Church of the Sacred Heart in Prague, Czech Republic by Josef Plecnik, 1933
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Church of the Sacred Heart in Prague, Czech Republic by Josef Plecnik, 1933
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The U.S. economy slowed to a crawl in the first quarter, held back by falling investments in homes, shrinking inventories and a large trade gap, the Commerce Department reported Thursday.Note that the 4th quarter 2006 GDP was also revised dramatically lower (see US GDP Flunks Smell Test). Now we are starting see the same thing happen with 1st quarter 2007 estimates. Is there a pattern here?
The economy grew at a 0.6% annualized pace in the quarter, revised down from the initial estimate of 1.3%, the government said in its second estimate of quarterly gross domestic product. It was the slowest growth since late 2002.
The economy has grown just 1.9% in the past four quarters, well below the 3% growth most economists say is the long-run potential. It's the weakest year-over-year growth in four years.
"The details of the report suggest some reasons for even more optimism for the second quarter," wrote Drew Matus, an economist for Lehman Bros. The faster businesses cut their inventories, the sooner they'll be ready to ramp up production again.
Considering the large upward revision to consumer spending, the report "will widely be viewed as a positive when the details are scoured," wrote Tony Crescenzi, chief bond market strategist for Miller Tabak & Co. Although the drags from inventories and home building will lessen in coming quarters, consumer spending is weakening, he said.
"The composition of GDP will turn unfavorable in the second quarter, putting into question the sustainability of a rebound in GDP," Crescenzi said. Data on consumer spending will be the main variable to watch.
Select Details of GDP
- Real consumer spending increased 4.4% annualized, the fastest in a year, compared with the 3.8% initial estimate. Spending on durable goods increased 8.8%, spending on nondurable goods rose 3.5% and spending on services increased 4%.
- Consumer spending contributed 3 percentage points to growth.
- Business fixed investments increased at a 2.9% annual pace, revised up from 2% earlier. Investments in equipment and software rose 2%, while investments in structures increased 5.1%. Business investments contributed 0.3 percentage points to growth.
- Inventories shrank by $4.5 billion. The change in inventory investment cut 1 percentage point from growth.
- Exports fell 0.6%, the biggest decline in four years. Meanwhile, imports rose 5.7%. The trade deficit cut 1 percentage point from growth.
- Government spending rose 1% in the first quarter. Federal spending fell 3.9%, including a 7.3% drop in national defense spending. State and local government spending rose 3.9%.
- Government spending contributed 0.2 percentage points to growth.
U.S. home prices increased 0.5% in the first quarter, the slowest quarter-to-quarter price gain in 10 years, the Office of Federal Housing Enterprise Oversight reported Thursday.It borders on ridiculous to suggest with a straight face and no explanation that "Home prices are rising slowly in most areas". Home prices are not rising and have not been rising for at least a year. Want proof? Just ask the CEO of any homebuilder if home prices including incentives are rising. I suspect they would all laugh in your face.
The OFHEO price index shows home prices are up 4.3% compared with a year earlier, the smallest gains in 10 years. Price appreciation has slowed sharply from a 13.7% year-over-year gain in 2005.
"Prices are rising slowly in most areas," said Patrick Lawler, chief economist for the federal agency, which regulates mortgage giants Fannie Mae and Freddie Mac. The price index is derived from mortgage data from the two companies.
In the OFHEO index, prices fell in seven states from the fourth quarter to the first, including California, Nevada and Florida, three states that saw the largest price gains in 2004 through 2006.
Prices were dropping at a 3.4% annual rate in California and at a 2% annual pace in Nevada and Massachusetts.
Prices were down quarter-to-quarter in 96 of 285 cities, including 13 of 18 Florida cities and 22 of 26 cities in California. Among 22 major cities around the nation, prices were falling in eight.
On a year-over-year basis, prices fell in two states: Michigan and Massachusetts.
This groundbreaking book is a new comprehensive round of debate developed in response to the lack of research on design pedagogy. It provides thoughts, ideas, and experiments of design educators of different generations, different academic backgrounds, who are teaching and conducting research in different cultural contexts. It probes future universal visions within which the needs of future shapers of the built environment can be conceptualized and the design pedagogy that satisfies those needs can be debated.Spaces Speak, Are You Listening?
