Nurse Practitioners Treat Patients Well, Cheaply. So Doctors Want to Stop Them.

 

Health-care costs are up and demand for services will only
increase under Obamacare. In many areas, nurse practitioners can
provide high-quality care at cheaper costs than traditional
doctors.

So why do doctors and other regulators want to clamp down on
nurse practitioners?

This video was originally released on December 3, 2013.
Go here
for more details, resources, and downloadable
resources.

Here’s the original writeup:

“The major motivation in this opposition is kind of a turf war,”
says Dale Ann Dorsey, a nurse practitioner (NP) who runs her own
women’s health clinic in Scottsdale, Arizona.

A nurse practitioner is a registered nurse (RN) who has pursued
extra clinical training and a master’s degree and is able to
practice medicine beyond the scope of what a regular RN can. How
far beyond that scope NPs should be allowed to go is a question
facing legislators across the country.

Arizona is one of 18 states that allow nurse practitioners to
run independent primary care practices, with full prescribing
privileges, and without the oversight of a licensed physician.
Earlier this year, nurse practitioners in California pushed to
liberalize scope-of-practice rules in the Golden State, only to
be stopped
dead in their tracks
 by the powerful California Medical
Association (CMA), which poured
more than $1 million into lobbying efforts
 in the first
half of 2013 to defeat the legislation.

“[Nurse practitioners’] training is very limited compared to
physicians,” says Paul Phinney, a California pediatrician and
former CMA president. “They lack a certain kind of experience that
I believe is very important to the safety of patients and the
quality of medical care that they’re providing.” 

He has a point. Physicians are required to obtain far
more education and clinical experience
 than are nurse
practitioners. But there’s little to no evidence showing that, when
it comes to primary care, all of that extra education makes any
difference in the health outcomes of patients. A 2012 Health
Affairs survey of the medical literature foundno
difference in patient health
 between groups treated by
doctors and by nurse practitioners. The survey did find a slightly
higher satisfaction rate among patients of nurse practitioners.

So if outcomes are similar, and patients are satisfied, why are
states such as California hesitant to let more nurses open their
own practices? The question is especially pressing since groups
such as the Association of American Medical Colleges
are expecting
a severe doctor shortage
 in the near future due to the
aging population. Reason Foundation analyst Adam Summers says that
concern for the public good is a secondary consideration at best in
this case.

“Licensing laws are almost always sold as being in the public
interest,” says Summers. “But in reality all they do is drive up
prices and reduce competition, which reduces the incentive to
provide good services to the consumer.”

Watch the video to learn more about the nurse practitioners’
struggle for clinical independence – a fight that just make health
care cheaper and more available.

Scroll down for downloadable links, and subscribe
to Reason TV’s YouTube
channel
 for daily content like this.

Approximately 5 minutes. Produced by Zach Weissmueller. Shot by
Tracy Oppenheimer and Weissmueller. Graphics by William Neff.

from Hit & Run http://ift.tt/1kyjYLB
via IFTTT

Chris Christie Booed At Times Square By "We Hate Traffic"-Chanting New Yorkers

Philadelpia may have booed Santa Claus, but last night it was New York’s turn to boo a not so jolly, calorie-challenged man, embattled NJ governor Chris Christie, during the ceremonial Super Bowl “handoff” at Times square. However, in the aftermath of Friday’s NYT revelations that evidence exists that Christie was aware about the real reason behind the bridge closures as they happened, onlookers only had a brief 30 seconds during which to boo Christie before he promptly departed the stage on his own.

The Post describes Saturday’s event as follows:

Amid a chorus of boos, New Jersey Gov. Chris Christie took a Times Square stage Saturday for the ceremonial Super Bowl “handoff” — then ran for daylight from “Bridgegate” questions.

 

The usually loquacious governor spoke for just 30 seconds at the event, during which one detractor jeered, “We hate traffic! We hate traffic!”

 

The ceremony, during which Christie and Gov. Cuomo passed on Super Bowl responsibilities to next year’s host, Arizona Gov. Jan Brewer, came a day after a disgraced Christie crony claimed “evidence exists” to show Christie knew about the George Washington Bridge traffic snarl as it unfolded.

