We have previously discussed (here and here) the growing conflicts over businesses that decline to accommodate same-sex weddings and events in a clash between anti-discrimination and free speech (and free exercise) values. Despite my support for gay rights and same-sex marriage, I have previously written that anti-discrimination laws are threatening the free exercise of religion. Some of these cases involve bakeries that insist that making wedding cakes for same-sex couples violates their religious principles. Now we have a twist on this trending litigation. The Azucar Bakey has been found to have broken discrimination laws by refusing to make an anti-same-sex cake. The bakery was asked to make a Bible-shaped cake with an anti-gay slur and owner Marjorie Silva refused. The customer brought a complaint to the Colorado Civil Rights Commission and won.
The customer wanted the bakery to draw two males holding hands with “a big ‘X’ on them.”
Silva identifies herself as a practicing Christian and makes Christian cakes, but balked at making an anti-gay cake at her Lakewood bakery in December 2013. Previously in Colorado, Masterpiece Cakeshop owner Jack Phillips broke discrimination laws when he refused to make a cake for the same-sex wedding of Dave Mullins and Charlie Craig in July of 2012. That decision was upheld by the Colorado Civil Rights Commission.
Now we have the flip side. Silva offered to leave the bible page blank to allow the customer (who she describes as disruptive) to write whatever he wanted but she declined to write it herself. Ironically, she could have simply refused to serve him on the basis for any disruption in the store. She was later sent a notice by the Colorado Department of Regulatory Agencies (DORA) that a religious discrimination complaint has been filed against Azucar Bakery. She has since received a notice from DORA requesting a final letter describing her account of events.
The question raised by these cases is whether anti-discrimination laws are driving too deeply into free speech rights. Bakers and photographers view themselves as engaged in a form of speech generally. The loss of a bright-line defining free speech has meant that we are finding ourselves increasingly on a slippery slope of speech regulation. On the other hand, we fought hard to guarantee accommodation for all races in places of public accommodation. Stores are not allowed to ban black customers under the same rationale. The question is whether there is a difference between refusing to serve customers on the basis for sexual orientation generally as opposed to taking an active or direct role in a same-sex wedding.
Where do you think we should draw the line?
Source: KDVR
Is this story true Ross or this just another lie like the Rolling Stone rape case? Why send us to search for it if you have the details? Or did you just pull this out of your ass as usual?
I did a double check through Google. You’re simply wrong on the facts, Professor. No determination has been made by anyone – nor does a determination against the bakery appear even remotely likely in this case.
Even the Daily Mail didn’t go this far, and they are renowned for manufactured controversy.
The ongoing IT costs in maintaining and upgrading EMRs, including protecting the data and complying with government mandates, are huge and escalating.
Paper records merely needed storage.
I love using my EMR.
But it costs money, lots of money, and saves very little money, mostly theoretically.
Paul Schulte,
Guilt-by-association is both illegal and un-American. The U.S. Constitution protects “individual” rights, you can’t punish one citizen based on the actions of another citizen.
You can contact Florida Attorney Genera Pam Bondi or the Office of Civil Rights for the current number of open investigations of ADA fraud by private religious schools. The ACLU of Florida is another great resource.
Ross – you have made the claim, please back it up with something.
EMR in a huge healthcare network makes sense for several reasons, but it won’t save money.
EMR is terrible for small groups and solo practices, and it won’t save money.
Money is not saved by any technology unless it can increase worker productivity.
This means that I can either see more patients per hour or bill more per hour for the same patients.
Every other ‘savings’ cited is the usual illusory vapor that doesn’t end up as an actual accounting item on a financial balance statement.
More like ‘good will’ or some such.
The cost, however, well that a real measurable effect on net income.
Show me real balance sheet with an EMR actually saving money, and I’ll admit I am wrong.