We experience spaces not only by seeing but also by listening. We can navigate a room in the dark, and "hear" the emptiness of a house without furniture. Our experience of music in a concert hall depends on whether we sit in the front row or under the balcony. The unique acoustics of religious spaces acquire symbolic meaning. Social relationships are strongly influenced by the way that space changes sound. In Spaces Speak, Are You Listening?, Barry Blesser and Linda-Ruth Salter examine auditory spatial awareness: experiencing space by attentive listening. Every environment has an aural architecture.�ltimasmag
To provide a publication designed for the internet with the body and graphic concept of a magazine or a book is the complement to 3 years of images in ultimareportagens, with special dossiers, audio slide-shows and a small collection of FG + SG books of photography on contemporary Portuguese architecture. �ltimasmag is yet another form we use to transmit architecture and hence our work. And to coincide with �ltimas� third anniversary, this first number has a special flavour. Each bilingual edition will focus on an architectural work of special and topical relevance, analysed in a complete dossier including everything from sketches to critical texts, building blueprints and, of course, photographs. It will be regularly available and completely free for online reading or to download in order to collect or print. The choice is yours.
The rate of home price appreciation in the U.S. remained steady in the fourth quarter of 2006, extending a general trend of deceleration begun earlier in the year. Home prices, based on repeat sales and refinancings, were 1.1 percent higher in the fourth quarter than they were in the third quarter of 2006. This is slightly above the revised growth estimate of 1.0 percent from the second to the third quarter.Does anyone possibly believe that housing prices in general were still rising at the end of 2006? I don't. I doubt even David Lereah believes that.
Prices in the fourth quarter of 2006 were 5.9 percent higher than they were in the same quarter in 2005. Price appreciation in 2006 was substantially smaller than the tremendous price gains of recent years, which ranged from 7.4 percent in 2002 to 13.2 percent in 2005. The figures were released today by OFHEO Director James B. Lockhart, as part of the House Price Index (HPI), a quarterly report analyzing housing price appreciation trends.
�These data show that, on the whole, prices are still rising, albeit at a much slower
pace,� said Lockhart. �This suggests that house price appreciation is, for now, more in line with historical norms.�
U.S. home prices dropped 1.4% in the first quarter compared with a year earlier, the first year-over-year decline in national home prices since 1991, according to the S&P/Case-Shiller index released Tuesday.HPI Methodology
A year ago, home prices were rising at an 11.5% pace. Prices have been falling for the past three quarters.
The Case-Shiller indexes cover three geographical areas. The national index is released quarterly, while the 10-city and 20-city indexes are released each month.
The 10-city Case-Shiller price index fell 1.9% year-on-year through March, while the 20-city index dropped 1.4%. The 10-city index has fallen nine months in a row, while the 20-city index has fallen for eight straight months.
Thirteen of 20 cities in the Case-Shiller index have seen falling prices in the past year, led by Detroit (down 8.4%) and San Diego (down 6%). Home prices rose 10% in Seattle, 7.4% in Charlotte, N.C., and 7% in Portland, Ore. Prices in Phoenix and Las Vegas, Nev., have fallen the furthest from their peak. After growing at a 49.3% pace in September 2005, home prices in Phoenix are now down 3% year-on-year. In Las Vegas, price gains went from 53.2% in September 2004 to negative 1.6% in March 2007.
Among other major cities tracked by the index, home prices are down 4.9% in Boston, down 4.8% in Washington, down 3% in Tampa, Fla., down 2.4% in Cleveland, and down 2.3% in San Francisco. Prices fell 2% in Denver, 1.9% in Minneapolis, 1.4% in Los Angeles and 1.1% in New York. In addition to the price gains in Seattle, Charlotte and Portland, prices rose 2% in Atlanta, 1.6% in Dallas, 1.3% in Chicago and 1% in Miami.
The Case-Shiller index is considered a superior gauge of home prices compared to the median sales-price data released by the Commerce Department or National Association of Realtors, because it tracks multiple sales on the same property and is therefore not influenced by a different mix of homes sold in a period.
Unlike the price index produced by the Office of Federal Housing Enterprise Oversight, the Case-Shiller index does not include refinancings. And, also unlike the OFHEO index, it includes homes with mortgages larger than the conforming limit of $417,000.