 

“We look forward to handing it over to Arizona,” Christie told the crowd. “I was proud to be in New Orleans last year to accept the handoff on behalf of the region.”

 

As he scrambled to leave, Christie ignored a Post reporter’s questions on the new “evidence” mentioned in a letter released Friday by former Port Authority official David Wildstein.

Guess the governor should have handed out some more Christiephones with which to buy the affection of the great unwashed in advance. In the meantime, Christie defended himself with the following 700 page email leaked yesterday:

 

The above summarized as to the reasons suggested by the Christie camp for Wildstein’s allegations:

Because as a “a 16-year-old kid” he filed a lawsuit over a school board election and was “publicly accused by his high school social studies teacher of deceptive behavior.” Because he was, according to Christie, a “tumultuous” person (not the correct usage of that word, Governor, but whatever). Because he was “a political animal” who had “a controversial tenure” as the mayor of Livingston. Because he “made moves that were not productive.”

Sadly for Christie, at this point few are buying it, as yet another politician is dragged right back into the same maelstrom of petty cronyism and corruption from which he fought so hard to show he is not part of, ahead of a presidential campaign that is now all but finished.


    



via Zero Hedge http://ift.tt/1nEgv0D Tyler Durden

Chris Christie Booed At Times Square By “We Hate Traffic”-Chanting New Yorkers

Philadelpia may have booed Santa Claus, but last night it was New York’s turn to boo a not so jolly, calorie-challenged man, embattled NJ governor Chris Christie, during the ceremonial Super Bowl “handoff” at Times square. However, in the aftermath of Friday’s NYT revelations that evidence exists that Christie was aware about the real reason behind the bridge closures as they happened, onlookers only had a brief 30 seconds during which to boo Christie before he promptly departed the stage on his own.

The Post describes Saturday’s event as follows:

Amid a chorus of boos, New Jersey Gov. Chris Christie took a Times Square stage Saturday for the ceremonial Super Bowl “handoff” — then ran for daylight from “Bridgegate” questions.

 

The usually loquacious governor spoke for just 30 seconds at the event, during which one detractor jeered, “We hate traffic! We hate traffic!”

 

The ceremony, during which Christie and Gov. Cuomo passed on Super Bowl responsibilities to next year’s host, Arizona Gov. Jan Brewer, came a day after a disgraced Christie crony claimed “evidence exists” to show Christie knew about the George Washington Bridge traffic snarl as it unfolded.

 

“We look forward to handing it over to Arizona,” Christie told the crowd. “I was proud to be in New Orleans last year to accept the handoff on behalf of the region.”

 

As he scrambled to leave, Christie ignored a Post reporter’s questions on the new “evidence” mentioned in a letter released Friday by former Port Authority official David Wildstein.

Guess the governor should have handed out some more Christiephones with which to buy the affection of the great unwashed in advance. In the meantime, Christie defended himself with the following 700 page email leaked yesterday:

 

The above summarized as to the reasons suggested by the Christie camp for Wildstein’s allegations:

Because as a “a 16-year-old kid” he filed a lawsuit over a school board election and was “publicly accused by his high school social studies teacher of deceptive behavior.” Because he was, according to Christie, a “tumultuous” person (not the correct usage of that word, Governor, but whatever). Because he was “a political animal” who had “a controversial tenure” as the mayor of Livingston. Because he “made moves that were not productive.”

Sadly for Christie, at this point few are buying it, as yet another politician is dragged right back into the same maelstrom of petty cronyism and corruption from which he fought so hard to show he is not part of, ahead of a presidential campaign that is now all but finished.


    



via Zero Hedge http://ift.tt/1nEgv0D Tyler Durden

Cathy Young Questions Allegations of a Cyber War on Women

InternetLast month,
freelance journalist Amanda Hess, in a lengthy feature in Pacific
Standard, declared that women are not welcome on the Internet.
After describing her own frightening experience of online stalking,
Hess lists other ugly incidents and cites statistics and studies
arguing that women on the Internet—journalists, bloggers, and
general users—are routinely terrorized solely because of their sex.
New York Times conservative columnist Ross Douthat called
the article “a candidate for the most troubling magazine essay of
2014.” 

Troubling, indeed. But is it true?

