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Breathe deeply while you still can for free.

Soon enough, someone will find a way to make you pay a premium for clean air. And if you can't afford the good stuff, America . . . well, you can just kindly remove yourself to the back of the bus, where the "free market" makes "those people" sit.

Every day and in every way, the ranks of "those people" are swelling.

Take health care, for example. If you'd like some, it will cost you. If you'd like the good stuff, it will cost you a lot -- though you really can't afford the good stuff.

AND KNOW that to the extent the well-off opt for the "good stuff -- something we're coming to know as "concierge" care, where the doctor actually gives you the time of day . . . and his phone number -- what's left for the rest of us likely will come to resemble the scraps from the rich man's table.

According to Sunday's Omaha World-Herald, you can just call the vast majority of us Lazarus:

Imagine opening a letter like this from your doctor:

“I'd love to keep you as a patient, but to stay with me you'll have to pay an extra annual fee of $2,500.

“Please let my office know if you will be paying the fee. If not, we'll help you find another primary care doctor.”

Although it might be worded more politely, that's the gist of the letter you could receive if your doctor adopts a style of primary health care known as concierge medicine.

Its backers say the concept can attract and retain more primary care doctors by improving their lives and enabling them to practice medicine the way they want, rather than under the time-constrained demands of the typical doctor's office.

But the concept also raises philosophical and ethical issues. Concierge physicians limit the number of patients they see by charging annual fees, which wealthy people can more easily afford. Also, this kind of medicine could reduce the number of primary care doctors at a time when demand already exceeds supply.

Nationally, the practice of concierge medicine is still small — perhaps 400 primary care physicians out of about 250,000 nationally — but in some regions it is firmly established.

The largest concierge company, MDVIP, has more than 300 doctors nationwide and recently was purchased by Procter & Gamble. It's been more than 12 years since the first such practice opened in Seattle. There's even a cable TV program, “Royal Pains,” about concierge medicine.

But the approach has only recently arrived here. Nebraska's first, a two-doctor practice, opened last month near 90th Street and West Dodge Road in Omaha after a three-year trial at the University of Nebraska Medical Center.

It's affiliated with a new Omaha management company, Members.MD, whose chairman is former Burger King franchise owner and cancer survivor Mike Simmonds.

“Primary care is broken,” said Dr. Joel Bessmer, who is medical director of Members.MD and who opened the new practice with partner Dr. Robert Schwab. “It allows us to step off the treadmill and spend time with patients. This is a different world of trying to provide primary care.”

Physicians get to know patients thoroughly and become their health partners, he said. The doctor's office becomes the patients' comfortable, easily accessible medical home, instead of a hurried place full of other sick people and doctors who have no time to spare.

But Dr. John Goodson of Harvard Medical School said concierge medicine could worsen a system that to some degree already dispenses care based on whether people can afford insurance.

“Do we as physicians hang together and maintain our commitment to access?” he said. “That really ought to be a fundamental principle of medicine. We're there to help people, and we're not going to discriminate against people because of their economics.”
Goodson said primary care doctors should supervise their patients' hospital stays as part of normal care, not for an extra fee. Members.MD offers hospital supervision only with its upper level of care.

Eliminating people from a medical practice by charging a fee is “abandonment,” he said. Even if a patient's records transfer, the new doctor doesn't know all the information that the first doctor learned about the patient.

Yet the rise of concierge care, he said, shows that as a profession, primary care “is on the ropes and dying fast. It's like the polar ice cap, starting to fracture. It ought to be a wake-up call to everybody.”

He said that the start of a practice in Omaha indicates the concierge model, although marginal in most regions, isn't going away. “It makes me sad as a professional that my colleagues are doing this sort of charging.”

WE NOW LIVE in a country where one's bank account determines one's worth in life. You are what you make. Human dignity has become a commodity.

"Life, liberty and the pursuit of happiness"? Formerly available for free from one's Creator, they now are available only with purchase of the America Plus premium package.

If you don't want to die before the next operator is available to schedule your appointment with a Proletarian Partners physician's assistant, it's going to cost you. And you'd better hope your insurance plan allows diagnostic stethoscope use.

But that's not important now. What's important is that "concierge medicine" is the talk of the town -- the part of town that matters, that is:

Simmonds, who was inducted in the Omaha Business Hall of Fame last year for his success in the fast-food business, said the concept is “sort of the talk of the town, at least in my circles.”