The OFHEO index for the first quarter will be released on Thursday. Through the fourth quarter, home price gains had slowed to 5.9% year-on-year from 13.3% a year earlier. The OFHEO purchase-only index (which excludes refinancings) had risen 4.1% year-over-year.
Each quarter, Fannie Mae and Freddie Mac provide OFHEO with information on their most recent mortgage transactions. These data are combined with the data of the previous 32 years to establish price differentials on properties where more than one mortgage transaction has occurred. The data are merged, creating an updated historical database that is then used to estimate the HPI.Shiller Methodology
The HPI is a weighted, repeat-sales index, meaning that it measures average price changes in repeat sales or refinancings on the same properties.
The HPI is based on repeat transactions. That is, the estimates of appreciation are based on repeated valuations of the same property over time. Therefore, each time a property "repeats" in the form of a sale or refinance, average appreciation since the prior sale/refinance period is influenced.
Eligibility CriteriaShiller attempts to adjust for time factors by giving more weighting to repeat sales (as long as they are at least 6 months apart) as the following chart shows.
To be eligible for inclusion in the indices, a house must be a single-family dwelling. Condominiums and co-ops are specifically excluded. Houses included in the indices must also have two or more recorded arms-length sale transactions. As a result, new construction is excluded.
High Turnover Frequency
Data related to homes that sell more than once within six months are excluded from the calculation of any indices. Historical and statistical data indicate that sales made within a short interval often indicate that one of the transactions 1) is not arms-length, 2) precedes or follows the redevelopment of a property, or 3) is a fraudulent transaction.
Time Interval Adjustments
Sales pairs are also weighted based on the time interval between the first and second sales. If a sales pair interval is longer, then it is more likely that a house may have experienced physical changes. Sales pairs with longer intervals are, therefore, given less weight than sales pairs with shorter intervals.
The Florida legislature plans to convene a special session in mid-June that could result in more than $30 billion in property-tax relief over the next five years, the Wall Street Journal reported.That post got me to thinking about dilemmas in general.
- Thanks to the housing boom, the average annual property-tax bill in the U.S. was $1,132 per person in 2005, up 13% from 2000 in inflation-adjusted terms, according to data from the Commerce Department.
- The boom was so strong that in many areas housing prices rose too fast for local tax assessors to keep up, the WSJ said.
- Now, tax assessments are catching up just as market prices are declining, a double whammy for homeowners facing increasing mortgage payments due to resets, or homeowners now trapped in residents with property tax bills edging them out of their comfort zone.
- But that's the homeowners problem.
- Here is the dilemma for states: Reducing property-tax revenues threatens budgets of cities and counties. However, a property-tax cut could stimulate the economy by leaving homeowners with a bit more money in their pockets.
- Florida doesn't have a personal income tax, and its cities and counties depend heavily on property taxes to pay for services such as police and firefighters, the Journal noted.
[The Jewelers' Building] was created for the city�s diamond merchants and had an unusual security procedure � to reduce the chances that its tenants would be mugged walking between their cars and their offices, the building featured a central auto elevator. People would drive into this elevator and it would take them to the floor where their office was. Jewelers loaded down with precious stones and metals wouldn�t have to be exposed to a potentially hostile exterior environment. Though innovative, it was an arrangement that didn�t last very long. By the Second World War the auto elevators were abandoned and decked over to make more office space.This description might actually fit 200 Eleventh Avenue, where owners of $16 million condos won't have to worry about being mugged or be exposed to the potentially hostile exterior environment of Chelsea and the rest of Manhattan!
Short sellers are betting against U.S. stocks like never before as the Standard & Poor's 500 Index approaches an all-time high. That's making some of the biggest bulls even more optimistic.Dow 15,000 on a short squeeze huh? I am hearing other targets like 1800 on the S&P. And there is talk of bears piling it on when bulls are pressing their bets based on merger mania in leveraged buyouts (LBOs) and banking on short squeezes.
"What the short seller appears to be doing is doubling down," said Kenneth Fisher, who oversees about $40 billion as chairman of Fisher Investments in Woodside, California. "You love to see it, because if you believe there is a basic driver to the bull market, they're going to get run over."
