It has been the most bizarre prolonged winter in 30 years, with the weather alternating starkly between bouts of clouds and driving rain followed by a spell of intense cold at night (50/10 which is cold for around here) and cold brightly sunny days with temperatures in the 65/17 range. The sunny days are intensely beautiful but...those blue skies come at a price.I cannot bring myself to wear long pants but I do bundle up in a woolly jacket with a woolly hat provided courtesy of the knitting needles of Cousin Lyn in Chicago. It strikes me as absurd that I am getting cold weather care packages from Illinois to get me through this endless Keys winter.
Ironies abound this winter all across the land with snow melting and bringing an early spring to Alaska, and the late unlamented Olympic Games in British Columbia being forced to truck snow to the circus. A peculiar extravagance that seems horribly at odds with our unemployment and lack of economic prospects south of the 49th parallel.
And yet in the Keys we see some effects from the chaos Up North, there are lots of homes for sale, many of them likely on offer owing to foreclosures but homes have been traded like baseball cards in the Keys for the last couple of decades. Streets everywhere have been littered with For Sale signs, only nowadays I tend to see more houses, particularly outside Key West itself, showing signs of neglect with weedy yards and streaking damp spots on the walls.
Yet the tourist flow is absolutely amazing. Highway One frequently appears to be one long line of cars, SUVs, pick up trucks and motorcycles all heading into and out of the Keys. Sitting at the end of our side street can be an exercise in Zen patience turning left to go to Key West. While these long droning lines of traffic traveling well below the speed limit would try the patience of a saint, they are a testament to the resilience of the Key West tourist market. Hotel room prices have dropped since the crazy prices of the boom years but visitors are coming and filling them. People are shopping and taking tours, and while there have been layoffs I'm told there is none of the devastation apparent in many communities elsewhere.
Florida's State budget is in better shape than the real estate market might indicate. This is a state that relies on property taxes and sales taxes to fund public services and while incomes have dropped the shortfalls so far seem manageable. naturally this is a Republican dominated state so the burden of meeting the budget requirements will be borne by the poor and there is no chance gaping holes in the sales tax structure will be plugged. Nevertheless Governor Charlie Crist, a moderate Republican had actually planned to increase the state budget this year relying on expansion of Indian gaming, a proposal that was shot down by the part time legislature.
These are subjects for me to ponder as I wander the mangrove stands on the southern end of Big Pine Key. It always surprises me when I find trash lurking in the bushes, tons of it, the sign of a throw way society. And around here on the shores of an island stuck out next to a major shipping channel trash comes from all over the world to wash up in the Keys. This bottle looked like it came from the Netherlands, so I suspect "bleek" is Dutch for bleach, but who knows? Perhaps the trash washed off one of those big Dutch flagged cruise ships whose names all end in "Dam." Which is how I feel when I see the plastic littering the mangroves.
And what this is doing lying here being useless I'm sure I couldn't say:
Monday, March 8, 2010
Beach Combing
Sunday, March 7, 2010
Change Is Good
http://conchscooterscommonsense.blogspot.com/
More Street Walking
This house fit into no single essay with it's classic Key West attributes of white paint, tin roof, contrasting shutters and shiny green palms. It seemed a pity to toss this picture out. On Margaret Street I think.A cyclist heading west from the cemetery with a huge hand warmer (or yoga mat more likely) on the handlebars. A day of 60/15 is cold in Key West, even in midwinter.
The always lovely Dade Pine valued for it's resistance to rot in the 19th century, so much so they cut it all down in Dade County and had to go to the Panhandle to find more. You'd be hard pressed to find a Miami home made of this stuff (not impossible- just very difficult). It's not uncommon in Key West though you will find occasional ill advised attempt to paint the stuff.
A valiant attempt at a cheap fix for an old timer. I sometimes tend to forget that old homes are a rarity in many places across the US, then I see tourists gawping and I reminded why these are here, because they were forgotten for a while, saved from destruction almost by accident and here they still are, still lived in and on display as it were by the side of the streets.
