India’s constant demand for gods has saved atheist China’s biggest ‘Hindu god factory’ from the global recession.
Indian consumers are also inspiring more Chinese to learn the tricky art of mass-producing cut-price gods with names they cannot pronounce.
Across south China, known as the world’s export factory, sinking markets in the US and Europe have crippled over 67,000 factories and left 20-30 million migrants unemployed since last year.
But the Chinese workers, who make 40 Hindu gods per person per day in a factory in southeast China’s Quanzhou near Taiwan, are clocking overtime 7-10 pm shifts to make the Ganesha you will buy in Mumbai or Gurgaon.
These 120-150 workers from rural China, who don’t know the names of any of the gods they mould and paint, can make 1,000 idols of any style in 45 days — cheaper than Indian artisans. When Hindustan Times visited them, not a single worker paused from the task at hand to look up.
“The demand for Hindu gods is always stable in India, but US buyers of gods stopped coming,” said Donna Du, an English major graduate who started the factory in 2004 to make sculptures of couples and doves for India’s Valentine’s Day and Friendship Day. But the religious demand grew so fast that the factory decided to focus exclusively on Hindu gods.
The lightweight and hollow idols travel in a container packed with 1,000 cartons — each carton crammed with 144, 288 or over 300 pieces — on the ancient maritime silk route. The idols are sent by road from coastal Quanzhou to Xiamen port, and then by sea via Hong Kong or Singapore to Mumbai..
“India’s economy is still growing, so demand is good,” said Donna, who remembers the names of only Sai Baba, Krishna and Ganesha. “Inexperienced Chinese competitors are trying to make Ganeshas, but they make mistakes, like the trunk on the wrong side.”
Quanzhou is surrounded by the world’s shoe factories making over one billion pairs of sneakers every year. But the young Indians who travel here every three months head to this lesser-known factory where the Chinese take the Ganesha global.
The factory’s showpiece is an air-conditioned sample room stacked with idols of at least a dozen gods in all sizes and a table with a maroon velvet tablecloth. Here, the Indians meet manager Chen who doesn’t speak English or Hindi and wears an Om locket to “show sincerity”.
“Indians bargain until midnight over a few cents,” said Donna. “The cost of raw material and labour went up last year, but Indians are tough. They won’t pay more.”
Indian traders bring pictures of idols they want copied. A local sculptor makes the design and mould. The sculpture for the mould can cost Rs 700 per inch. A two-inch Ganesha sold for Rs 14 will sell in India for over Rs 100-200. A big idol sold here for Rs 350 each will sell for many times the price in India.
Across a floor that smells like a laboratory, workers manually pour creamy polyresin into moulds. Since the 1990s, Quanzhou has been a hub for making cheap sculptures of polyresin, a flexible compound with a finish like fibreglass.
On another floor, local Chinese with no art training paint 40 idols per day, one part at a time. Hindustan Times saw one worker just spraying black paint on the hooves, tail and snout of Krishna’s cows. A girl was painting the gold blouse on every Saraswati.
A girl painting gold lines on Ganesha identified herself as Zhen, and said she trained on the job. “I thought it was very difficult,” she said. She sends part of her 1,000 RMB (Rs 7,000) monthly salary to her parents in a village three hours away and spends the rest.
In another factory, while workers loaded Christmas shipments, the manager said his staff has begun learning to make Hindu gods. But they finish only three or four idols per day. “Hindu gods, very difficult,” he said, shaking his head.
Saturday, June 6, 2009
‘Small investors need special rights’
Salman Khursheed has taken charge as the country’s Corporate Affairs Minister in the backdrop of the Satyam Computer Services scandal that has triggered calls for better regulation and corporate governance to protect investors. He spoke to Mahua Venkatesh on reforming the way India Inc is governed. Excerpts:
The Satyam episode has so far remained an isolated case. But how would you ensure that in future a scandal of this magnitude does not recur?
It is extremely important to ensure that there are no more Satyam-like cases here. We are planning to put in place an early warning system to be able to detect any early sign. We have already said that this will be priority for us.
Routine surveys take place by auditors and if there are complaints from investors but we need to look beyond that. Early warning system will be aimed at picking signs at a nascent stages. We
have to chalk out the finer points of this system.
Several questions have also been raised on the role of independent directors. Is the current system flawed?
We have very strong guidelines but now we have to strengthen and tighten them further and take them to the next level. Accountability is key and we will see how this can be further enhanced and naturally the role of independent directors would be crucial.
The new Companies Bill which we intend to introduce in Parliament at the earliest has already dealt with several of these issues.
How do you plan to protect the small investor?
Protection of small investor is our focus. The small investor needs to be given some special rights. We need to demystify corporate governance for the aam admi (common man) It is important to speak a language which does not sound like a mystery.
When do you plan to take up the new Companies Bill?
It is a priority, but in view of the Satyam case, do we need to review the bill? That is something we need to see.
The Satyam episode has so far remained an isolated case. But how would you ensure that in future a scandal of this magnitude does not recur?
It is extremely important to ensure that there are no more Satyam-like cases here. We are planning to put in place an early warning system to be able to detect any early sign. We have already said that this will be priority for us.
Routine surveys take place by auditors and if there are complaints from investors but we need to look beyond that. Early warning system will be aimed at picking signs at a nascent stages. We
have to chalk out the finer points of this system.
Several questions have also been raised on the role of independent directors. Is the current system flawed?
We have very strong guidelines but now we have to strengthen and tighten them further and take them to the next level. Accountability is key and we will see how this can be further enhanced and naturally the role of independent directors would be crucial.
The new Companies Bill which we intend to introduce in Parliament at the earliest has already dealt with several of these issues.
How do you plan to protect the small investor?
Protection of small investor is our focus. The small investor needs to be given some special rights. We need to demystify corporate governance for the aam admi (common man) It is important to speak a language which does not sound like a mystery.
When do you plan to take up the new Companies Bill?
It is a priority, but in view of the Satyam case, do we need to review the bill? That is something we need to see.
13 killed in Peru as Indians battle police
Protests by indigenous communities over oil drilling and mining in the Peruvian Amazon region turned violent Friday, leaving at least 13 people dead in clashes with police and subsequent rioting.
According to local officials, nine police officers and four Indians were killed in an early morning confrontation on a road between Jaen and Bagua in northern Peru and in the protests that followed. The Bagua public defender's office said 45 people were injured.
Violence continued throughout much of the day. Rioters sacked city offices, the local headquarters of President Alan Garcia's political party and 50 stores.