The amount of shorting -- where traders sell borrowed stocks expecting to buy them back after prices fall -- jumped to 3.1 percent of the total shares listed on the New York Stock Exchange this month. That's the highest since at least 1931, according to Bespoke Investment Group LLC, a research firm in Mamaroneck, New York.
The wagers represent billions of dollars that could be invested in equities if short sellers close their positions. The bears also reassure fund managers who get skittish when few traders anticipate the possibility of a stock market decline.
"Ultimately you have to cover the short positions and that tends to create more of a buying frenzy," said Andy Engel, co- manager of the Leuthold Core Investment Fund, which has outperformed 99 percent of similar funds over the past five years.
Losses are mounting for traders speculating on a drop in stocks. So-called short interest on the NYSE rose to a record 11.8 billion shares as of May 15, 7 percent more than a month earlier, according to the world's biggest exchange.
"Anyone that did the theory, sell in May and go away, they're going to wish they never read that," Chicago-based Froehlich said. He expects the Dow average to climb 11 percent and reach 15,000 by Christmas.
A similar claim is that �there are a lot of shorts out there, and they're going to be forced to cover.�In today's Buzz, Jason Goepfert at SentimentTrader responded to this Mini-Minyan Mailbag:
Again, this is not supported by the data. Recent years have seen a proliferation of hedge funds, market neutral strategies, and merger arbitrage vehicles. All of these are based on matched long and short positions. These are not �speculative� or �naked� shorts, and in many cases are not even bets that the stocks sold short will decline (instead, the objective is to earn a difference in performance between the longs and the shorts, regardless of whether they both rise or fall in absolute terms). It is wrong to quote the current short interest as a bullish argument, as if the shorts are somehow compelled to cover here.
"Regarding the record-breaking levels of short sales: My question stems from the fact, and from the remembrance of something (Prof. Succo) touched on awhile back, that the short sale figures can't really be relied upon due to traders who may be short, but vs. derivatives of some kind (in most cases being calls on a delta ratio)...So there you have it. Thus there are three solid reasons why short interest is not what it seems: derivatives hedging, long/short funds, and arbs on convertible bonds. Once again mainstream media presents a distorted view of what is really happening and draws the wrong conclusions.
That being said my question is how much of the short sales out there do you believe to be part of a larger vol play and how much do you think is due to a plain vanilla short."
Minyan Michael
Reply from Jason Goepfert at SentimentTrader
Michael, this is a difficult question on which to even hazard a guess, since we don't know how many traders are using the options as a hedge versus speculation, and for those who do hedge, on what kind of ratio they're doing so.
But, that doesn't mean we can't take a guess, right? So here's my shot. From mid-April through mid-May, the NYSE reported 11.7 billion shares short, which was a change of +772 million from the previous month.
Over approximately the same period, there were 18 million call options bought to open on all the U.S. exchanges by large traders. By "large traders," I mean those that did transactions of 50 or more contracts at a time.
Assuming that every trader hedged those call options they bought, and they wanted to remain delta-neutral, and the average delta of the calls was 0.50, then they would need to short about 902 million shares.
There are a whole host of wild assumptions in that previous paragraph, but it resulted in these hedgers shorting 117% of the change in the NYSE short interest! That's obviously not possible, which means that some of our assumptions are off base.
If we assume that only half the traders were fully hedging those calls, then last month's activity would have explained about 60% of the change in short interest. Or, assuming that the traders did not remain exactly delta-neutral, or the average delta was lower, would also reduce the number of shares they had to short.
So without knowing a lot more detail, this is basically an impossible question to answer, but given the information we do have, it seems like derivative activity could possibly explain a big chunk of the monthly changes in short interest.
The Museo Nacional Reina Sof�a in Madrid, Spain by Jean Nouvel, 2005.