There is no doubt that many women, prominent and obscure, have
experienced severe online harassment that can spill over into “real
life,” writes Cathy Young. Hess’s stalker, who repeatedly
threatened her with rape and murder, went from emails to phone
calls and voice mail messages. Whether such harassment is a
female-specific problem and so pervasive as to actually deter
women’s online participation, is far less clear.

View this article.

from Hit & Run http://ift.tt/1fNuGuy
via IFTTT

China’s Epic Skyscraper Construction Spree: A Harbinger Of The Crash?

If the Barclays Skyscraper Index, which posits bursts of skyscraper construction are a harbinger of great economic collapse and market crashes, is accurate, then the world is in for a, well, world of pain. And nowhere more so than in China.

While for nearly a century the undisputed leader in the constuction of massive, phallic-looking, mega-buildings that reach for the skies was the US, over the past decade the baton has undpisutedly shifted to the middle east, and specifically the Arab Emirates and Saudi Arabia, which currently house the top and second tallest skyscrapers in the world. The visual progression of the title holder for world’s tallest building is shown on the chart below.

 

The complete list of the Top 100 currently completed skyscrapers, courtesy of Skyscraper Center, is shown below.

 

However, as the following summary from Vizual-Statistix indicates, one country that is embarrassingly “only” in fifth place when it comes to tallest buildings is China.

 

Which is why the centrally-planned communist country with a penchant for issuing trillions of dollars in loans each year then bailing out all insolvent financial institutions and shadow banks, and an even greater penchant for creating excess capacity, has taken it upon itself to catch up.

And as the following list of projected skyscrapers, over the next several years China will be host of 5 of the world’s top 10 tallest buildings, and 14 of the top 20!

 

That’s ok though – China is obviously suffering from a case of Skyscraper envy.

However, the true scale of the problem only emerges when one expands the list of buildings either already in construction or already proposed. The list below shows only the skyscrapers proposed or currently in construction just in China!

Which is why if the Barclays Skysraper Index is indeed correct, then China – ignoring all other sirens of an imminent credit bubble implosion – better watch out below.

Source: Skyscraper Center


    



via Zero Hedge http://ift.tt/1j2gq6g Tyler Durden

China's Epic Skyscraper Construction Spree: A Harbinger Of The Crash?

If the Barclays Skyscraper Index, which posits bursts of skyscraper construction are a harbinger of great economic collapse and market crashes, is accurate, then the world is in for a, well, world of pain. And nowhere more so than in China.

While for nearly a century the undisputed leader in the constuction of massive, phallic-looking, mega-buildings that reach for the skies was the US, over the past decade the baton has undpisutedly shifted to the middle east, and specifically the Arab Emirates and Saudi Arabia, which currently house the top and second tallest skyscrapers in the world. The visual progression of the title holder for world’s tallest building is shown on the chart below.

 

The complete list of the Top 100 currently completed skyscrapers, courtesy of Skyscraper Center, is shown below.

 

However, as the following summary from Vizual-Statistix indicates, one country that is embarrassingly “only” in fifth place when it comes to tallest buildings is China.

 

Which is why the centrally-planned communist country with a penchant for issuing trillions of dollars in loans each year then bailing out all insolvent financial institutions and shadow banks, and an even greater penchant for creating excess capacity, has taken it upon itself to catch up.

And as the following list of projected skyscrapers, over the next several years China will be host of 5 of the world’s top 10 tallest buildings, and 14 of the top 20!

 

That’s ok though – China is obviously suffering from a case of Skyscraper envy.

However, the true scale of the problem only emerges when one expands the list of buildings either already in construction or already proposed. The list below shows only the skyscrapers proposed or currently in construction just in China!

Which is why if the Barclays Skysraper Index is indeed correct, then China – ignoring all other sirens of an imminent credit bubble implosion – better watch out below.

Source: Skyscraper Center


    



via Zero Hedge http://ift.tt/1j2gq6g Tyler Durden

Nine Event Risks

The investment climate has proven extremely difficult for investors to navigate.  Fed tapering and better world growth was to lead to higher interest rates.  Yet interest rates for the developed world have fallen sharply in recent weeks.    Aggressive quantitative easing by the Bank of Japan was widely understood to be yen negative, yet the yen is the only currency to have been stronger than the dollar in January.    Toward the emerging markets, investors were to take a more differentiated approach.  Countries with large current account deficit were particularly vulnerable, yet it appears that the entire asset class was tarred with the same brush.   Reports suggest that ETF for Mexican equities (EWW) showed the largest outflow, which seems counter-intuitive, especially since the higher wages and economic slowdown in China appear to work to its benefit. 