Simmonds said he heard about Bessmer's practice from a fellow airplane traveler, called Bessmer the next morning, interviewed him over lunch at Charleston's and “hired him” as his doctor. Simmonds' former primary care doctor was good and even a friend, but Simmonds couldn't call or e-mail him whenever he wanted.

“When I don't feel good, I like to talk to somebody right now,” he said. “Joel spoiled me,” including supervising his care when he was hospitalized and providing other care over the past year and a half. He was diagnosed with cancer several years ago.

IF YOU BELIEVE it's a self-evident truth that "all men are created equal," you should be offended as hell right now. Some folk think their money makes their well-being more important than yours. They think that rationing isn't rationing if they slap a "free market" label on it and have enough cash to game the system in their favor.

There's a four-letter word for that kind of thinking: E-V-I-L.

And I think the Bolshevik Revolution happened for a reason. I hope people like Mike Simmonds have another think coming before finding out exactly what that reason was.

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The world is going to hell in a handbasket, people are scared, government doesn't govern anymore and Tea Party Airlines is flying non-stop -- and one-way -- into your local IRS office.


We live in perilous times. The national mood is dark. There is a crisis of confidence. Tensions are rising. A cloud hangs over the land. Uncertainty has cast a shadow over fill-in-the-blank, and clichés are running rampant.

If you are a major national news operation, there is only one thing to do. Fire a s***load of people so the stockholders can enjoy a modest short-term windfall from the middling benefits to the bottom line of your corporate overlord.

THIS TIME, it's ABC News' turn to throw journalists out of work and add to national ignorance.

The New York Times blog Media Decoder has the details about a newsroom bloodletting that, for a change, isn't one of its own:

In what it called a “fundamental transformation,” ABC News said Tuesday that it was seeking to substantially reduce its staff, possibly by up to 25 percent.

Employees said they were told that the news division is seeking 300 to 400 buyouts, and would resort to layoffs if necessary. ABC News currently employs roughly 1,400 people.

The cuts at ABC, a unit of The Walt Disney Company, are among the steepest ever conducted by a network news division, and are likely to be seen as a further erosion of the company’s news-gathering arm.

ABC News employees said Tuesday that the reaction to the cutbacks was muted, mostly because the announcement had been expected for weeks. “Everyone sees the reality of the industry, and everyone wants to stay competitive,” said one employee who spoke on condition of anonymity because they were not authorized by the network to speak to other media outlets.

In a memorandum to staffers, the ABC News president David Westin said the “transformation” would result in a leaner, smaller news division. “The time has come to re-think how we do what we are doing,” Mr. Westin wrote.

IN THE LOS ANGELES TIMES, meantime, there's this:

For the last month, the newsroom has been rife with rumors about the cutbacks, which are poised to be the most dramatic reshaping of ABC News since Roone Arledge revolutionized the division by recruiting a team of high-wattage anchors and launching new franchises during his 20-year tenure as news president. Anxious staffers are not only fearful about losing their jobs, but are apprehensive about how the restructuring will impact their ability to chase big stories and swarm major news events if they remain.

ABC executives are internally casting the belt-tightening not as a retrenchment but as a repositioning. By streamlining news-gathering operations now, officials hope to stave off repeated cuts in the coming years. They argue that a smaller news division does not mean a less competitive one. With technological advancements such as hand-held digital cameras, the news division can now dispatch one person to cover a story that once required a correspondent, producer and two-person crew.

News organizations large and small have been forced to let go of staff and reduce expenses in the last few years to cope with a drop in advertising revenue caused by the global economic slowdown. Earlier this month, CBS News cut at least 90 positions, shuttering its Moscow bureau and significantly shrinking its staff in Washington, London and Los Angeles.

NOTE WELL, regarding the touting of "technological advancements such as hand-held digital cameras," that media outlets do not often pursue a grand plan of using technology to dramatically expand or improve basic news coverage. At least not out of the unfettered public-spiritedness of their selfless hearts.

Instead, it's more like this: They use technology a) to get a competitive edge on the competition, b) to cut costs or c) to look cool in front of all the other kids at the trade conventions.