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architectural videos*
A blog dedicated to architectural videos. (added to sidebar under architectural links::audio/video; via architechnophilia)
Smart City Radio
"A weekly, hour-long public radio talk show that takes an in-depth look at urban life, the people, places, ideas and trends shaping cities." (added to sidebar under architectural links::audio/video)
Architorture
"A documentary that captures five diverse students in a single studio at one university throughout the entirety of their thesis project...Check back with us often to watch our concept evolve." (via too many pages to list)
Round II of the Strategic Economic Dialog has come and gone. In just eight months time, this carefully orchestrated consultation between senior officials from the US and China has established a robust framework of engagement between the world�s first and fourth largest economies. The good news is there is progress to report. The bad news is that the progress was predictably incremental � insufficient to defuse the political angst now bubbling over in the US Congress.If Roach has it correct that there is a 60% chance of massive protectionist legislation out of Congress, then I will suggest that it will be the equivalent of another Smoot Hawley Tariff Act if it passes.
In an era of accelerating globalization, the Chinese strain of open development offers the world considerably greater opportunity than the closed approach long advocated by Japan.
The US Congress could care less. The economic pressures bearing down on Washington come straight from the American middle class. And with understandable reason: According to the US Bureau of Labor Statistics, the median real wage � inflation-adjusted wages for the worker in the middle of the pay distribution � has risen a cumulative total of just 0.9% over the seven years ending in the first quarter of 2007.
Over the past 30 years, China has been exceedingly careful to balance the pace of reforms against the risks of instability. At no point did it follow the shock-therapy approach embraced by states of the former Soviet Union. �Determined incrementalism� is the best way I would describe the character of three decades of Chinese reforms � no backtracking but steady and unrelenting progress toward private ownership and markets. This approach is very much at odds with the search for the �magic potion� that always seems to dominate the short-term problem-solving mentality of Washington politicians. The radical currency-fix option that is now on the table in Washington is very much at odds with the gradualism that has served China so well over the past 30 years.
The easy answer is to blame someone else � in this case, scapegoating China because it accounts for the largest bilateral piece of America�s record multilateral trade deficit. The tougher answer is to get to the bottom of the real wage stagnation problem � and put policies in place that could rectify this situation.
I stand by my view that there is about 60% chance that a veto-proof majority of the US Congress will pass a WTO-compliant bill by the end of 2007 that will impose broad-based trade sanctions on Chinese products sold in America.
Sometimes the statistics that take the longest to arrive can provide the most important information, particularly when they point to inflection points in the economy.One has to be nuts in the midst of this housing slump to think that we are adding construction jobs at the pace estimated by the BLS, but nonetheless, the BLS seems to be sticking to their model (without ever explaining it I might add). It is one gigantic optimistic black box that will not turn negative until it is obvious to everyone on the planet that the US is in recession.
So it may be with jobs data that the Bureau of Labor Statistics released this month for the third quarter of 2006. The new data calls into question the previous conclusion that employment grew at a strong rate in late 2006.
And it indicates that many small businesses, which had been leading the way in job creation, are now suffering. As is shown in the accompanying graphic, companies with fewer than 50 employees lost workers in the quarter, while larger ones kept hiring, albeit at a reduced pace.
It also appears that 8,000 more businesses closed than opened in that quarter, making it the worst quarter by that measure since the third quarter of 2001, when an economy already in recession was jolted by the Sept. 11 attacks.
The data is included in a quarterly report, titled �Business Employment Dynamics,� that comes from reviewing employment at every company in the United States that is subject to state unemployment compensation laws. By that measure, private-sector employment rose by just 19,000 jobs in the quarter.
The widely reported data from the bureau�s monthly survey of employers concluded that the quarter had a net gain in private-sector jobs of 498,000. That led economists to conclude that employment growth was holding up well even though the overall economy had slowed, growing at just a 2 percent annual rate.
A big difference was in construction employment, which the quarterly study found contracted by 77,000 jobs in the quarter, in contrast to the increase of 34,000 jobs shown by the monthly surveys.
�The data show we had two consecutive quarters of job losses in construction,� said David Talan, an economist at the bureau, noting the small decrease shown in the second quarter of last year.
Those in their 30s make less than dads did, a report says. Outsourcing and the advancement of women are cited.Let me be the first to say that any study that blames women for shrinking men's wages is simply way off base as to cause and effect. Excuses are now running rampant.
American men in their 30s earn less than their fathers' generation did at the same age, potentially reversing longtime assumptions that each successive generation will be better off than their predecessors, according to a study released Friday.
Family incomes of thirtysomething men have continued to rise in recent decades, but mostly because more of their wives are working, the study's authors said. Yet even with the addition of women's paychecks, the rate of family income growth has slowed.