 

We identify, discuss and assess nine event risks of global investors in the week ahead. 

 

Emerging Markets (High Risk):   The MSCI Emerging Market equity index peaked in 2011 and is off a little more than 20% since then.   Last month, it fell 6%.   Investors’ post-2009 love affair with emerging markets is over.   The fact of the matter is that most were emerging markets 20 years ago and are likely to be emerging markets 20 years from now.   There were two attractors—liquidity and structural reforms and we suspect, as is their wont, investors have tended to emphasis the latter and under appreciate the former.   One clear implication is that real interest rates will have to rise through most of the emerging market universe.     And this will have negative knock-on effects for growth.    

 

However, due to some structural reforms, including more flexible currency regimes, somewhat deeper capital markets, and the accumulation of reserves, which can be understood as a type of self-insurance, many emerging market countries are better able to cope with a capital outflows.     The key to whether investor panic leads to a crisis seems to be largely a function of the response by policy makers.   The IMF/World Bank and the US Treasury have urged developing countries to take advantage of the signals to strengthen their own policy reaction.  They might as well be shouting in the wind. 

 

Portfolio Allocation (High Risk):   In addition to sizeable outflows from emerging market funds that have been widely reported, there have been three other notable portfolio adjustments.   First, anecdotal reports indicate that in recent weeks, several large asset managers have shifted from stocks to bonds.  In this context, we note that US Treasuries had their single best month in January since the middle of 2012.  To the extent there is foreign investment component, we note that due to relative volatilities, foreign fixed income investment tends to carry a higher hedge ratio than foreign equity investments.  Second, after strong foreign interests in recent months that has helped drive Spain and Italian rates to record lows, some large asset managers have reportedly begun adjusting positions on valuation grounds.   Third, Japanese investor appetite for foreign bonds that was evident in the second half  of 2013 appears to have waned in January, as they turned net sellers again.  For their part, foreign investors have slowed their purchases of Japanese shares. 

 

Trade Promotion Authority (Low Risk):  Within 24-hours of President Obama’s State of the Union Speech in which he called on Congress to grant him Trade Promotion Authority to complete the negotiations for Trans-Pacific Partnership and the Trans-Atlantic Trade and Investment Partnership, Senate Majority Leader Reid underscored his opposition.     Even though the risk that TPP, which was initially to be completed last year, is further delayed is high, the risk to investors appears minimal.  Yet, it speaks volumes about the outlook for fresh initiatives ahead of the November election and the consequence of the erosion of support for President Obama.  Note that this follows the recent refusal by Congress to ratify the long planned increase in the IMF’s quota.  Some observers talk about a new wave of isolationism in the US, but sometimes in the past, isolationism was a shroud to cover unilateralism.

 

China (Near-term Low Risk):   The Lunar New Year celebration will keep China out of the spotlight in the coming week.  It will report the service sector PMI reading first thing Monday in Beijing, but other than that, it will likely be out of the news in the coming days.  The official manufacturing PMI was reported at 50.5, which was in line with expectations, but is the lowest reading since last July.  Output hit a four month low and new orders slipped to six month lows, though both are still above the 50 boom/bust level.  Employment and export orders were below 50.  

 

Reserve Bank of Australia (Medium Risk):  The RBA is the first of the three central bank meetings from the high income countries.  There is little doubt that policy is on hold with the cash rate at a record low 2.5%.   The credit expansion, the somewhat higher than expected CPI  inflation figures, and the roughly 8% decline in a trade-weighted measure of the Australian dollar over the last four months remove the sense of urgency to cut rate further.  At the same time, the weakness of the labor market, the softness in producer prices (pipeline inflation?) and the erosion of the terms of trade, means the RBA is unlikely to close the door completely on another rate cut, which now seems more likely in Q2 than Q1.  We attribute a medium risk to the prospect of a more neutral sounding RBA statement.  We note that central bank officials have cited $0.8500 and $0.8000 as targets for the exchange rate.