If newspaper journalists paid their publishers to come to work every day and Linotypes were cheaper than computers, reporters would still be yelling "Toots, get me rewrite!" into candlestick telephones while hot lead flew in backshops unchanged since H.L. Mencken was Jon Stewart.

And ink-stained wretches reeking of Seagram's VO and surrounded by paste pots, pica poles and soft-lead pencils still would be closing out the final edition of The Daily Blab at 2 a.m. -- not the 12 midnight made possible by our glorious technology.

REWRITE! Hold the line!

Isn't technology supposed to let us do the same with less, like the miracle it's going to work at ABC News?

Yeah, right. Ask The Daily Blab, where positions started disappearing long ago because technology allowed publishers to get three jobs' worth of work out of each digitally assisted employee. Instead of giving the public a greatly enhanced, more timely newspaper, what computerization allowed publishers to do instead was give readers the same old thing produced by lots fewer people.

It also allowed publishers to give themselves a 20- or 30-percent profit margin.

Which, I suspect, is where the 2 a.m. deadline went in an age when, theoretically, papers should have been able to push them back instead of moving them way up. It's about the cash, Nash.

It's about deciding cost efficiency dictated that you close out the morning paper at midnight with a staff of 100 instead of making deadline at 2 with a staff of 120.

TO BE SURE, paradigms and business models are shifting underneath nervous traditional-media types as I write this. To be surer, greed and corporate overreach has given scribblers and newsreaders less room to maneuver as the future bears down on them.

And to be surer still, the biggest problem is that corporations like Disney, or CBS Corporation (or pick a newspaper or radio group) have been focused on short-term profits rather than long-term survival -- and, now, squeezing the last drops of profitability out of suddenly iffy (Surprise!!!) concerns.

So save the bushwa about the wonderful journalistic efficiency of digital camcorders and one-man-band TV reporters. I might believe it if bunches of reporters, editors, cameramen and soundmen weren't getting the ol- heave-ho to make room for the Glorious Age of Technology.

Instead of, like, you know, putting two or three times as many "digital journalists" out on the streets to keep the bastards honest.

'You can make it less brutal. . . .'

An item on the web site of the Columbia Journalism Review got noticed by Jim Romenesko at the Poynter Institute, but didn't get nearly the attention it should have.

That's probably because -- apart from all the folks who used to be network-TV journalists but aren't anymore -- CJR's online columnist Michael Massing might be the only media figure who gives a flying furlough. Sigh.

NEVERTHELESS, read this (and go read the whole thing, too) and try to decide what's more hopelessly screwed -- journalism or capitalism:

While doing some recent research on the news business, I came upon this remarkable fact: Katie Couric’s annual salary is more than the entire annual budgets of NPR’s Morning Edition and All Things Considered combined. Couric’s salary comes to an estimated $15 million a year; NPR spends $6 million a year on its morning show and $5 million on its afternoon one. NPR has seventeen foreign bureaus (which costs it another $9.4 million a year); CBS has twelve. Few figures, I think, better capture the absurd financial structure of the network news.

This is not a new development, of course. It’s been unfolding since 1986, when billionaire Laurence Tisch bought CBS and eviscerated its news division in order to boost profits. (For a sharp, first-hand account of this process, see Bad News: The Decline of Reporting, The Business of News, and the Danger to Us All, by former CBS correspondent Tom Fenton.) But the issue seems worth revisiting in light of the recent naming of Diane Sawyer to replace Charlie Gibson as the anchor of ABC’s World News. We don’t yet know how much Sawyer is going to be paid, but it will no doubt surpass Gibson’s current estimated salary of $8 million. Sawyer will thus be perpetuating the corrosive, top-heavy system of the network news.

What’s striking is how little notice this received in the flood of coverage of Sawyer’s appointment. With the notable exception of Jack Shafer in Slate, who cheekily urged Sawyer to turn down the job “and persuade ABC News to divert the millions it ordinarily pays its anchor and spend it on 50 or 80 additional reporters to break stories,” the press treated her ascension as a dramatic milestone.

I DON'T THINK any further commentary is necessary. Except, perhaps, the above clip from Broadcast News.

You can get anything you want . . . .

I've been scarce around these cyberparts, off fighting another skirmish in the ongoing war against cyberobsolescence. Mine.

Or, more precisely, my computer's.