Taken together with data showing more workers are earning less in comparison with the stratospheric incomes of top earners, the report suggests that a growing number of Americans "believe that the rules of the game are no longer fair," said John E. Morton, director of the Economic Mobility Project at the Pew Charitable Trusts and one of the study's lead authors.
In 2004, the median income for a man in his 30s was $35,010, 12% less than that of men in their 30s in 1974, adjusted for inflation, according to the study, which was based on Census Bureau data. By contrast, thirtysomething men in 1994 earned 5% more than their older counterparts.
The generational income gap highlights troubling questions, Morton said, including what happens if an increasing percentage of Americans believe the American dream "is off limits to them."
Die-hard careerist baby boomers may partly explain the inability of thirtysomething men to move up the income ladder as quickly as their fathers. From the moment Generation Xers first set foot in the workplace, the boomers have been the "ceiling" blocking their way up the income ladder, said Peter Rose, a partner with marketing research firm Yankelovich Inc. in Los Angeles.
"The boomers stand out in defining themselves in terms of their work and have shown a disinclination to get out of the way," he said.
Freelancer Hayslett thinks there's another factor at play: "Honestly, it seems that women are more together," he said.
They're more stable and focused, he said, as compared with "a lot of guys who feel so frustrated that they tend to move around and leave."
The Shrine of Remembrance Visitor Centre in Melbourne, Australia by Ashton Raggatt McDougall.
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Regence BlueShield on Tuesday began notifying 137,000 individual-plan customers that their premiums are rising an average of 19 percent in July in the steepest increase for individual plans this year by a Washington health insurer.Cute. Hold off rate hikes, get 30,000 more customers then jack up costs 19-40%. Inquiring minds might be asking if this is just a Washington state thing. So let's take a look.
And for 16,000 of those enrollees, the rate increase will total 40 percent because they also happen to be moving into an older, more expensive age group.
The rate jump is a sharp change from last year, when Regence proposed � then rescinded � raising premiums by 5 percent. Regence has gained 30,000 new customers, bringing its total individual members to 137,000.
The rate boost does not apply to people who buy their coverage through employer plans or small-group plans. But both Regence's rate reversal last year and the size of this latest premium increase have outraged Washington Insurance Commissioner Mike Kreidler, who accuses the insurer of a bait-and-switch.
"I have serious concerns that consumers may have been whipsawed in an effort by Regence to increase market share," Kreidler wrote in a letter sent Tuesday to state legislative leaders.
A common refrain this spring in local town and city halls is that despite increased revenues, jobs or programs will have to be cut. The culprit, according to municipal officials, is an increase in fixed costs, which are rising faster than tax receipts.In the state of Michigan Inmate health care costs soar.
The major factor is health insurance. But per-employee annual costs for healthcare to municipalities covered by City Weekly have almost doubled since 2000, according to officials in Boston, Brookline, Cambridge, and Somerville.
According to a Boston Municipal Research Bureau report of November 2006, the city cut 1,176 employees between 2002 and 2006. But in that time it also spent an additional $187.5 million on employees, two-thirds of which was to cover benefits, such as healthcare.
The cost of sending Michigan's 51,000 inmates to hospitals and medical specialists outside prison walls has skyrocketed this year, with state officials predicting spending will run 61 percent over budget.U.S. is Dead Last
Corrections officials expect the bill for specialty care and hospitalization to grow from $58.8 million to nearly $95 million by Sept., 30, the end of the fiscal year.
"It's huge," said Barry Wickman, the Michigan Department of Corrections chief financial officer.
In all, taxpayers will spend $281 million this year to cover physical and mental health treatment and prescriptions for prisoners, even as the state considers cuts to schools and local governments to deal with a deficit that's pegged at $686 million.
Driving the increase are more inmate referrals to specialists outside prison and more hospital stays. In 2004, inmates spent 9,612 days in hospitals, jumping to 13,039 in 2006. Similarly, the number of referrals to care outside prison rose from 18,777 in 2004 to 23,294 in 2006.
Corrections officials say they have little choice but to pay the bills. A 1976 U.S. Supreme Court decision mandated health care to prisoners as an entitlement, including dental, vision, pharmaceutical and mental heath treatment.