 

Bank of England (Low Risk):  The Bank of England is securely on the sidelines.  BOE Governor Carney has already indicated that the next step in the evolution of forward guidance will be announced with the quarterly inflation report on February 12.  Contrary to claims that Carney is jettisoning the forward guidance, we expect the BOE to drive home the point that the 7.0% unemployment rate was a threshold not a trigger for tighter policy.  In effect, the BOE will say, we re-examined the economic conditions in light of the threshold being approached and we continue to judge the economy as recovering but still in need to very low interest rates.   The September short sterling futures contract rallied in January and the implied yield is 16 bp lower than it was in late-December at an implied yield of about 64 bp.   It can fall toward 50 bp bank rate on dovish comments and data that suggest the economic activity is leveling off, which is expected to be seen in the PMI reports in the coming days. 

 

Euro Area PMI (Low Risk):  The flash readings steal much of the thunder from the final reports that are out in week ahead.  The focus will be on Spain and Italy for signs of continued recovery.  The manufacturing PMI for the euro area is at its best level since 2011, which has lifted the composite as well.  The service sector has lagged, though the flash reading put it at four month highs.  We note that the criticism of the lack of progress reform in the German service sector appears to be on the rise.

 

ECB Meeting (High Risk):  The two pillars of ECB monetary policy, money supply and inflation, disappointed on the downside.  This has spurred speculation that the ECB will take action at its meeting on February 6.  A large German bank has forecast a small cut in the 25 bp repo rate and, more important, a move to a negative deposit rate.  Others have predicted an end to the efforts to sterilize the SMP purchases.     Since EONIA has traded above the repo rate, we think a repo rate cut is largely immaterial.  Cutting the 75 bp lending rate would be more significant in capping the increase in EONIA.    A negative deposit rate could be potentially very disruptive as it puts the ECB in unprecedented territory.  Even Japan through its deflationary years never adopted a negative deposit rate.    

 

The ECB does not need to open the can of worms by formally ending its sterilization of the SMP sovereign bond purchases.  It would likely be highly controversial as some (read Germany and its creditor allies) may see it is an illegal monetization of sovereign debt.  It can take a stay with its more passive of failing to attract enough interest in its sterilization operations.  This would be less controversial but effective in providing more liquidity on a weekly basis.   We see ECB officials more concerned about lending to the SME sector.   In one of the more important discussions at Davos, Draghi indicated a willingness to consider buying bank bonds, backed by loans to households and SMEs.   Though it does not appear imminent, development along these lines seem more promising. 

 

US Jobs Data (High Risk):  The market generally anticipates a dramatic recovery in non-farm payrolls in January after the disappointing 74k increase in December.   However, there is substantial risk that the frigid temperatures in the Midwest, South and Northeast will make for another disappointing report.   Last month, we noted how well the ADP estimates had anticipated the official data, just in time for the large miss (ADP Jan estimates was 238k, while the private sector NFP grew by only 87k).  Having been burned last month, investors will likely put less weight on it this time.    The market will quickly look at the weather distortions and make adjustment accordingly.   Before the Fed meets again (mid-March), it will see another jobs report, so the policy implications of a disappointing report may not be that great.   Most investors and observers see the bar relatively high against the Fed deviating from the tapering strategy outlined by the FOMC in December.  There is also substantial risk that without emergency unemployment benefits being extended there may be an unusually large decline in the unemployment rate as more people leave the labor market.  Arguably the Fed’s forward guidance anticipates this possibility by saying rates will remain low even after unemployment falls through the 6.5% threshold.   

 

While the employment report is the last major event of the week, at the start of the week, the US reports January auto sales.   The consensus calls for a 15.7 mln unit selling pace after the disappointing 15.3 mln unit pace in December.  If true this would put the January sales about the average in H2 13.  However, there is risk of disappointment due to weather disruptions and this would weigh on the retail sales report (January 13), which already are looking soft even excluding auto sales.   Lastly, the debt ceiling debt poses headline risk, though distortions to the short-dated T-bills appears to have eased somewhat. 