Some reports said the death toll was even higher. One said protesters were holding 38 police officers hostage and threatening to kill them unless the police withdrew.
The Health Ministry said it was sending emergency teams of doctors and paramedics to the area, raising concern that the casualty totals were far higher than officially reported.
Tensions between the indigenous communities and the government have been boiling since early April, when tribal members began protesting Garcia's granting of mineral development rights to foreign companies. Half a dozen indigenous communities claim the jungle as their ancestral lands.
The government regards mineral and oil resources as national property that is crucial to Peru's economic development. The nation's booming mining industry has been essential to its rapid growth in recent years.
Interior Minister Mercedes Cabanillas declared a curfew Friday, but it wasn't clear whether police had control of the area.
The clash between protesters and security forces occurred after the government sent 650 police officers to clear protesters from the Fernando Belaunde Highway, a main thoroughfare in the Amazon region.
Police officers said the Indians fired first. Cabanillas said Indians took weapons from the officers and used them against members of the force.
There were reports of protesters dragging the bodies of police officers through the streets.
Spokesmen for the umbrella indigenous group known as AIDESEP said in Lima, the capital, that it was the police who set off the violence.
"We are sad and outraged by how the government has assassinated our brothers who were struggling peacefully," said Agustina Mayan, an AIDESEP spokeswoman. "Today the government has persisted in hunting down and kidnapping us."
Protests by the indigenous communities against oil and gas exploration have intensified in recent weeks, with the closing of several roads and waterways.
In mid-May, demonstrators succeeded in shutting down an oil pipeline operated by PetroPeru by taking over a pump station.
The government attempted to negotiate with the tribes, but Garcia lost patience and called on Cabinet ministers to "assume your responsibilities."
"This is why we have been elected, not to wash our hands, while we are left with no gas and petroleum," Garcia said. "Is that what people want?"
Kraul and Leon are special correspondents.
According to local officials, nine police officers and four Indians were killed in an early morning confrontation on a road between Jaen and Bagua in northern Peru and in the protests that followed. The Bagua public defender's office said 45 people were injured.
Violence continued throughout much of the day. Rioters sacked city offices, the local headquarters of President Alan Garcia's political party and 50 stores.
Some reports said the death toll was even higher. One said protesters were holding 38 police officers hostage and threatening to kill them unless the police withdrew.
The Health Ministry said it was sending emergency teams of doctors and paramedics to the area, raising concern that the casualty totals were far higher than officially reported.
Tensions between the indigenous communities and the government have been boiling since early April, when tribal members began protesting Garcia's granting of mineral development rights to foreign companies. Half a dozen indigenous communities claim the jungle as their ancestral lands.
The government regards mineral and oil resources as national property that is crucial to Peru's economic development. The nation's booming mining industry has been essential to its rapid growth in recent years.
Interior Minister Mercedes Cabanillas declared a curfew Friday, but it wasn't clear whether police had control of the area.
The clash between protesters and security forces occurred after the government sent 650 police officers to clear protesters from the Fernando Belaunde Highway, a main thoroughfare in the Amazon region.
Police officers said the Indians fired first. Cabanillas said Indians took weapons from the officers and used them against members of the force.
There were reports of protesters dragging the bodies of police officers through the streets.
Spokesmen for the umbrella indigenous group known as AIDESEP said in Lima, the capital, that it was the police who set off the violence.
"We are sad and outraged by how the government has assassinated our brothers who were struggling peacefully," said Agustina Mayan, an AIDESEP spokeswoman. "Today the government has persisted in hunting down and kidnapping us."
Protests by the indigenous communities against oil and gas exploration have intensified in recent weeks, with the closing of several roads and waterways.
In mid-May, demonstrators succeeded in shutting down an oil pipeline operated by PetroPeru by taking over a pump station.
The government attempted to negotiate with the tribes, but Garcia lost patience and called on Cabinet ministers to "assume your responsibilities."
"This is why we have been elected, not to wash our hands, while we are left with no gas and petroleum," Garcia said. "Is that what people want?"
Kraul and Leon are special correspondents.
First Couple's date night a fascination and inspiration
During a highly unscientific survey in front of the Papaya Dog, where the special is "2 eggs, potatoes and toast, 99 cents," New Yorkers revealed that they are, in fact, hopeless romantics.
Days after President Obama took his wife for a pricey night out on this town, the orchestrated whining about taxpayers footing the $81,000 tab was getting a big Bronx cheer all week.
"Eighty-one thousand dollars or 81 cents, that's what keeps a relationship going," said David Slurff, a construction worker who spent the last 17 days straight pulling out the seats of the old Yankee Stadium. He firmly believes a little time with your sweetheart is how relationships survive the insanity of 21st century life.
It turns out "date night" -- along with text messaging, Swiffer mops and frozen Hot Pockets -- is now an official staple of modern marriage. Experts say a night out -- or in, whatever works, as long as it's just the two of you -- is one easy cure for the inevitable marital drift that sets in when the BlackBerry won't stop buzzing and the kids suck all the oxygen out of the house.
"It's the thing that grounds us, makes us sit across the table from one another and say, 'Hey, I remember you,' " said Pepper Schwartz, chief relationships expert for Perfectmatch.com.
Our parents did some version of it, cards and cocktails with the neighbors, but our generation had to elevate it to a term of art. And now the impossibly elegant Obamas -- he was sleek and tie-less, she wore black -- have only raised the bar with a third date night since Inauguration Day.
They flew to John F. Kennedy International Airport in a mini Air Force One, (who knew it came in mini?) helicoptered into Manhattan, ate organic in a chic Greenwich Village restaurant (known to elicit "ecstatic whispering about the quality of summer peas") and saw a play that didn't even have show tunes.
This opened a floodgate for detractors, mostly Republicans, who squawked that the First Couple's motorcade had inconvenienced much of New York and blown a wad of taxpayer money just as General Motors was going belly up.
"Oh, please," said Chaya Kennedy, a 31-year-old office manager who is divorced, but ever hopeful. "Would we rather he'd be like other politicians and spend it on a prostitute? At least he spent it on his wife."
Even some (cranky) Democrats of the male persuasion took off on the debonair president as a bit of a "rate buster" who was making the rest of the guys look bad.
"Take it down a notch, dude . . . " the Daily Show's Jon Stewart bellyached. "By the end of your term, you're having NASA write her name on the moon in laser."