Aridog – your provider has to add the information first and since they have seen you they might change the information anyway. Before we allowed students to be bi-racial, they always had to pick a race, to pick one was to deny the other, some would refuse to make a decision. We were required to pick a race for them. We always picked the one that would get us the most money. 🙂
Paul C said …
This is an indicator that Obamacare is collecting data from the doctors for some purpose that has nothing to do with my healthcare.
You are correct, of course. Just be grateful they (H&HS) are digitally clueless (witness the original Db for the roll out) and require manual pen & paper reports. If they had a clue it could be far worse. I suggest you enter “White Samoan Native” under “other” next time…or maybe “Homo Erectus” like me. Then there will two of us in the massive paper pile in DC. It’s mean, of course, because it will perplex the GS-07 trying to fulfill the demands of his SES bosses. No column for the entry…oh, my 🙂
“CONCLUSION: Implementation of an electronic medical record system in primary care can result in a positive financial return on investment to the health care organization. The magnitude of the return is sensitive to several key factors.”
Bellevue, after 6 years and nearly $260k, the EMR system was in place and only then were the providers ready to return to normal business hours.
Of course in the first example we should completely ignore the word “CAN” as well as the notion the study is “sensitive to several key factors”.
Let’s completely ignore anecdotal evidence provided by an actual doctor from an actual practice.
DBQ, Don’t you love it when folks like Ross, who have obviously never run a biz, lectures those like us who have, on how they should be run. LOL!
Savings to the health care organization are obtained
under both capitated and fee-for-service reimbursement,
but these savings depend on the reimbursement mix: the
greater the proportion of capitated patients, the greater
the total return
From your article, which is over 10 years old and does not deal with the issue of the Obamacare medical records mandate. Do you even read the stuff you link to?
So for a large organization, like a hospital or very large medical group the possible benefits of electronic records might create some savings.
However, they state that the greater proportion of patients who are capitated the greater the return or savings.
You might be wondering what captiated is. Probably not since you didn’t read the article. Here.
Capitation refers to a form of healthcare payment system. In a capitation model, a provider or hospital is paid by the insurer (or other payer) an amount per patient during a period of time.
An example of a capitation model would be an insurer / payer who would negotiate to pay a doctor $500 per year per person in a group. For 1,000 people, the insurer would pay the doctor $500,000 and the doctor would be expected to supply all services necessary to those 1,000 people.
Since most family medical or general medical groups do not use this model, your article is meaningless.
This is similar the fee for advisory arrangement as an RIA that I had with some clients. Of course if you know that you will have a steady supply of fees or capitation, you can better control your costs and realize savings from investments in technology. A regular doctor doesn’t usually have that luxury.
However, since many doctors are going the concierge route….membership only….fee for service…. then perhaps this could be a cost benefit that they could look into. However, that is a completely different discussion.
This does not appear to be at all accurate – at least from the only reference cited. DORA doesn’t appear to have reached any decision yet and is merely asking for the baker’s response to a complaint.
The Civil Rights Commission does not appear to have commented in any way.
Paul Schulte:
I think the Office of Civil Rights at the U.S. Department of Justice enforces federal ADA fraud.
The Florida schools in question committed a federal crime because there are requirements that the school can’t discriminate if it receives taxpayer dollars – that is a condition of receiving the money.
It should outrage everyone that any school punishes any child – not for the actions of the disabled child – but for the parents sexual orientation. The children did nothing wrong.
Ross – do you have a cite that these Florida schools committed or were charged with fraud? Actually, this would be a discrimination case. The child is the client, not the parents. And the parents are not part of a protected class.
Making a cake for a customer and putting something on a cake are different things.
Jude – putting something on the cake (decorating) the cake is usually part of the package in buying a cake. I bought a cake for my brother and sister-in-law’s 50th wedding anniversary. The frosting and message came with the price of the cake.
leejcaroll … your comment above about note taking reminds me of the day my care system (a major teaching hospital) switched to a new database for digital record keeping. My PCP had a very nice screen with about 6 point fonts (squinting required) asking him to verify, via me, all manner of information. The funny part was the large font instructions to him to look me in the eyes while talking to me…e.g., enter tinsy check marks in appointed tinsy squares and notes by hand while not looking at the screen. I am positive the dude who wrote those instructions had to be an HR person who probably still used Windows 3.1 at home….and likely was a prior “fed.”
