36 thoughts on “Autumn Sunrise 🌅 at Whaleback Lighthouse at sunrise from Great Island Common

  • November 13, 2017 at 7:23 pm

    Hey I know this is off topic but I was wondering if you knew of any widgets I could add to my blog that automatically tweet my newest twitter updates. I’ve been looking for a plug-in like this for quite some time and was hoping maybe you would have some experience with something like this. Please let me know if you run into anything. I truly enjoy reading your blog and I look forward to your new updates.

  • November 16, 2017 at 2:54 pm

    Simply wish to say your article is as astonishing. The clarity in your post is simply great and i can assume you’re an expert on this subject. Well with your permission allow me to grab your RSS feed to keep up to date with forthcoming post. Thanks a million and please carry on the enjoyable work.

  • November 18, 2017 at 9:47 am

    You are completely correct. I loved reading through this and I will certainly come back for more as soon as possible. Our site is on getapk apk, you can take a glance if you’re still interested in this.

  • November 18, 2017 at 5:30 pm

    Eat at Burger King For a Year!
    Go to the [b][url=http://burger.socaf.info]site[/url][/b].
    Enter your email now for a chance to win Burger King lunch for a year.

  • November 18, 2017 at 9:54 pm

    Hello. I just saw this excellent website and I really like it. I love to talk about kik on computer at times. Great to be around, thanks a lot!

  • November 20, 2017 at 5:31 am

    First, let’s get a little historical perspective on American health care. This is not intended to be an exhausted look into that history but it will give us an appreciation of how the health care system and our expectations for it developed. What drove costs higher and higher?

    To begin, let’s turn to the American civil war. In that war, dated tactics and the carnage inflicted by modern weapons of the era combined to cause ghastly results. Not generally known is that most of the deaths on both sides of that war were not the result of actual combat but to what happened after a battlefield wound was inflicted. To begin with, evacuation of the wounded moved at a snail’s pace and this caused severe delays in treating the wounded. Secondly, many wounds were subjected to wound care, related surgeries and/or amputations of the affected limbs and this often resulted in the onset of massive infection. So you might survive a battle wound only to die at the hands of medical care providers who although well-intentioned, their interventions were often quite lethal. High death tolls can also be ascribed to everyday sicknesses and diseases in a time when no antibiotics existed. In total something like 600,000 deaths occurred from all causes, over 2% of the U.S. population at the time!

    Let’s skip to the first half of the 20th century for some additional perspective and to bring us up to more modern times. After the civil war there were steady improvements in American medicine in both the understanding and treatment of certain diseases, new surgical techniques and in physician education and training. But for the most part the best that doctors could offer their patients was a “wait and see” approach. Medicine could handle bone fractures and increasingly attempt risky surgeries (now largely performed in sterile surgical environments) but medicines were not yet available to handle serious illnesses. The majority of deaths remained the result of untreatable conditions such as tuberculosis, pneumonia, scarlet fever and measles and/or related complications. Doctors were increasingly aware of heart and vascular conditions, and cancer but they had almost nothing with which to treat these conditions.

    This very basic review of American medical history helps us to understand that until quite recently (around the 1950’s) we had virtually no technologies with which to treat serious or even minor ailments. Here is a critical point we need to understand; “nothing to treat you with means that visits to the doctor if at all were relegated to emergencies so in such a scenario costs are curtailed. The simple fact is that there was little for doctors to offer and therefore virtually nothing to drive health care spending. A second factor holding down costs was that medical treatments that were provided were paid for out-of-pocket, meaning by way of an individuals personal resources. There was no such thing as health insurance and certainly not health insurance paid by an employer. Except for the very destitute who were lucky to find their way into a charity hospital, health care costs were the responsibility of the individual.