If all this blather about one Saturday night feels like last week's jelly doughnuts when everyone else has moved on to Obama's speech to the world's Muslims, then why were the tabloids still honking about "President Obama and Michelle's Picture Perfect Marriage" even as he was en route to Saudi Arabia?
Everyone from marriage counselors to suddenly sentimental New Yorkers getting a cheap breakfast across from the Empire State Building would say it's because the president is on to something.
"Behind every great man is a strong woman, and she needs to be appreciated," said Lenny Renny, 49, who married shortly after arriving in New York 20 years ago from the Caribbean island of St. Lucia and treats his own strong woman "like a morning flower." The night the Obamas were out on the town he was home in Brooklyn, cooking his wife a birthday dinner of chicken and rice.
As much as we hate to admit it, the more the Obamas date, the greater the national fascination: How do they do it?
For a lot of us, a date night generally means a burger down the block and, maybe, a deftly timed movie if three more hours doesn't mean the sitter ends up costing more than dinner. Women's magazines love to think up imaginative ways for married people to reconnect. As in: Get a fondue pot and have a feast! Add a French movie and French kiss all night! Make a finger-foods-only dinner and feed each other!
Such contortions fatigue us. Wasn't the whole point supposed to be that we wouldn't have to feed anybody?
Perhaps, as the Republicans insist, the Obamas were "putting on a show" winging it to the Big Apple. But this isn't about partisan politics. These public displays of a wedded White House bliss are increasingly compared to the Reagans', except the Obamas are managing to make time for each other with two kids and a puppy.
Seeing the First Couple out once in a while or holding hands just might be something for us to aspire to: a table set for two, sport coat, high heels, a real conversation.
We can do that.
Yes we can.
Days after President Obama took his wife for a pricey night out on this town, the orchestrated whining about taxpayers footing the $81,000 tab was getting a big Bronx cheer all week.
"Eighty-one thousand dollars or 81 cents, that's what keeps a relationship going," said David Slurff, a construction worker who spent the last 17 days straight pulling out the seats of the old Yankee Stadium. He firmly believes a little time with your sweetheart is how relationships survive the insanity of 21st century life.
It turns out "date night" -- along with text messaging, Swiffer mops and frozen Hot Pockets -- is now an official staple of modern marriage. Experts say a night out -- or in, whatever works, as long as it's just the two of you -- is one easy cure for the inevitable marital drift that sets in when the BlackBerry won't stop buzzing and the kids suck all the oxygen out of the house.
"It's the thing that grounds us, makes us sit across the table from one another and say, 'Hey, I remember you,' " said Pepper Schwartz, chief relationships expert for Perfectmatch.com.
Our parents did some version of it, cards and cocktails with the neighbors, but our generation had to elevate it to a term of art. And now the impossibly elegant Obamas -- he was sleek and tie-less, she wore black -- have only raised the bar with a third date night since Inauguration Day.
They flew to John F. Kennedy International Airport in a mini Air Force One, (who knew it came in mini?) helicoptered into Manhattan, ate organic in a chic Greenwich Village restaurant (known to elicit "ecstatic whispering about the quality of summer peas") and saw a play that didn't even have show tunes.
This opened a floodgate for detractors, mostly Republicans, who squawked that the First Couple's motorcade had inconvenienced much of New York and blown a wad of taxpayer money just as General Motors was going belly up.
"Oh, please," said Chaya Kennedy, a 31-year-old office manager who is divorced, but ever hopeful. "Would we rather he'd be like other politicians and spend it on a prostitute? At least he spent it on his wife."
Even some (cranky) Democrats of the male persuasion took off on the debonair president as a bit of a "rate buster" who was making the rest of the guys look bad.
"Take it down a notch, dude . . . " the Daily Show's Jon Stewart bellyached. "By the end of your term, you're having NASA write her name on the moon in laser."
If all this blather about one Saturday night feels like last week's jelly doughnuts when everyone else has moved on to Obama's speech to the world's Muslims, then why were the tabloids still honking about "President Obama and Michelle's Picture Perfect Marriage" even as he was en route to Saudi Arabia?
Everyone from marriage counselors to suddenly sentimental New Yorkers getting a cheap breakfast across from the Empire State Building would say it's because the president is on to something.
"Behind every great man is a strong woman, and she needs to be appreciated," said Lenny Renny, 49, who married shortly after arriving in New York 20 years ago from the Caribbean island of St. Lucia and treats his own strong woman "like a morning flower." The night the Obamas were out on the town he was home in Brooklyn, cooking his wife a birthday dinner of chicken and rice.
As much as we hate to admit it, the more the Obamas date, the greater the national fascination: How do they do it?
For a lot of us, a date night generally means a burger down the block and, maybe, a deftly timed movie if three more hours doesn't mean the sitter ends up costing more than dinner. Women's magazines love to think up imaginative ways for married people to reconnect. As in: Get a fondue pot and have a feast! Add a French movie and French kiss all night! Make a finger-foods-only dinner and feed each other!
Such contortions fatigue us. Wasn't the whole point supposed to be that we wouldn't have to feed anybody?
Perhaps, as the Republicans insist, the Obamas were "putting on a show" winging it to the Big Apple. But this isn't about partisan politics. These public displays of a wedded White House bliss are increasingly compared to the Reagans', except the Obamas are managing to make time for each other with two kids and a puppy.
Seeing the First Couple out once in a while or holding hands just might be something for us to aspire to: a table set for two, sport coat, high heels, a real conversation.
We can do that.
Yes we can.
Private insurance companies push for 'individual mandate'
Some may find it hard to believe that the U.S. health insurance industry supports making major changes to the nation's healthcare system.
The industry, after all, scuttled President Clinton's healthcare overhaul bid with ads featuring "Harry and Louise" fretting about change.
But this time, it turns out, the health insurance industry has good reason to support at least some change: It needs it.
Private health insurance faces a bleak future if the proposal they champion most vigorously -- a requirement that everyone buy medical coverage -- is not adopted.
The customer base for private insurance has slipped since 2000, when soaring premiums began driving people out. The recession has accelerated the problem. But even after the economy recovers, the downward spiral is expected to continue for years as baby boomers become eligible for Medicare -- and stop buying private insurance.
Insurers do not embrace all of the healthcare restructuring proposals. But they are fighting hard for a purchase requirement, sweetened with taxpayer-funded subsidies for customers who can't afford to buy it on their own, and enforced with fines.
Such a so-called individual mandate amounts to a huge booster shot for health insurers, serving up millions of new customers almost overnight.