    



via Zero Hedge http://ift.tt/1ikVvIJ Marc To Market

Super Bowl Confidential: Why No Smart City Should Want an NFL Franchise

On the morning of
the Super Bowl, take a few minutes to ponder Alexis Garcia’s video
for Reason TV (originally released on January 31, 2014).

It’s all about Los Angeles’ mad, desperate, pathetic, and
utterly misguided search for a NFL franchise to replace the two bum
teams, the Raiders and the Rams, that routinely failed to sell out
games. LA has been without a pro football team for 20 years, which
turns out to be a boon for NFL fans who never have to worry about a
game being blacked out and for taxpayers, who haven’t shelled out
massive amounts of money like the idjits in places such as Atlanta
and Minneapolis.
Full writeup and text here
.

If you’re curious as to why sports stadium subsidies always seem
to win,
go here
.

And if you want more detail on how the NFL has learned to blitz
taxpayers’ wallets like the Fearsome Foursome on steroids (which
they would have been if they could have been), click below to get
the play-by-play from Gregg Easterbrook, whose The King of Sports
is a great read for those of us who love watching football and yet
are appalled by the welfare that the pro and college teams suck up
like no other business.
Full writeup, links, and more here.

from Hit & Run http://ift.tt/1jZUB7E
via IFTTT

Scott Shackford on When Postage Stamps Are Bad Role Models

Postage stampsAt the beginning of 2013, the postal
service unveiled a series of stamps inspired in part by First Lady
Michelle Obama’s “Let’s Move” anti-obesity campaign. Titled “Just
Move,” the 15-stamp collection, originally scheduled for release in
2014, featured drawings of children in various athletic activities.
But, writes Scott Shackford, when members of the President’s
Council on Fitness, Sports, and Nutrition saw the images, they
objected. The children were frolicking unsafely! In one stamp, a
child was skateboarding without kneepads. In another, a child was
jumping into the water cannonball-style.

View this article.

from Hit & Run http://ift.tt/MN9Rr4
via IFTTT

Third Banker, Former Fed Member, “Found Dead” Inside A Week

If the stock market were already crashing then it would be simple to blame the dismally sad rash of dead bankers in the last week on that – certainly that was reflected in 1929. However, for the third time in the last week, a senior financial executive has died in what appears to be a suicide. As Bloomberg reports, following the deaths of a JPMorgan senior manager (Tuesday) and a Deutsche Bank executive (Sunday), Russell Investments’ Chief Economist (and former Fed economist) Mike Dueker was found dead at the side of a highway in Washington State. Police said the death appeared to be a suicide.

Via Bloomberg,

Mike Dueker, the chief economist at Russell Investments, was found dead at the side of a highway that leads to the Tacoma Narrows Bridge in Washington state, according to the Pierce County Sheriff’s Department. He was 50.

 

He may have jumped over a 4-foot (1.2-meter) fence before falling down a 40- to 50-foot embankment, Pierce County Detective Ed Troyer said yesterday. He said the death appeared to be a suicide.

 

Dueker was reported missing on Jan. 29, and a group of friends had been searching for him along with law enforcement. Troyer said Dueker was having problems at work, without elaborating.

 

Dueker was in good standing at Russell, said Jennifer Tice, a company spokeswoman. She declined to comment on Troyer’s statement about Dueker’s work issues.

But as Michael Snyder noted recently, if the stock market was already crashing, it would be easy to blame the suicides on that.  The world certainly remembers what happened during the crash of 1929

Historically, bankers have been stereotyped as the most likely to commit suicide. This has a lot to do with the famous 1929 stock market crash, which resulted in 1,616 banks failing and more than 20,000 businesses going bankrupt.

 

The number of bankers committing suicide directly after the crash is thought to have been only around 20, with another 100 people connected to the financial industry dying at their own hand within the year.

Dueker had also been a research economist at the St. Louis Fed:

He published dozens of research papers over the past two decades, many on monetary policy, according to the St. Louis Fed’s website, which ranks him among the top 5 percent of economists by number of works published. His most-cited work was a 1997 paper titled “Strengthening the case for the yield curve as a predictor of U.S. recessions,” published by the reserve bank while he was a researcher there.

So, with stocks a mere 4% off their highs, are so many high ranking and well respected bankers committing suicide?


    



via Zero Hedge http://ift.tt/1cCSjHI Tyler Durden