A flat-screen monitor Mrs. Favog and I found at an estate sale for $40 suddenly decided the other day to follow its former owner to the Great Beyond. Or to Florida -- whatever.

Having been burned by our quest to get some LCD magic for (next to) nothing, my better half and I trekked to Nebraska Furniture Mart in search of some brand-new monitor goodness . . . some 22-inch widescreen goodness. As if we had a choice.

Computer-monitor makers still might be cranking out 4x3 displays these days, but the Mart and Best Buy weren't selling them. When in Rome, and all that, you know.

And I love me some wide-format computing. You used to have to hook up multiple monitors to get this kind of virtual workspace.

And the picture. . . . oh, dear me, can a Blu-Ray burner for the old Dell be far behind?

OF COURSE, being that we're talking computers -- particularly 4-year-old ones -- you know the path to widescreen goodness had to be a bumpy one. Very. The road to planned obsolescence is never an Autobahn experience for the poor consumer, who just wants a lot for a little.

Like me and that estate-sale flat-screen.

First, the fargin' integrated video controller, I discover when I hook up the new monitor, wouldn't support widescreen monitors. So everything had that funhouse-mirror look -- the video version of getting the news from home via a phone call from Mama.

Well, I figured that might happen. So I head down to Best Buy to get me an inexpensive video card. Excuse me . . . graphics card.

I can put it in. I can put anything in a computer. Hell, since we got our first one in 1993, I've replaced everything there is to replace inside a computer tower except the power supply and motherboard.

But there's a problem. My Dell Dimension 3000, which I didn't think was that old or decrepit . . . is. And it features an undersized (by today's standards) 250-watt power supply. Most video -- er, graphics -- cards won't give you a crappy black-and-white kinescope view of the world for under 350-watts of the Omaha Public Power District's finest.

ON THE OTHER HAND, it might cause your computer to melt down.

And not only that, most of the graphics cards Dell says are compatible with my model of computer most certainly aren't compatible with the tiny-ass power supply they put in my computer. Power supply, anyone?

To go along with the new monitor and a new video -- OK, graphics, GRAPHICS!!! -- card.

What was a $40 estate-sale bargain so far had turned into a $192 Nebraska Furniture Mart shopping trip. It was threatening to ring up another $65 for a video card and at least that much for a bigger power supply.

Face it, if we all had to constantly rebuild our automobiles just to be allowed on the Interstate, we'd all be taking the bus. But that's the "world of personal computing" in a world that eats the computer-deprived for lunch.

AFTER A DAY of back and forth on the graphics-card issue, I opened up the Dell to see who was full of it -- the folks in Round Rock, Tejas, and their system specs and upgrade recommendations, or . . . the folks in Round Rock, Tejas, who maybe put more power supply in my "old" Dimension 3000 than I thought.

As it turns out, the folks in Round Rock, Tejas, were full of it. And they did put a puny 250-watt power supply in the computer . . . as promised. And it looked like not just any off-the-shelf power supply would fit in that thing.

And it looked like the only place I'd find a graphics card that wouldn't suck up more juice than old Dell could give was online. Trouble is, I was sick of messing with the damned thing -- which was lying half taken apart on the dining-room table.

So we went to the one place in town that carried a 250-watt card and happily paid too much for it. And here I sit, in widescreen bliss . . . $250-odd poorer.

BUT THIS ISN'T about my computer.

It's about how the city of Omaha has gutted the public library system -- and is about to gut God knows what else -- all because some loud taxpayers, and some feckless city council members, think you can run a city on $40 estate-sale, flat-screen computer monitors and not have to pay the piper at some point.

It's about how folks still expect the city to cut, cut and cut some more even when the budgetary fat is gone and the muscle ain't looking so good anymore.

It's about how cops aren't being hired, one library branch will close for the rest of the year (at least) while others slash their hours (and staff) and youth-recreation programs in poor neighborhoods are being axed (great combination, eh?) all because a bunch of loud-mouthed, right-wing yahoos are raising holy hell from somewhere east of Eden and west of the 'hood. Because it would just be completely scandalous and unreasonable to expect people who live in $100,000 houses to pay $25 more a year in property tax.

From the Omaha World-Herald on Wednesday:

Although libraries and other services drew strong support, Festersen said he thought the common theme for many average citizens was their opposition to tax increases.