"I think that's why we've seen the industry basically trying to play the administration's game," said Jane DuBose, an analyst with HealthLeaders-InterStudy, an industry tracking firm. "They really could be licking their chops over the potential here."
The industry says its interest in change flows not from narrow self-interest but from broader concerns.
"What's driving this is we have 47 million people who don't have access to the system, who get help through emergency rooms and that results in higher costs and inefficient care," said Robert Zirkelbach, a spokesman for industry trade group America's Health Insurance Plans. "There's both a social and economic reason to get everybody in the healthcare system."
Jay Gellert, chief executive of Woodland Hills-based Health Net, said industry support for certain changes is driven by "a recognition that public frustration with many of the problems in the system are increasing pretty significantly. So I think there's as much of a commitment to this because we've seen other industries where they haven't dealt with issues early enough, like financial services and auto, and that's not a happy place."
Still, industry observers say, private insurers need the government's help in transforming some of the nation's 45 million uninsured residents into paying customers.
Private health insurers lost an estimated 9 million customers between 2000 and 2007. In many cases, people lost coverage because they or their employers could no longer afford it as premium increases outpaced wage growth and inflation.
Recession job losses are adding to the toll. Some economists estimate that every percentage-point increase in the jobless rate adds 1 million people to the ranks of the uninsured.
The industry's real trouble begins in 2011, when 79 million baby boomers begin turning 65. Health insurers stand to lose a huge slice of their commercially insured enrollment (estimated at 162 million to 172 million people) over the next two decades to Medicare, the government-funded health insurance program for seniors.
"The rate of aging far and away exceeds the birth rate," said Sheryl Skolnick, a CRT Capital Group healthcare investment analyst. "That's got to be very scary. . . . This is the biggest fight for survival managed care has ever faced, at least since they went bankrupt in the late '80s."
With Democrats in power and public sentiment strongly in favor of change, the industry can't afford to just say, "No; we're against this," said Julius Hobson, a Washington, D.C., lobbyist for hospitals and insurers with law firm Bryan Cave.
"This time, you get the sense something is going to happen," he said. "So to stand up and just say no is probably not wise, because politically you could get run over."
For insurers, getting "run over" would be the adoption of a so-called single-payer plan, where the government pays all medical bills. Such a plan would wreak havoc on the private insurance market, and is widely viewed as politically unfeasible this year.
So the best way for the industry to preserve the private insurance market -- and derail the campaign for a single-payer system -- may be to go along with more palatable proposals on the table now, said Jeffrey Miles, a healthcare analyst and president of the Miles Organization, a Los Angeles insurance brokerage firm.
"If healthcare goes down this year, you are going to end up with single-payer care much sooner than anyone expected," he said.
But there is a limit to how much change the industry will abide. It draws the line at proposals, supported by President Obama and others, to offer consumers a public insurance alternative to private coverage.
The idea is that consumers could buy into a government-run health plan, such as or similar to Medicare or the federal employees insurance program.
Proponents say that if consumers are required to buy coverage, it is only fair to give them a public option.
In a recent letter to Senate Finance Committee Chairman Max Baucus (D-Mont.), for example, Jerry Flanagan of the Santa Monica-based advocacy group Consumer Watchdog wrote that adopting an individual mandate without a public alternative would amount to "a bailout for HMOs -- whose greed, waste and indifference to our health have created the current mess."
The industry fears that the government would force lower fees on hospitals and physicians, enabling a public health insurance plan to offer consumers a better bargain.
That, they say, would make it hard for private companies to compete for customers. Insurers also fear that a public option could easily be converted later into a single-payer healthcare system.
Health insurers don't see a public plan "as the nose of the camel under the tent; they see it as the front half of the camel under the tent," said Robert Laszewski, a former insurance company executive and industry consultant.
"They are interested in 45 million new customers," he said, "but the first thing in everybody's mind is preserving their right to do business in a way that can be profitable and meet shareholder needs."
The industry, after all, scuttled President Clinton's healthcare overhaul bid with ads featuring "Harry and Louise" fretting about change.
But this time, it turns out, the health insurance industry has good reason to support at least some change: It needs it.
Private health insurance faces a bleak future if the proposal they champion most vigorously -- a requirement that everyone buy medical coverage -- is not adopted.
The customer base for private insurance has slipped since 2000, when soaring premiums began driving people out. The recession has accelerated the problem. But even after the economy recovers, the downward spiral is expected to continue for years as baby boomers become eligible for Medicare -- and stop buying private insurance.
Insurers do not embrace all of the healthcare restructuring proposals. But they are fighting hard for a purchase requirement, sweetened with taxpayer-funded subsidies for customers who can't afford to buy it on their own, and enforced with fines.
Such a so-called individual mandate amounts to a huge booster shot for health insurers, serving up millions of new customers almost overnight.
"I think that's why we've seen the industry basically trying to play the administration's game," said Jane DuBose, an analyst with HealthLeaders-InterStudy, an industry tracking firm. "They really could be licking their chops over the potential here."
The industry says its interest in change flows not from narrow self-interest but from broader concerns.
"What's driving this is we have 47 million people who don't have access to the system, who get help through emergency rooms and that results in higher costs and inefficient care," said Robert Zirkelbach, a spokesman for industry trade group America's Health Insurance Plans. "There's both a social and economic reason to get everybody in the healthcare system."
Jay Gellert, chief executive of Woodland Hills-based Health Net, said industry support for certain changes is driven by "a recognition that public frustration with many of the problems in the system are increasing pretty significantly. So I think there's as much of a commitment to this because we've seen other industries where they haven't dealt with issues early enough, like financial services and auto, and that's not a happy place."
Still, industry observers say, private insurers need the government's help in transforming some of the nation's 45 million uninsured residents into paying customers.
Private health insurers lost an estimated 9 million customers between 2000 and 2007. In many cases, people lost coverage because they or their employers could no longer afford it as premium increases outpaced wage growth and inflation.
Recession job losses are adding to the toll. Some economists estimate that every percentage-point increase in the jobless rate adds 1 million people to the ranks of the uninsured.
The industry's real trouble begins in 2011, when 79 million baby boomers begin turning 65. Health insurers stand to lose a huge slice of their commercially insured enrollment (estimated at 162 million to 172 million people) over the next two decades to Medicare, the government-funded health insurance program for seniors.