    What does health care insurance have to do with health care costs? Its impact on health care costs has been, and remains to this day, absolutely enormous. When health insurance for individuals and families emerged as a means for corporations to escape wage freezes and to attract and retain employees after World War II, almost overnight a great pool of money became available to pay for health care. Money, as a result of the availability of billions of dollars from health insurance pools, encouraged an innovative America to increase medical research efforts. More Americans became insured not only through private, employer sponsored health insurance but through increased government funding that created Medicare and Medicaid (1965). In addition funding became available for expanded veterans health care benefits. Finding a cure for almost anything has consequently become very lucrative. This is also the primary reason for the vast array of treatments we have available today.

    I do not wish to convey that medical innovations are a bad thing. Think of the tens of millions of lives that have been saved, extended, enhanced and made more productive as a result. But with a funding source grown to its current magnitude (hundreds of billions of dollars annually) upward pressure on health care costs are inevitable. Doctor’s offer and most of us demand and get access to the latest available health care technology in the form of pharmaceuticals, medical devices, diagnostic tools and surgical procedures. So the result is that there is more health care to spend our money on and until very recently most of us were insured and the costs were largely covered by a third-party (government, employers). Add an insatiable and unrealistic public demand for access and treatment and we have the “perfect storm” for higher and higher health care costs. And by and large the storm is only intensifying.

    At this point, let’s turn to the key questions that will lead us into a review and hopefully a better understanding of the health care reform proposals in the news today. Is the current trajectory of U.S. health care spending sustainable? Can America maintain its world competitiveness when 16%, heading for 20% of our gross national product is being spent on health care? What are the other industrialized countries spending on health care and is it even close to these numbers? When we add politics and an election year to the debate, information to help us answer these questions become critical. We need to spend some effort in understanding health care and sorting out how we think about it. Properly armed we can more intelligently determine whether certain health care proposals might solve or worsen some of these problems. What can be done about the challenges? How can we as individuals contribute to the solutions?

    The Obama health care plan is complex for sure – I have never seen a health care plan that isn’t. But through a variety of programs his plan attempts to deal with a) increasing the number of American that are covered by adequate insurance (almost 50 million are not), and b) managing costs in such a manner that quality and our access to health care is not adversely affected. Republicans seek to achieve these same basic and broad goals, but their approach is proposed as being more market driven than government driven. Let’s look at what the Obama plan does to accomplish the two objectives above. Remember, by the way, that his plan was passed by congress, and begins to seriously kick-in starting in 2014. So this is the direction we are currently taking as we attempt to reform health care.

    Through insurance exchanges and an expansion of Medicaid,the Obama plan dramatically expands the number of Americans that will be covered by health insurance.

    To cover the cost of this expansion the plan requires everyone to have health insurance with a penalty to be paid if we don’t comply. It will purportedly send money to the states to cover those individuals added to state-based Medicaid programs.

    To cover the added costs there were a number of new taxes introduced, one being a 2.5% tax on new medical technologies and another increases taxes on interest and dividend income for wealthier Americans.

    The Obama plan also uses concepts such as evidence-based medicine, accountable care organizations, comparative effectiveness research and reduced reimbursement to health care providers (doctors and hospitals) to control costs.

    The insurance mandate covered by points 1 and 2 above is a worthy goal and most industrialized countries outside of the U.S. provide “free” (paid for by rather high individual and corporate taxes) health care to most if not all of their citizens. It is important to note, however, that there are a number of restrictions for which many Americans would be culturally unprepared. Here is the primary controversial aspect of the Obama plan, the insurance mandate. The U.S. Supreme Court recently decided to hear arguments as to the constitutionality of the health insurance mandate as a result of a petition by 26 states attorney’s general that congress exceeded its authority under the commerce clause of the U.S. constitution by passing this element of the plan. The problem is that if the Supreme Court should rule against the mandate, it is generally believed that the Obama plan as we know it is doomed. This is because its major goal of providing health insurance to all would be severely limited if not terminated altogether by such a decision.