Council members are cool to Suttle's proposed entertainment tax and property tax hike, and they are looking for ways to cut spending further. They are set to vote on the budget Sept. 1.

Suttle and the council face a projected $11 million shortfall next year. The mayor also is trying to close a $12 million revenue gap in the current budget.

The hearing followed weeks of bad news on the city budget: The temporary closing of Florence Library, and cuts in library hours at other branches. Layoffs of 130 civilian employees. The grounding of the police helicopter for the rest of the year. Swimming pools closing early for the season.

Earlier Tuesday, Suttle announced furloughs in the Mayor's Office, saying all members of his staff will take eight unpaid leave days before the end of the year.

(snip)

Doug Kagan, chairman of the Nebraska Taxpayers for Freedom, urged the council to cut spending.

“Don't tell us about sacred cows that cannot be touched. Sacred cows make the best hamburger,” Kagan said.

IT SEEMS we have a couple of dynamics at work here in the "don't tax you, don't tax me" contingent.

One group wants a really great computer monitor but sees no real need to pay for it. The other, exemplified by the Nebraska Grumblers for Screw You, already has a computer monitor and figures a Big Chief tablet is good enough for everybody else.

The common good is not a popular notion these days. Obviously.

Which brings us back to, you guessed it . . . computers. In Wednesday's Omaha paper. Really.

Florence is part of northeast Omaha, lying within an area bounded by the Missouri River, Redick Avenue, 45th Street and the Washington County line. It includes the Ponca Hills area.

The decision to close the library has upset residents of all ages.

Teresa Miller, 20, and her brother Jonas, 15, were checking out story and music CDs when they heard the news Tuesday.

“That's weird to close a library,” Jonas said. “I mean, you need books, right?”

It never occurred to Teresa that her childhood library had a shortage of customers. She said the Florence library probably has fewer visitors because it is smaller than most branches.

“I like the small things,” she said, adding that she's frustrated that she'll have to use more gas to drive to a different branch.

For Craig and Deborah Johnson, a stroll to their public library is a family affair they hate to see end.

As a reporter approached the couple, they already were asking, why Florence?

“Things are going downhill real fast,” said Craig. “A snowball effect.”

Both he and his wife have been laid off from jobs as, respectively, equipment operator and office clerk. Tuesday, the couple walked to the library — their 2-year-old and 6-year-old in tow — to search for employment via library computers. The little ones also signed on to a computer.

The older Johnson children use the library as well, often taking a break to go across the hall to play basketball or participate in some other activity at the Florence recreation center. A senior center also is in the complex that contains the library.

Paying for bus fare to go elsewhere is an expense the Johnsons said they didn't need.

Hartline on Tuesday was at the senior center arranging a volunteer visit. She is a frequent library customer and also stops weekly at the post office a few blocks away.

“It's very upsetting,” said Hartline. “We are just as deserving of community facilities as any other part of Omaha.”

SURE YOU ARE. But Doug Kagan would rather you have this really cool $40 estate-sale, flat-screen computer monitor.

Just don't expect him to throw in a couple of bucks toward fixing it.

The Curse of Homer Simpson be upon them

Instead of hounding preachers who criticize the gay-rights agenda and publishers who speak out against the Great White Jihad, why don't Canada's human-rights tribunals attend to some real violations of inalienable rights?

We're talking As Bad as It Gets, here.

FOR INSTANCE, this unspeakable horror perpetrated against the elderly, as reported by Reuters:

Beer maker Molson is turning off the tap and cutting off the supply of free suds to its retirees, the Toronto Star reported on Tuesday.

Molson, a division of Molson Coors, said it was looking to "standardize" its complimentary beer policy.

There are 2,400 Molson retirees in Canada and their free beer costs the company about C$1 million ($900,000) a year, the Star said.

Molson retirees in the province of Newfoundland will see their monthly allotment of beer fall from six dozen a month to zero over the next five years.

IF THIS ISN'T awful enough on its own merit -- in my opinion, far worse than anything right-winger Mark Steyn may have had to say about the booze-hating Mahometans in Maclean's newsweekly -- let me add this in hopes of prodding the Canadians into action.

Read carefully: Molson Coors is half-owned by Americans, who no doubt have, with imperial malice, exerted malign influence over their Dominion partners.

Now go get 'em, eh?