"The rate of aging far and away exceeds the birth rate," said Sheryl Skolnick, a CRT Capital Group healthcare investment analyst. "That's got to be very scary. . . . This is the biggest fight for survival managed care has ever faced, at least since they went bankrupt in the late '80s."
With Democrats in power and public sentiment strongly in favor of change, the industry can't afford to just say, "No; we're against this," said Julius Hobson, a Washington, D.C., lobbyist for hospitals and insurers with law firm Bryan Cave.
"This time, you get the sense something is going to happen," he said. "So to stand up and just say no is probably not wise, because politically you could get run over."
For insurers, getting "run over" would be the adoption of a so-called single-payer plan, where the government pays all medical bills. Such a plan would wreak havoc on the private insurance market, and is widely viewed as politically unfeasible this year.
So the best way for the industry to preserve the private insurance market -- and derail the campaign for a single-payer system -- may be to go along with more palatable proposals on the table now, said Jeffrey Miles, a healthcare analyst and president of the Miles Organization, a Los Angeles insurance brokerage firm.
"If healthcare goes down this year, you are going to end up with single-payer care much sooner than anyone expected," he said.
But there is a limit to how much change the industry will abide. It draws the line at proposals, supported by President Obama and others, to offer consumers a public insurance alternative to private coverage.
The idea is that consumers could buy into a government-run health plan, such as or similar to Medicare or the federal employees insurance program.
Proponents say that if consumers are required to buy coverage, it is only fair to give them a public option.
In a recent letter to Senate Finance Committee Chairman Max Baucus (D-Mont.), for example, Jerry Flanagan of the Santa Monica-based advocacy group Consumer Watchdog wrote that adopting an individual mandate without a public alternative would amount to "a bailout for HMOs -- whose greed, waste and indifference to our health have created the current mess."
The industry fears that the government would force lower fees on hospitals and physicians, enabling a public health insurance plan to offer consumers a better bargain.
That, they say, would make it hard for private companies to compete for customers. Insurers also fear that a public option could easily be converted later into a single-payer healthcare system.
Health insurers don't see a public plan "as the nose of the camel under the tent; they see it as the front half of the camel under the tent," said Robert Laszewski, a former insurance company executive and industry consultant.
"They are interested in 45 million new customers," he said, "but the first thing in everybody's mind is preserving their right to do business in a way that can be profitable and meet shareholder needs."
Women Bridging Gap in Science Opportunities
The prospects for women who are scientists and engineers at major research universities have improved, although women continue to face inequalities in salary and access to some other resources, a panel of the National Research Council concludes in a new report.
In recent years “men and women faculty in science, engineering and mathematics have enjoyed comparable opportunities,” the panel said in its report, released on Tuesday. It found that women who apply for university jobs and, once they have them, for promotion and tenure, are at least as likely to succeed as men. But compared with their numbers among new Ph.D.’s, women are still underrepresented in applicant pools, a puzzle that offers an opportunity for further research, the panel said.
The panel said one factor outshined all others in encouraging women to apply for jobs: having women on the committees appointed to fill them.
In another report this week in the Proceedings of the National Academy of Sciences, researchers at the University of Wisconsin reviewed a variety of studies and concluded that the achievement gap between boys and girls in mathematics performance had narrowed to the vanishing point.
“U.S. girls have now reached parity with boys, even in high school and even for measures requiring complex problem solving,” the Wisconsin researchers said. Although girls are still underrepresented in the ranks of young math prodigies, they said, that gap is narrowing, which undermines claims that a greater prevalence of profound mathematical talent in males is biologically determined. The researchers said this and other phenomena “provide abundant evidence for the impact of sociocultural and other environmental factors on the development of mathematical skills and talent and the size, if any, of math gender gaps.”
The research council, an arm of the National Academy of Sciences, convened its expert panel at the request of Congress. The panel surveyed six disciplines — biology, chemistry, mathematics, civil and electrical engineering and physics — and based its analysis on interviews with faculty members at 89 institutions and data from federal agencies, professional societies and other sources.
The panel was led by Claude Canizares, a physicist who is vice president for research at M.I.T., and Dr. Sally Shaywitz of Yale Medical School, an expert on learning.
The Wisconsin researchers, Janet S. Hyde and Janet E. Mertz, studied data from 10 states collected in tests mandated by the No Child Left Behind legislation as well as data from the National Assessment of Educational Progress, a federal testing program. Differences between girls’ and boys’ performance in the 10 states were “close to zero in all grades,” they said, even in high schools were gaps existed earlier. In the national assessment, they said, differences between girls’ and boys’ performance were “trivial.”
In recent years “men and women faculty in science, engineering and mathematics have enjoyed comparable opportunities,” the panel said in its report, released on Tuesday. It found that women who apply for university jobs and, once they have them, for promotion and tenure, are at least as likely to succeed as men. But compared with their numbers among new Ph.D.’s, women are still underrepresented in applicant pools, a puzzle that offers an opportunity for further research, the panel said.
The panel said one factor outshined all others in encouraging women to apply for jobs: having women on the committees appointed to fill them.
In another report this week in the Proceedings of the National Academy of Sciences, researchers at the University of Wisconsin reviewed a variety of studies and concluded that the achievement gap between boys and girls in mathematics performance had narrowed to the vanishing point.
“U.S. girls have now reached parity with boys, even in high school and even for measures requiring complex problem solving,” the Wisconsin researchers said. Although girls are still underrepresented in the ranks of young math prodigies, they said, that gap is narrowing, which undermines claims that a greater prevalence of profound mathematical talent in males is biologically determined. The researchers said this and other phenomena “provide abundant evidence for the impact of sociocultural and other environmental factors on the development of mathematical skills and talent and the size, if any, of math gender gaps.”
The research council, an arm of the National Academy of Sciences, convened its expert panel at the request of Congress. The panel surveyed six disciplines — biology, chemistry, mathematics, civil and electrical engineering and physics — and based its analysis on interviews with faculty members at 89 institutions and data from federal agencies, professional societies and other sources.
The panel was led by Claude Canizares, a physicist who is vice president for research at M.I.T., and Dr. Sally Shaywitz of Yale Medical School, an expert on learning.
The Wisconsin researchers, Janet S. Hyde and Janet E. Mertz, studied data from 10 states collected in tests mandated by the No Child Left Behind legislation as well as data from the National Assessment of Educational Progress, a federal testing program. Differences between girls’ and boys’ performance in the 10 states were “close to zero in all grades,” they said, even in high schools were gaps existed earlier. In the national assessment, they said, differences between girls’ and boys’ performance were “trivial.”