The payment for outside care had been running $5 million per month, but jumped to $8.15 million during each of the first four months of the fiscal year starting in October, according to Corrections. Lawmakers appropriated $11.7 million for extra costs last fiscal year and $12.6 million this fiscal year. A request for an additional $23.3 million this year is pending.
"The increase in (health care) costs within the prison system far outstrips what we're seeing in the rest of society,'' Kahn said. "This is much, much, much worse."
Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. Compared with five other nations�Australia, Canada, Germany, New Zealand, the United Kingdom�the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill.Health Care Stats
The most notable way the U.S. differs from other countries is the absence of universal health insurance coverage. Other nations ensure the accessibility of care through universal health insurance systems and through better ties between patients and the physician practices that serve as their long-term "medical home."
With the inclusion of physician survey data in the analysis, it is also apparent that the U.S. is lagging in adoption of information technology and national policies that promote quality improvement.
My dad has alzheimer's. He qualified for Hospice care several years ago and has been under the care of odyssey hospice since 2004. Hospice is a service aimed at comfort, mainly for the last 6 months. My dad is a tough, sweet guy, so he's chosen to keep hanging on ;-) There are clients who have had this care for 5-6 years, in some cases, where the health decline is steady but serious.In response to Julie's post PeterTribo responded with his story on hospice care.
Odyssey was sued in a whistle blowing case a couple of years ago for giving services to people who didn't qualify and they had to pay the government millions of dollars. See the Hospice Blog article Is Odyssey Hospice the tip of the iceberg?
I just recently got notice that my dad no longer qualifies for hospice. It is ironic because the guy is very much bedridden now and he is literally wasting away as the disease progresses. However they consider his condition "stable". They have a new feature to call and contest it. I did, and the person was very sympathetic, but my dad was denied services. I then got a three page letter about the denial of services.
I contacted another hospice provider who hasn't been sued by the government for fraud and they did an initial evaluation of my father and will return in a month to chart any changes. I fully expect my dad to requalify for hospice. I just wanted to give the heads up in case anyone else is involved with Hospice or will be considering Hospice. I think the government might just be shifting the burden of end of life care back onto the families, despite past promises. ~julie
Part of my skeptical attitude toward all things "official" and "bureacratic" comes from my caring for my mother for three years while she was in a nursing home. This occurred in Massachusetts 1993-96 and I was a naive layman with no experience dealing with either the Healthcare or the Legal System. I did a lot of research on both at that time and what I found horrified me.Plans are floating everywhere but little attention is focused on fraud, waste, paperwork, the right to die, liability costs, or health care rationing. Is it any wonder costs are soaring?
One of the first books I read at a Probate and Family Court Law Library run by the MA government was a tome titled THE LAWYER'S GUIDE TO MEDICARE. I had read a few "civilian" books about MEDICARE by that time but this book was a real shocker. I can only describe it as a "nudge, nudge, wink, wink" guide to scammming MEDICARE. It described in detail methods to hide assets and get MEDICARE to pay fraudulent legal bills. This book really sat me up in my chair as to the state of affairs in the US since it was written by a Law Professor!
One of the techniques used by the nursing home to raise additional revenue was quite a shocker. My mother had to be hospitalized two times outside of the nursing home. When that happens, the nursing home gave me the choice: do you want to reserve your mother's place if she returns from the hospital? If not, we do not guarantee that she can return to the facility. So, for each day that you pay, you may or may not be paying for a place that might have been empty anyway. Only the nursing home knows their occupancy rate. This is classic double billing.
Another shocker was that the nursing home dealt with only one drug supplier. At one point, they changed the supplier and the cost of a drug my mother was taking was tripled!
Another time I received a call from someone who said they were my mother's "audiologist". My mother had never had any trouble with her hearing. I did some research on this and found out that a private company was allowed into the facility to examine patients and sell their wares. I was never consulted on this. It sure looked like a revenue raiser for both the hearing aid company and the nursing home via fees paid to them.
On four occasions, ambulances were used and I thought the fees for these rides were exorbitant.
I can only imagine a room full of Healthcare Beancounters examining every nook and cranny of Operations and devising schemes and methods to maximize profits. In short, I am rather amazed that more Americans working in this vast system are not whistle blowing. Like many institutions in American society, one must ask if the corruption and venality are not beyond critical mass.
