned that many hospitals have a “Dr. Hodad” somewhere on staff (sometimes more than one). In a business where reputation is everything, doctors who call out other doctors can be targeted. I’ve seen whistleblowing doctors suddenly assigned to more emergency calls, given fewer resources or simply badmouthed and discredited in retaliation. For me, I knew the ramifications if I sounded the alarm over Dr. Hodad: I’d be called into the hospital chairman’s office, a dread scenario if I ever wanted a job. So, as a rookie, I kept my mouth shut. Like the other trainees, I just told myself that my 120-hour weeks were about surviving to become a surgeon one day, not about fixing medicine’s culture.

Hospitals as a whole also tend to escape accountability, with excessive complication rates even at institutions that the public trusts as top-notch. Very few hospitals publish statistics on their performance, so how do patients pick one? As an informal exercise throughout my career, I’ve asked patients how they decided to come to the hospital where I was working (Georgetown, Johns Hopkins, D.C. General Hospital, Harvard and others). Among their answers: “Because you’re close to home”; “You guys treated my dad when he died”; “I figured it must be good because you have a helicopter.” You wouldn’t believe the number of patients who have told me that the deciding factor for them was parking.

There is no reason for patients to remain in the dark like this. Change can start with five relatively simple—but crucial—reforms.

Online Dashboards

Every hospital should have an online informational “dashboard” that includes its rates for infection, readmission (what we call “bounce back”), surgical complications and “never event” errors (mistakes that should never occur, like leaving a surgical sponge inside a patient). The dashboard should also list the hospital’s annual volume for each type of surgery that it performs (including the percentage done in a minimally invasive way) and patient satisfaction scores.

A survey of New Yorkers found that approximately 60% look up a restaurant’s “performance ratings” before going there. If you won’t sit down for a meal before checking Zagat’s or Yelp, why shouldn’t you be able to do the same thing when your life is at stake?

Nothing makes hospitals shape up more quickly than this kind of public reporting. In 1989, the first year that New York’s hospitals were required to report heart-surgery death rates, the death rate by hospital ranged from 1% to 18%—a huge gap. Consumers were finally armed with useful data. They could ask: “Why have a coronary artery bypass graft operation at a place where you have a 1-in-6 chance of dying compared with a hospital with a 1-in-100 chance of dying?”

Instantly, New York heart hospitals with high mortality rates scrambled to improve; death rates declined by 83% in six years. Management at these hospitals finally asked staff what they had to do to make care safer. At some hospitals, the surgeons said they needed anesthesiologists who specialized in heart surgery; at others, nurse practitioners were brought in. At one hospital, the staff reported that a particular surgeon simply wasn’t fit to be operating. His mortality rate was so high that it was skewing the hospital’s average. Administrators ordered him to stop doing heart surgery. Goodbye, Dr. Hodad.

Safety Culture Scores

Imagine that a surgeon is about to make an incision to remove fluid from a patient’s right lung. Suddenly, a nurse breaks the silence. “Wait. Are we doing the right or the left chest? Because it says here left, but that looks like the right side.” The surgery was, indeed, supposed to be on the left lung, but an intern had prepped the wrong side. I was that doctor, and that nurse saved us all from making a terrible error. It isn’t every hospital where that nurse would have felt confident speaking up—but it’s this sort of cultural factor that is so important to safety.

Pagination

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Categories: America, Democrats, Health, I.R.S., Money, Obama, People, Republicans, Taxes, White House | Tags: , , , , , , , , , | Leave a comment
 
 

More On Tax Dodgers Loopholes


Comment: Has any Average American done this lately? live by Loopholes.
08-16-2012

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Taxpayers Subsidize CEO Pay, Report Says
By Susanna Kim | ABC News
08-15-2012

The Institute for Policy Studies, a self-described “progressive multi-issue think tank,” analyzed the link between tax loopholes and excessive executive compensation and concluded that the loopholes created an “uneven playing field” between large companies and small businesses and led to lost tax revenue.

The latest edition of the institute’s annual Executive Excess compensation study found that in 2011, 26 CEOs received more in compensation than their companies paid in taxes, and that the four major tax loopholes contributing to excessive executive pay cost taxpayers about $14.4 billion a year.

“The report is timely at a time when the tax debate is so intense in this country,” Sarah Anderson, the institute’s global economy project director and the report’s co-author, told ABC News. “Some leaders are saying we need to reduce the corporate tax burden even more while major companies are taking advantage of loopholes to lower their tax bill.”

The report critiqued the major tax loopholes, including the preferential treatment of “carried interest” income for hedge fund managers. “Carried interest” income can be taxed as capital gains – at 15 percent tops – instead of at 35 percent, the top income tax rate. The Congressional Budget Office‘s projected estimate for “carried interest” income – revenue from investment income or dividends – for 2012 to 2021 was $21.4 billion.

Companies can deduct executive pay as a business expense, just as they do inventory and appreciation. Because of a tax rule enacted in the early 1990s that limited the amount of cash that could be deducted to $1 million, corporations have increasingly paid executives in stock options. Corporations can exempt stock option compensation, and other performance-based pay, from taxation.