Did I mention how everyone is talking about how cold and prolonged this winter has been and still is. Check out this Pacific Northwest style of living, most unsuitable (normally) for the Southernmost City.Ooh look! A palm tree!
Saturday, March 6, 2010
A Comment on Health Care
I found the summit very useful, not just for exposing transparently obstructionist Republican tactics of the "let's just start over" (repeated ad nauseam) sort but also for laying out some honest-to-goodness policy differences. The mainstream media seemed to willfully ignore those, in favor flogging some personality driven sniping, of which there was actually comparatively little, the better to convey the meeting as some kind of demeaning, reality TV show.
Of the substantive differences, perhaps one of the most telling: Republicans object to the Obama plan in part on grounds of defending Medicare. When you hear a Republican defending Medicare, your bullshit antenna should go up, you should cover your nuts and grab your wallet (not necessarily in that order.) It became apparent that what they really meant is they want to protect Medicare C (aka "Medicare Advantage" plans.) I learned what these things are the hard way recently, by doing bureaucratic battle to get my geriatric father's Medicare advantage coverage accepted by a prominent national cancer center. In a nutshell, these things are private insurance market policies which "replace" the insured's Medicare, plus (in theory) provide a little additional coverage like preventative services, gym memberships, etc., of the sort which are extremely cheap and very infrequently used by senior citizens. For this, the private insurers can charge policy holders additional premium over and above what Medicare would charge, they also get paid an incentive from the government of about 15%, and are permitted to allow doctors and hospitals to whack insured's for an additional chunk of the total bill.
The kicker? Doctors and hospitals are free to accept or reject the coverage on a visit by visit basis. Meaning the policy holder cannot know in advance (as they can with other types of policies which have networks of hospitals and doctors)where they'll be eligible to be treated.
This is what Republicans mean by "market based solutions." The whole experiment has been an unmitigated disaster - - except for the agents and insurers who've reaped huge profits from a previously untapped market. And for Republicans who found a back door way to undercut Medicare, and provide themselves with another example of how "big government" programs don't work. Think Grover Norquist's wet dream of shrinking government down to the size where it can be drowned in the bathtub.
http://www.kunstler.com/blog/
Petronia On The Hill
Friday, March 5, 2010
Tort Reform
Texas Tort Reform is NOT a Model for Nationwide Health Care Reform
Mike Ferrara Attorney
September 07, 2009 8:24 PM
Tort reformers like to talk a lot about how the threat of malpractice suits raises health care costs by forcing doctors to practice “defensive medicine”—the ordering of unnecessary tests, procedures, and prescriptions in an attempt to protect themselves against a possible negligence lawsuit.
In a 2008 AMA survey, they remind us, a majority of the doctors who responded admitted to practicing defensive medicine—a number that translates, the AMA calculated, to $1.4 billion more spent annually on health care. If our doctors weren’t threatened into doing this, we’d all save loads of money and our national health crisis would be over.
Are the tort reformers right? Well, let’s look at Texas. Several years ago, the state passed a stringent medical malpractice law that capped awards for pain and suffering at $250,000, and brought the number of malpractice lawsuits down dramatically.
So the cost of health care in Texas must also be down, you suppose, since doctors don’t face the same malpractice threats as the rest of the country. Eh, No. In fact, Texas is home to three of the top ten most expensive cities in the country to receive health care: McAllen, Harlingen and Corpus Christi. In each of these cities, every Medicare patient is costing the country more than $10,000 a year (a couple thousand more than the national average).
So if defensive medicine against the threat of malpractice suits isn’t driving up costs, what is?
Harvard Medical School surgeon Atul Gawande got a candid answer to this question from a general surgeon in McAllen, Texas:
“Come on,” the general surgeon finally said. “We all know these arguments are [BS]. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.
The surgeon came to McAllen in the mid-nineties, and since then, he said, “the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about ‘How much will you benefit?’ ” –Atul Gawande, The NewYorker
While tort reform like Texas' won't improve the cost of our health care, changing our charge-per-service structure just might.
So, is the high cost of health care the doctors' fault or the lawyers? I'd argue neither: it's the insurance companies. Take your pick.