    As you would guess, the taxes covered by point 3 above are rather unpopular with those entities and individuals that have to pay them. Medical device companies, pharmaceutical companies, hospitals, doctors and insurance companies all had to “give up” something that would either create new revenue or would reduce costs within their spheres of control. As an example, Stryker Corporation, a large medical device company, recently announced at least a 1,000 employee reduction in part to cover these new fees. This is being experienced by other medical device companies and pharmaceutical companies as well. The reduction in good paying jobs in these sectors and in the hospital sector may rise as former cost structures will have to be dealt with in order to accommodate the reduced rate of reimbursement to hospitals. Over the next ten years some estimates put the cost reductions to hospitals and physicians at half a trillion dollars and this will flow directly to and affect the companies that supply hospitals and doctors with the latest medical technologies. None of this is to say that efficiencies will not be realized by these changes or that other jobs will in turn be created but this will represent painful change for a while. It helps us to understand that health care reform does have an effect both positive and negative.

    Finally, the Obama plan seeks to change the way medical decisions are made. While clinical and basic research underpins almost everything done in medicine today, doctors are creatures of habit like the rest of us and their training and day-to-day experiences dictate to a great extent how they go about diagnosing and treating our conditions. Enter the concept of evidence-based medicine and comparative effectiveness research. Both of these seek to develop and utilize data bases from electronic health records and other sources to give better and more timely information and feedback to physicians as to the outcomes and costs of the treatments they are providing. There is great waste in health care today, estimated at perhaps a third of an over 2 trillion dollar health care spend annually. Imagine the savings that are possible from a reduction in unnecessary test and procedures that do not compare favorably with health care interventions that are better documented as effective. Now the Republicans and others don’t generally like these ideas as they tend to characterize them as “big government control” of your and my health care. But to be fair, regardless of their political persuasions, most people who understand health care at all, know that better data for the purposes described above will be crucial to getting health care efficiencies, patient safety and costs headed in the right direction.

    A brief review of how Republicans and more conservative individuals think about health care reform. I believe they would agree that costs must come under control and that more, not fewer Americans should have access to health care regardless of their ability to pay. But the main difference is that these folks see market forces and competition as the way to creating the cost reductions and efficiencies we need. There are a number of ideas with regard to driving more competition among health insurance companies and health care providers (doctors and hospitals) so that the consumer would begin to drive cost down by the choices we make. This works in many sectors of our economy but this formula has shown that improvements are illusive when applied to health care. Primarily the problem is that health care choices are difficult even for those who understand it and are connected. The general population, however, is not so informed and besides we have all been brought up to “go to the doctor” when we feel it is necessary and we also have a cultural heritage that has engendered within most of us the feeling that health care is something that is just there and there really isn’t any reason not to access it for whatever the reason and worse we all feel that there is nothing we can do to affect its costs to insure its availability to those with serious problems.

    OK, this article was not intended to be an exhaustive study as I needed to keep it short in an attempt to hold my audience’s attention and to leave some room for discussing what we can do contribute mightily to solving some of the problems. First we must understand that the dollars available for health care are not limitless. Any changes that are put in place to provide better insurance coverage and access to care will cost more. And somehow we have to find the revenues to pay for these changes. At the same time we have to pay less for medical treatments and procedures and do something to restrict the availability of unproven or poorly documented treatments as we are the highest cost health care system in the world and don’t necessarily have the best results in terms of longevity or avoiding chronic diseases much earlier than necessary.

    I believe that we need a revolutionary change in the way we think about health care, its availability, its costs and who pays for it. And if you think I am about to say we should arbitrarily and drastically reduce spending on health care you would be wrong. Here it is fellow citizens – health care spending needs to be preserved and protected for those who need it. And to free up these dollars those of us who don’t need it or can delay it or avoid it need to act. First, we need to convince our politicians that this country needs sustained public education with regard to the value of preventive health strategies. This should be a top priority and it has worked to reduce the number of U.S. smokers for example. If prevention were to take hold, it is reasonable to assume that those needing health care for the myriad of life style engendered chronic diseases would decrease dramatically. Millions of Americans are experiencing these diseases far earlier than in decades past and much of this is due to poor life style choices. This change alone would free up plenty of money to handle the health care costs of those in dire need of treatment, whether due to an acute emergency or chronic condition.