William McBride, chief economist with the Tax Foundation, a conservative-leaning nonpartisan think tank, said this makes sense, because stock options are speculative compensation.

“They’re worth nothing unless they’re in the money,” McBride told ABC News. “It wouldn’t be fair to tax someone for getting paid an option that doesn’t have any real value until it has been exercised.”

Steven Balsam, an accounting professor at the Fox School of Business at Temple University and who published a study earlier this week for the Economic Policy Institute, “Taxes and Executive Compensation,” said from a business viewpoint, “it’s an expense, just like any other person’s salary.”

Others defend performance-based compensation for high-performing executives who have overseen companies with increasing earnings and stock prices.

Balsam said it was unlikely that boards would limit executive pay even if their pay was not tax deductible.

Anderson, who co-wrote the report, said that company boards that might choose to forfeit the deduction and continue paying high compensation packages “are stacked with executives from other firms that have a vested interest in maintaining the status quo.

“However, we need to keep chipping away at the myth that massive payouts are necessary to attract talented managers,” she said. “Having a meaningful deductibility cap would send the right message, and at least taxpayers wouldn’t have to continue to subsidize excessive pay.”

The report points to the largest beneficiaries of the tax loopholes, saying they benefit the most from the unlimited tax deductibility of executive paybecause their compensation has the largest proportion of deductible, performanced-based pay.

Oracle’s Larry Ellison, the sixth richest person in the world with a net worth of $36 billion, according to Forbes, tops the list, and is followed by Discovery Communications’ David Zaslav; Viacom’s Philippe Dauman; Motorola Mobility Holdings’ Sanjay Jha; and CBS Corp.’s Leslie Moonves.

Neither Oracle, Discovery Communications, Viacom and Motorola Mobility Holdings returned calls requesting comment. A spokeswoman for CBS Corp. and a spokeswoman for Discovery declined to comment.

Categories: Abuse, America, Corruption, Democrats, GREED, I.R.S., Money, Politics, Republicans, Rich, Taxes, White House | Tags: , , , , , , , | Leave a comment

More to Blame on the Government, Especially the Democrets


Comment On Ignorance and Stupidity the Government way
08-08-2012

Here we go again, a Government that spent money on Tax refunds and said that they should have done some thing about it when they saw it, but this is the problem with the Government today, a do nothing but complain about needing more taxes and spending money they do not have, but it seems to be the Democrats again saying why not, that is spreading around the wealth, that seems to be their thing.

This is Americans new symbol to put on the Flag for all  Government Agencies, Untrustworthy, and can not believe one word they say, because it seems that they do not believe in the Constitution or the flag, but what is the differences, they have always been that way, they lie, and use dirty politics until they get the people to believing it, that is not hard for some, they will believe any thing, and this Election is no different.

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Florida home files 741 tax returns in single year, gets more than $1M in refunds

By Eric Pfeiffer, Yahoo! News | The Sideshow
08-07-2012 Continue reading

Categories: America, Democrats, Financial Crisis, Governments, I.R.S., Money, People, Taxes, White House | Tags: , , , , , , , | Leave a comment

What has Axelrod got to Hide, or Any Politician have to Hide


Comment By Every one has some thing to HIDE
07-05-2012

Comment By Devin Dwyer: [“As job growth slows, manufacturing activity stalls, and our economy continues to sputter, President Obama knows he can’t make a legitimate argument for another term in office, so instead he is trying to tear down his opponent,” she said. “This is just the latest example of President Obama and his political machine saying or doing anything to distract from his abysmal record over the last four years.”] End Continue reading

Categories: Abuse, America, Corruption, Democrats, Freedom Lost, GREED, I.R.S., People, Profiling, Taxes, White House | Tags: , , , , , , | Leave a comment

‘Truth, justice, and the American Governments GREED For MONEY


Tax time pushes some Americans to take a hike

Reuters
By Atossa Araxia Abrahamian | Reuters
Mon, Apr 16, 2012

A year ago, in Action Comics, Superman declared plans to renounce his U.S. citizenship.

[Genette Eysselinck renounced her U.S. citizenship to become Belgian. (Credit: Reuters/Pascal Parrot)]

“‘Truth, justice, and the American way’ – it’s not enough anymore,” the comic book superhero said, after both the Iranian and American governments criticized him for joining a peaceful anti-government protest in Tehran. Continue reading

Categories: Abuse, America, Democrats, Governments, GREED, I.R.S., Money, Obama, People, Politics, Taxes, White House | Tags: , , , , , , , , , | 2 Comments

Congress’ Delay May Delay Your Tax Refund


Lets take a Moment for A Prayer for our Military And for a Safe Return Home, and A Prayer for the Families who lost loved ones!!!!!

Seasons Greetings and Happy Holidays To All!!!!

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Kiplinger'sPersonalFinance

By Kevin McCormally
Thursday, December 23, 2010

If you itemize deductions, that refund check may come later this spring.

In a lump-of-coal announcement on the eve of Christmas Eve, the IRS announced that, due to last-minute maneuvering on Capitol Hill, the agency won’t Continue reading

Categories: America, Democrats, I.R.S., Money, People, Politics, Republicans, Taxes | Tags: , , , | Leave a comment

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