If All Doctors Had More Time to Listen
WHEN Dr. José Batlle met his 93-year-old patient in her small Bronx apartment, she didn’t have much furniture beyond a small TV, a sofa and a wheelchair. What she did have in abundance were pills — 15 types from a variety of doctors, including a pulmonologist, a cardiologist and a gerontologist. He discovered that some medicines had expired, others were unnecessary and some were dangerous if taken together.
Dr. Lili Sacks moved to a clinic in Seattle that focuses on longer appointments. She now sees up to 12 patients a day instead of 25.
Sitting with his patient and her son
Dr. Batlle cut the number of her medicines to four. He also gave the family his personal cellphone number.
Before coming to see him, the woman had endured several emergency-room visits and hospital stays. With Dr. Batlle, she was able to avoid all of that.
Calling a doctor on his cell? No waiting for an appointment? It’s the type of service that Dr. Batlle tries to offer to all of his 1,500 patients. “I prefer to keep them healthy than treat them when they are sick,” he says.
The efforts of Dr. Batlle and other primary care physicians may get a boost at the federal level. The Obama administration is considering ways to persuade medical students to pursue careers in primary care by raising their pay, and is channeling them to work in underserved rural areas. And the White House has already set aside $2 billion for community health centers through the economic stimulus package.
But more far-reaching health care reform remains an uncertainty, and in the interim a small but growing number of doctors are trying to take matters into their own hands.
By stepping off the big-clinic treadmill, where doctors are sometimes asked to see a different patient every 15 minutes, Dr. Batlle has joined the vanguard of physicians trying to redefine health care. These doctors spend more time with patients, emphasize prevention and education to keep them healthy and can handle many medical problems without referrals to specialists.
In many cases, this kind of care can reduce a patient’s medical bills. That’s more crucial than ever: according to a study published online by the American Journal of Medicine, 60 percent of all bankruptcies in the United States in 2007 were driven by health care costs.
Exact numbers are hard to come by, but doctors involved in this movement, called “patient centered” practices, say its popularity is growing.
“I travel to a lot of medical conferences, and I’m meeting more and more doctors embarking on this path,” said Dr. L. Gordon Moore, who runs IdealMedicalPractices.org, a program to help small practices become more innovative and efficient. The Web site IdealMedicalHome.org has about 800 doctors who post and trade ideas, while more than 700 physicians have adopted methods from HowsYourHealth.org. Many of these doctors see fewer patients per day than they did before.
To make personalized care possible in an era when compensation is often tied to the number of patients they see, doctors use technology to streamline processes and reduce administrative costs. Dr. Batlle, for example, uses online appointment scheduling and manages his medical records electronically. He prescribes medications from his computer and offers virtual visits by phone and e-mail.
It cost Dr. Batlle about $25,000 to buy the technology to make all of this possible, but he estimates that he saves close to $100,000 a year in salaries and billing costs. And he has made enough money to begin renovations on a new office in Washington Heights in Manhattan.
The model seems to be working, according to a 2008 study by Dr. John H. Wasson at Dartmouth Medical School. His research showed that patients in patient-centered practices were more likely to say they were informed about how to manage chronic diseases and got the care they needed, compared with those in a national sample of medical practices. They also were less likely to say they had to wait for an appointment.
“If the goal is to deliver patient care when and how they want and need it, this is the way to go,” Dr. Wasson said.
Of course, even doctors in this movement acknowledge that it is not a panacea for the country’s health care problems. Privacy advocates warn that electronic patient records can be breached, and computer glitches can make patient records inaccessible for hours. Big clinics can be better for people who have several health problems and need easy access to a variety of specialists. Moreover, some doctors may not want to leave a big clinic because they feel they lack the technical or business skills they need — or because a salaried job there may be more stable in this economy.
And while the patient-centered movement is growing, the nation may not be able to afford to have all its primary care doctors reduce the number of patients they see. Across the country, primary care physicians are in short supply, in part because average salaries for family practitioners are the lowest of any medical specialty. According to a 2008 survey of physician salaries by the American Medical Group Association, their average annual salary is $201,555, versus $356,166 for a general surgeon and $614,536 for a neurological surgeon.
“Medical school loans can be so high, you need to be a specialist to pay them back,” Dr. Batlle said. “But our country doesn’t need yet another sleep apnea specialist.”
LILI SACKS, a primary care doctor in Seattle, says she began thinking differently about her work on the day she realized she was beginning each appointment with the words, “Sorry I’m late.”Scheduled to see as many as 25 patients a day at a large clinic, she lacked the time for thorough examinations and discussions. Because of this, she said, primary care doctors are often forced to order tests and send patients to specialists.
“Could I have helped some people without specialists and tests? Absolutely,” said Dr. Sacks. “Would it have saved the patient and the insurance company both money? Absolutely. Is the system set up for the best care and cost efficiency? Absolutely not.”
Dr. Sacks said she worried that seeing so many patients would lead to errors. Last year, she moved to a clinic that focuses on longer patient appointments, 30 to 60 minutes. This translates to 10 to 12 patients a day. Patients also communicate directly with her by phone or e-mail.
During those longer appointments, Dr. Sacks can perform basic lab tests and simple procedures, so patients see fewer specialists.
“I probably head off a handful of emergency-room visits and hospital stays every month because patients can see me as soon as they have a problem, and I can be thorough rather than rushed,” she said.
One patient who avoided the emergency room was Todd Martin, a store manager in Seattle who went to Dr. Sacks’s clinic on a Saturday.
“I couldn’t stop coughing and was having trouble breathing,” Mr. Martin said. “They were able to see me and give me a chest X-ray.”
Mr. Martin said he spent $40 for the resulting prescription but the rest was covered by a monthly fee he pays Dr. Sacks. “A weekend visit to the E.R. would have easily cost $1,000,” he said.
Dr. Sacks charges patients a direct monthly fee of $54 to $129 based on age, and she doesn’t take insurance. Her office calls its philosophy “direct practice” because it’s a direct contract between doctor and patient. But she advises patients to obtain insurance plans to cover large, unexpected health costs like those to treat cancer or a heart attack.
“We say it’s like having a car and paying for your own oil changes and tuneups, but getting insurance in case you need a big repair,” she said.
Dr. Garrison Bliss, who in 2007 founded the group where Dr. Sacks works, has offered direct-practice services since 1997. He says patients can save 15 to 40 percent of their medical costs by using this model, based on his examination of insurance rates and his belief that good primary care can fill most of a patient’s needs.