One might simply substitute the Mortgage Industry with its crooked appraisers, mortgage brokers willing to falsify paperwork, Wall Street ready to slice, dice, bury the paper and regulators turning a blind eye to all. It would seem that much of the American Economy is predatory.
The California Department of Insurance and the Orange County District Attorney's Office have arrested three doctors for medical fraud. The doctors are the latest charged defendants in what's being dubbed the Unity Outpatient Surgery Center scheme, and are accused of performing unnecessary surgical procedures and fraudulently billing more than $30 million to medical insurance companies.Arguing about competing healthcare plans and health savings plans or even mandating insurance as Massachusetts was dumb enough to do (see Massachusetts Marks Health-Care Milestone Insurance Required Of All Residents) is a waste of time unless those plans deal with fraud prevention, paperwork reduction, the right to die, liability costs, and some reasonable discussion about health care rationing. In other words the whole system probably ought to be scrapped not patched.
According to the DOI, the doctors participated in a $96 million billing scheme that recruited 2,000 healthy people from all over the country to receive unnecessary surgeries in exchange for money or low cost cosmetic surgery. The recruitment of patients, or "capping," is illegal in California. Insurance companies paid Unity more than $17 million during a 10-month period.
The Unity cappers, or recruiters, targeted employees from businesses in more than 32 states and covered by PPO insurance plans, as pre-approval from the insurance company would not be a requirement for surgery. More than 1,600 employers were affected by employees who were involved in this scheme. The cappers arranged transportation for the patients, scheduled the surgeries, and coached the healthy patients on what to say. In exchange for undergoing surgery, the "patients" would receive a cash payment, usually between $300 and $1,000 per surgery, or credit toward a free or discounted cosmetic surgery.
Chan is accused of performing procedures on 208 patients which resulted in more than $9.5 million in insurance billing with more than $1.8 million collected for the unnecessary and fraudulent work.
Rosenberg, on staff at Cedars-Sinai Medical Center and affiliated with Herbalife, primarily performed colonoscopies and esophagogastroduodenoscopy (EGDs). Rosenberg is accused of performing 646 procedures on 554 patients, which resulted in the fraudulent billing to insurance companies of more than $9 million, for which Unity was paid more than $2.3 million.
Hampton is accused of performing 180 procedures on 178 patients. He primarily performed thoracic sympathectomies, also known as sweaty palms surgeries, which is a highly unusual and dangerous medical procedure.
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The beleaguered housing industry is sending mixed signals, with sales of new homes surging in April by the biggest amount in 14 years while prices endured a record plunge. Analysts said the price drop could provide evidence of builders' desperation. They are looking to reduce a glut of unsold homes in the face of the worst slump in sales in more than a decade.Good News
The Commerce Department reported Thursday that sales of new single-family homes jumped by 16.2 percent in April to a seasonally adjusted annual rate of 981,000 units. That was the biggest one-month sales gain since a 16.4 percent surge in April 1993. Even with the increase, however, sales are 10.6 percent below the level of a year ago.
The median price of a new home -- the midway point between the costliest and cheapest -- fell to $229,100, a record 11.1 percent below the March level. The price was 10.9 percent below the level of a year ago, the biggest year-over-year price decline since 1970.
Analysts said the drop in home prices probably reflected efforts by builders to cut prices more aggressively to sell homes. The inventory of unsold new homes fell slightly to 532,000 in April. It still would take six months to deplete this inventory at the April sales rate.
American Express is breaking new ground, allowing its card members to pay their monthly mortgage bills on the card. I know what you're thinking, but hold on... Amex is requiring that these be prime loans only, so you can forget that whole subprime mortgage implosion issue. And of course, they'll be charging you $395 to enroll in the program.How anyone can think this is a good idea is simply beyond me. I guess everyone thinks prime is safe. Then again all the lenders acted as if subprime was safe. And of course we all know how well "contained" this problem is, don't we?
"Obviously you have to be approved for the loan and depending on your credit line, it's all governed by the same standards," Christine Elliott of American Express tells me.
The loans, for now, also have to come from American Home Mortgage Corp the first lender to offer this Express Rewards Mortgage program, and oh to think of the rewards!!