    Let’s go deeper on the first issue. Most of us refuse do something about implementing basic wellness strategies into our daily lives. We don’t exercise but we offer a lot of excuses. We don’t eat right but we offer a lot of excuses. We smoke and/or we drink alcohol to excess and we offer a lot of excuses as to why we can’t do anything about managing these known to be destructive personal health habits. We don’t take advantage of preventive health check-ups that look at blood pressure, cholesterol readings and body weight but we offer a lot of excuses. In short we neglect these things and the result is that we succumb much earlier than necessary to chronic diseases like heart problems, diabetes and high blood pressure. We wind up accessing doctors for these and more routine matters because “health care is there” and somehow we think we have no responsibility for reducing our demand on it.

    It is difficult for us to listen to these truths but easy to blame the sick. Maybe they should take better care of themselves! Well, that might be true or maybe they have a genetic condition and they have become among the unfortunate through absolutely no fault of their own. But the point is that you and I can implement personalized preventive disease measures as a way of dramatically improving health care access for others while reducing its costs. It is far better to be productive by doing something we can control then shifting the blame.

    There are a huge number of free web sites available that can steer us to a more healthful life style. A soon as you can, “Google” “preventive health care strategies”, look up your local hospital’s web site and you will find more than enough help to get you started. Finally, there is a lot to think about here and I have tried to outline the challenges but also the very powerful effect we could have on preserving the best of America’s health care system now and into the future. I am anxious to hear from you and until then – take charge and increase your chances for good health while making sure that health care is there when we need it.

  • November 22, 2017 at 3:46 pm

    I personally arrived right here from a different website related to iPhone cases and considered I may as well read this. I really like the things I see so I am just following you. Getting excited about checking out the website again.

  • November 23, 2017 at 9:35 am

    Hi and thanks for this terrific article! I certainly enjoyed learning about.I will make certain to take note of your blog and will return in the future. I wish to suggest you to continue your good posts, even talk about luxury real estate too, have a nice morning!

  • November 23, 2017 at 10:55 am

    Hi there, you are definitely right. I always go through your posts thoroughly. I’m also curious about real estate rentals, you could talk about that at times. Cheers!

  • November 23, 2017 at 5:58 pm

    I was discussing with a buddy of my own regarding this info and even about home intercom system as well. I feel you made a few good points on this page, we’re also looking forward to continue reading information from you.

  • November 23, 2017 at 10:36 pm

    Hey could you tell me which blog platform you are dealing with? I’m planning to do my own personal blog on intercom system upgrade NY soon although I’m having a difficult time choosing.

  • November 24, 2017 at 2:55 pm

    I cherished up to you will receive carried out right here. The sketch is attractive, your authored subject matter stylish. nevertheless, you command get bought an impatience over that you would like be turning in the following. in poor health indisputably come further previously once more since precisely the same nearly very frequently inside of case you shield this hike.

  • November 24, 2017 at 6:29 pm

    great points altogether, you simply won a emblem new reader. What could you recommend about your submit that you just made some days in the past? Any certain?

  • November 25, 2017 at 5:22 pm

    You are certainly right and I trust you. When you wish, we could also speak about kik on pc, something which intrigues me. Your site is amazing, cheers!

  • November 25, 2017 at 9:55 pm

    Admiring the commitment you invested in your site and thorough material you offer. It really is nice to discover a blogging site from time to time that isn’t the same unwanted rehashed information. Fantastic read! I have bookmarked your blog and I am including your RSS feeds to our best instagram followers app webpage.

  • November 26, 2017 at 12:20 pm

    Our LGV (Large Goods Vehicle) HGV training is based in East London, and our LGV/ HGV courses are taught by qualified DVSA LGV & HGV trainers. LGV was formerly known as HGV, where it used to be referred to as HGV Class 2 (now called LGV Category C) and HGV class 1 (Now called LGV Category C+E).