Insurance plans that cover every little thing can be very expensive, Dr. Bliss said. He said that a patient who paid an annual fee at his clinic and took out a higher-deductible insurance plan would usually come out ahead, even if the patient’s health needs meant that he or she had to pay the entire deductible.
Dr. Bliss’s office operates with just two administrative employees for seven doctors. He estimates that if he took insurance, one or two administrative workers would be needed per doctor.
Insurance administration costs can take a big bite out of a practice’s revenue. A recent Weill Cornell Medical College study found that a third of the money received by primary care physicians pays for interactions between a doctor’s practice and patients’ health plans.
Patricia Rogers Caroselli, a retired assistant principal who is a patient of Dr. Sacks, dreaded going to her former clinic. “The waiting room was always noisy and crowded,” she said. In the examining room, she felt that she should “get in and out and not waste the doctor’s time with questions,” she said.
In contrast, she said, she appreciates the friendly calm of Dr. Sacks’s new surroundings and the personal attention. “Everyone should have this kind of patient care,” she said.
Dr. Sacks said the financial mechanics of the direct-practice model match her medical goals. When she was compensated based on insurance, she was paid every time she saw a patient. Now, if she can use education and prevention to reduce office visits, she and her patients benefit, she said.
“Having more time to sit with each patient has made me a better doctor,” she said. “I had a disabled patient that I saw for 13 years. Until she came to my new clinic, I never had the time to learn the details of her accident and the resulting complications. I was always treating whatever the immediate concern was.”
TECHNOLOGY has helped many doctors reduce costs. Dr. Batlle says he has been building his arsenal of technology solutions one by one, with “lots of trial and error,” for eight years.
Recently, he saw a 52-year-old patient with hypertension. As he examined the patient, noting blood pressure and other vital signs, he entered the information into his laptop computer to add to the patient’s electronic medical record. He also typed in the codes for billing and insurance.
The patient wondered if he was due for a prescription refill, so Dr. Batlle checked his computer again, found that he was, and hit a button to send the refill request to the pharmacy. As the patient left, Dr. Batlle hit the keyboard to send the bill electronically to the insurance company.
“He’ll even go to the Web to schedule his follow-up appointment,” Dr. Batlle said. “I don’t pay a receptionist to sit and answer phones.”
Dr. Batlle says other doctors could outfit an office for less than the $25,000 he spent on technology.
“Most doctors think they need to hire two receptionists, a billing person and two nurses to run a primary care office,” he said. “But they can learn about these technologies from other doctors, and the software salespeople do some training.”
Some physicians hire consultants to find and install the right equipment. Doctors who want to switch to electronic health records may also receive financial support from the government through the stimulus package.
By using new technology and streamlining processes, small primary care practices can reduce their costs to half of what a typical practice pays, from about 60 percent of income down to 30 percent, Dr. Wasson said. He said that doctors who focus on reducing their costs can see fewer patients without sacrificing income. Dr. Sacks said she and her colleagues didn’t have to take a pay cut when they moved to Dr. Bliss’s practice.
As Congress and the Obama administration begin to focus more closely on health care, some primary care doctors are weighing in. Dr. Bliss, for instance, has been to Washington twice in the last month to share his ideas with legislators. He knows he’s in a debate with powerful voices, especially insurance companies and hospitals. So he and other doctors are encouraging patients to speak up as well.
“We need to bring the patients to the barricades with us,” Dr. Batlle says.
Dr. Lili Sacks moved to a clinic in Seattle that focuses on longer appointments. She now sees up to 12 patients a day instead of 25.
Sitting with his patient and her son
Dr. Batlle cut the number of her medicines to four. He also gave the family his personal cellphone number.
Before coming to see him, the woman had endured several emergency-room visits and hospital stays. With Dr. Batlle, she was able to avoid all of that.
Calling a doctor on his cell? No waiting for an appointment? It’s the type of service that Dr. Batlle tries to offer to all of his 1,500 patients. “I prefer to keep them healthy than treat them when they are sick,” he says.
The efforts of Dr. Batlle and other primary care physicians may get a boost at the federal level. The Obama administration is considering ways to persuade medical students to pursue careers in primary care by raising their pay, and is channeling them to work in underserved rural areas. And the White House has already set aside $2 billion for community health centers through the economic stimulus package.
But more far-reaching health care reform remains an uncertainty, and in the interim a small but growing number of doctors are trying to take matters into their own hands.
By stepping off the big-clinic treadmill, where doctors are sometimes asked to see a different patient every 15 minutes, Dr. Batlle has joined the vanguard of physicians trying to redefine health care. These doctors spend more time with patients, emphasize prevention and education to keep them healthy and can handle many medical problems without referrals to specialists.
In many cases, this kind of care can reduce a patient’s medical bills. That’s more crucial than ever: according to a study published online by the American Journal of Medicine, 60 percent of all bankruptcies in the United States in 2007 were driven by health care costs.
Exact numbers are hard to come by, but doctors involved in this movement, called “patient centered” practices, say its popularity is growing.
“I travel to a lot of medical conferences, and I’m meeting more and more doctors embarking on this path,” said Dr. L. Gordon Moore, who runs IdealMedicalPractices.org, a program to help small practices become more innovative and efficient. The Web site IdealMedicalHome.org has about 800 doctors who post and trade ideas, while more than 700 physicians have adopted methods from HowsYourHealth.org. Many of these doctors see fewer patients per day than they did before.
To make personalized care possible in an era when compensation is often tied to the number of patients they see, doctors use technology to streamline processes and reduce administrative costs. Dr. Batlle, for example, uses online appointment scheduling and manages his medical records electronically. He prescribes medications from his computer and offers virtual visits by phone and e-mail.
It cost Dr. Batlle about $25,000 to buy the technology to make all of this possible, but he estimates that he saves close to $100,000 a year in salaries and billing costs. And he has made enough money to begin renovations on a new office in Washington Heights in Manhattan.
The model seems to be working, according to a 2008 study by Dr. John H. Wasson at Dartmouth Medical School. His research showed that patients in patient-centered practices were more likely to say they were informed about how to manage chronic diseases and got the care they needed, compared with those in a national sample of medical practices. They also were less likely to say they had to wait for an appointment.
“If the goal is to deliver patient care when and how they want and need it, this is the way to go,” Dr. Wasson said.