  • November 27, 2017 at 3:46 pm

    Hi there I am so thrilled I discovered your website, I really found you by accident, when I was searching on Yahoo for free tv. Anyways I’m here now and would simply love to say many thanks for a fantastic blog post and the overall thrilling blog (I too adore the theme), I do not have sufficient time to read it entirely at the minute but I have book-marked it and even included your RSS feed, so once I have sufficient time I’ll be returning to look over more. Please do maintain the fantastic job.

  • November 27, 2017 at 9:31 pm

    Howdy! I recently noticed your site and I certainly love it. I also like to speak about tv shows at times. Great to be around, cheers!

  • November 28, 2017 at 2:52 pm

    It was amazing reading this info and I think you are really right. Let me know if perhaps you are thinking of personal injury attorney, that is my main expertise. Hope to check back with you soon enough, take care!

  • November 29, 2017 at 8:32 am

    I constantly go through your content attentively. I am likewise thinking about pokemon go news, perhaps you might talk about this sometimes. Have a good day!

  • November 29, 2017 at 8:34 am

    I am interested to discover just what website platform you have been working with? I am having several slight protection difficulties with our latest website related to pokemon go app so I’d love to find a thing much more safe. Do you have any solutions?

  • November 29, 2017 at 6:20 pm

    Good day! This is my first reply on your website so I simply wanted to say a quick shout out and say I really enjoy reading through your articles. Can you recommend other websites which go over how to buy ethereum? I am also very intrigued by this thing! Thanks a ton!

  • November 30, 2017 at 1:18 am

    You are totally right, I would really like to find out new information on this issue! I am as well interested in where can i buy ethereum because I believe it’s very trendy these days. Great!

  • November 30, 2017 at 8:10 pm

    You are absolutely correct, I’d like to find out even more on that subject! I am as well interested by best self propelled lawn mower because I believe it is really very trendy nowadays. Keep this up!

  • November 30, 2017 at 9:30 pm

    I personally arrived over here via a different web page relating to self propelled mower and imagined I may as well look at this. I love what I see thus I am just following you. Getting excited about looking into your website again.

  • December 2, 2017 at 10:04 am

    My family and I unquestionably like your blog and find most of your articles to be exactly what I am trying to find. Would you offer other people to write content for you? I wouldn’t mind producing a piece of text regarding heat repair or on many of the topics you’re posting about here. Great blog!

  • December 2, 2017 at 11:43 am

    You are absolutely right and I definitely agree with you. Whenever you want, we can also talk about new movies online, something which fascinates me. Your website is certainly awesome, cheers!

  • December 5, 2017 at 6:52 pm

    I really like what you guys are now up to. This sort of great effort and coverage! Keep up the excellent effort friends, I have you to canon printer setup webpage.

  • December 6, 2017 at 8:03 am

    You are absolutely right and I totally trust you. Whenever you want, we could as well speak about bitcoin from blockchain, something which intrigues me. Your site is really impressive, regards!

  • December 6, 2017 at 3:05 pm

    There is awesome changes on the style of this page, I definitely like that. My own is relating to where to buy bitcoin and right now there are plenty of stuff to do, I’m still a starter in web page design. Cheers!

  • December 7, 2017 at 8:02 pm

    I just arrived over here via another web page related to online computer games and considered I might as well read this. I really like the things I see therefore now I am following you. Looking towards looking over your website again.

  • December 8, 2017 at 3:09 pm

    You are certainly correct, I would really enjoy to know more info on the topic! I am also captivated by freight forwarder as I feel it really is quite trendy currently. Keep up the good work!

  • December 8, 2017 at 5:55 pm

    You are totally right and I trust you. If you want, we can also speak around air freight rates, a thing that fascinates me. The website is truly amazing, all the best!

  • December 9, 2017 at 9:35 am

    I like the things you guys are up to. This sort of smart work and exposure! Carry on the very good effort friends, I’ve included you on our worldwide shipping website.

Comments are closed.