Of course, even doctors in this movement acknowledge that it is not a panacea for the country’s health care problems. Privacy advocates warn that electronic patient records can be breached, and computer glitches can make patient records inaccessible for hours. Big clinics can be better for people who have several health problems and need easy access to a variety of specialists. Moreover, some doctors may not want to leave a big clinic because they feel they lack the technical or business skills they need — or because a salaried job there may be more stable in this economy.
And while the patient-centered movement is growing, the nation may not be able to afford to have all its primary care doctors reduce the number of patients they see. Across the country, primary care physicians are in short supply, in part because average salaries for family practitioners are the lowest of any medical specialty. According to a 2008 survey of physician salaries by the American Medical Group Association, their average annual salary is $201,555, versus $356,166 for a general surgeon and $614,536 for a neurological surgeon.
“Medical school loans can be so high, you need to be a specialist to pay them back,” Dr. Batlle said. “But our country doesn’t need yet another sleep apnea specialist.”
LILI SACKS, a primary care doctor in Seattle, says she began thinking differently about her work on the day she realized she was beginning each appointment with the words, “Sorry I’m late.”Scheduled to see as many as 25 patients a day at a large clinic, she lacked the time for thorough examinations and discussions. Because of this, she said, primary care doctors are often forced to order tests and send patients to specialists.
“Could I have helped some people without specialists and tests? Absolutely,” said Dr. Sacks. “Would it have saved the patient and the insurance company both money? Absolutely. Is the system set up for the best care and cost efficiency? Absolutely not.”
Dr. Sacks said she worried that seeing so many patients would lead to errors. Last year, she moved to a clinic that focuses on longer patient appointments, 30 to 60 minutes. This translates to 10 to 12 patients a day. Patients also communicate directly with her by phone or e-mail.
During those longer appointments, Dr. Sacks can perform basic lab tests and simple procedures, so patients see fewer specialists.
“I probably head off a handful of emergency-room visits and hospital stays every month because patients can see me as soon as they have a problem, and I can be thorough rather than rushed,” she said.
One patient who avoided the emergency room was Todd Martin, a store manager in Seattle who went to Dr. Sacks’s clinic on a Saturday.
“I couldn’t stop coughing and was having trouble breathing,” Mr. Martin said. “They were able to see me and give me a chest X-ray.”
Mr. Martin said he spent $40 for the resulting prescription but the rest was covered by a monthly fee he pays Dr. Sacks. “A weekend visit to the E.R. would have easily cost $1,000,” he said.
Dr. Sacks charges patients a direct monthly fee of $54 to $129 based on age, and she doesn’t take insurance. Her office calls its philosophy “direct practice” because it’s a direct contract between doctor and patient. But she advises patients to obtain insurance plans to cover large, unexpected health costs like those to treat cancer or a heart attack.
“We say it’s like having a car and paying for your own oil changes and tuneups, but getting insurance in case you need a big repair,” she said.
Dr. Garrison Bliss, who in 2007 founded the group where Dr. Sacks works, has offered direct-practice services since 1997. He says patients can save 15 to 40 percent of their medical costs by using this model, based on his examination of insurance rates and his belief that good primary care can fill most of a patient’s needs.
Insurance plans that cover every little thing can be very expensive, Dr. Bliss said. He said that a patient who paid an annual fee at his clinic and took out a higher-deductible insurance plan would usually come out ahead, even if the patient’s health needs meant that he or she had to pay the entire deductible.
Dr. Bliss’s office operates with just two administrative employees for seven doctors. He estimates that if he took insurance, one or two administrative workers would be needed per doctor.
Insurance administration costs can take a big bite out of a practice’s revenue. A recent Weill Cornell Medical College study found that a third of the money received by primary care physicians pays for interactions between a doctor’s practice and patients’ health plans.
Patricia Rogers Caroselli, a retired assistant principal who is a patient of Dr. Sacks, dreaded going to her former clinic. “The waiting room was always noisy and crowded,” she said. In the examining room, she felt that she should “get in and out and not waste the doctor’s time with questions,” she said.
In contrast, she said, she appreciates the friendly calm of Dr. Sacks’s new surroundings and the personal attention. “Everyone should have this kind of patient care,” she said.
Dr. Sacks said the financial mechanics of the direct-practice model match her medical goals. When she was compensated based on insurance, she was paid every time she saw a patient. Now, if she can use education and prevention to reduce office visits, she and her patients benefit, she said.
“Having more time to sit with each patient has made me a better doctor,” she said. “I had a disabled patient that I saw for 13 years. Until she came to my new clinic, I never had the time to learn the details of her accident and the resulting complications. I was always treating whatever the immediate concern was.”
TECHNOLOGY has helped many doctors reduce costs. Dr. Batlle says he has been building his arsenal of technology solutions one by one, with “lots of trial and error,” for eight years.
Recently, he saw a 52-year-old patient with hypertension. As he examined the patient, noting blood pressure and other vital signs, he entered the information into his laptop computer to add to the patient’s electronic medical record. He also typed in the codes for billing and insurance.
The patient wondered if he was due for a prescription refill, so Dr. Batlle checked his computer again, found that he was, and hit a button to send the refill request to the pharmacy. As the patient left, Dr. Batlle hit the keyboard to send the bill electronically to the insurance company.
“He’ll even go to the Web to schedule his follow-up appointment,” Dr. Batlle said. “I don’t pay a receptionist to sit and answer phones.”
Dr. Batlle says other doctors could outfit an office for less than the $25,000 he spent on technology.
“Most doctors think they need to hire two receptionists, a billing person and two nurses to run a primary care office,” he said. “But they can learn about these technologies from other doctors, and the software salespeople do some training.”
Some physicians hire consultants to find and install the right equipment. Doctors who want to switch to electronic health records may also receive financial support from the government through the stimulus package.
By using new technology and streamlining processes, small primary care practices can reduce their costs to half of what a typical practice pays, from about 60 percent of income down to 30 percent, Dr. Wasson said. He said that doctors who focus on reducing their costs can see fewer patients without sacrificing income. Dr. Sacks said she and her colleagues didn’t have to take a pay cut when they moved to Dr. Bliss’s practice.
As Congress and the Obama administration begin to focus more closely on health care, some primary care doctors are weighing in. Dr. Bliss, for instance, has been to Washington twice in the last month to share his ideas with legislators. He knows he’s in a debate with powerful voices, especially insurance companies and hospitals. So he and other doctors are encouraging patients to speak up as well.
“We need to bring the patients to the barricades with us,” Dr. Batlle says.
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