That new system has worked well, now that it is past the start up phase…however, given there was already an Oracle based Db of digital electronic records, why did it not occur to the new folks to utilize the ODBC function of their new Db to glean info from the old? I did this for a living, more or less, with four global US Army databases…never “re-entered” a single field in any corollary Db I designed. One step forward, two steps back?
I am not sure where your doctor gets this, that he is required to have a designated person
I didn’t say required to hire a designated person. Read carefully. He needed to hire.
Because…….
1. His other staff is already busy dealing with patients, billing, scheduling, insurance questions, pharmacy refills etc etc etc not only for him but for the other doctors in the practice.
2. He doesn’t have the time to do computer input himself while talking to and examining patients. He would rather actually deal with his patients instead of dealing with a computer screen. We as patients would rather have this too. Personal attention.
3. There is no time in between patients to sit at a computer, look up the codes in the giant code book, and enter notes as well as prescription orders.
4. To write notes while in the room with the patient and then transcribe to the computer is a redundancy. He is peddling as fast as he can and doesn’t have time to do two clerical jobs at once. He would rather be a…..gasp…..doctor.
5. Now that Obamacare is kicking in with the computerized records requirement, it isn’t an option anymore. It is either buy the expensive computer system and enter all the information or GET FINED and have your income cut down.
6. His other staff is all busy and it is not feasible to have them or some of them, attend the patient meetings or do computer input all day long. So he NEEDED to hire some additional workers.
I swear…..it’s like I’m talking to second graders here. Sheesh 🙁
Comments like it is liking talking to second graders does nothing to make you seem more credible just like a playground bully.
Maybe that is your doctors experience however,
DISCUSSION
Our analysis indicates that the net financial return to a
health care organization from using an ambulatory electronic
medical record system is positive across a wide
range of assumptions. The primary areas of benefit are
from reductions in drug expenditures, improved utilization
of radiology tests, improvements in charge capture,
and decreased billing errors. Benefits increase as more
features are used and as the time horizon is lengthened. In
sensitivity analyses, the net return was positive except
when the most pessimistic assumptions were used.
Savings to the health care organization are obtained
under both capitated and fee-for-service reimbursement,
but these savings depend on the reimbursement mix: the
greater the proportion of capitated patients, the greater
the total return. Among fee-for-service patients, a large
portion of the savings from improved utilization may accrue
to the payer instead of the provider organization. As
a result, payers may be motivated to offer incentives to
providers to use an electronic medical record to help control
costs” http://nyehealth.org/wp-content/uploads/2012/07/Wang_EMRCostBenefit.pdf
Noyt anecdotal like your doctor but an actual study.
and another Implementing an EMR System: One Clinic’s Experience persp[ctive: The power of an EMR
Implementing an EMR system in a clinical practice is a daunting task. It requires good planning, strong physician leadership and supportive staff. The most immediate benefits of our EMR system have been accurate medication lists, legible notes and prescriptions, immediately available charts, decreased chart pulls and lower transcription costs. We are still just beginning to scratch the surface of what’s possible, but we would never go back to paper again.
http://www.aafp.org/fpm/2003/0500/p37.html
adults actually do their homework rather then rely solely on anecdote. Geesh.
leejcaroll – I have no problem with a computerized record system. However, I take exception to having to give them the same information again and again. This time they demanded information on my race. That has nothing to do with the care I am being given. This is an indicator that Obamacare is collecting data from the doctors for some purpose that has nothing to do with my healthcare.
leejcaroll – if I get run over by a bus, I can anecdotally tell you I was hit by the bus, I do not have to list stats for buses hitting pedestrians in the US for the last 20 years.
Paul:
Put another way, if a single mother made an annual salary of $30,000 and essential expenses (groceries, clothes, vacations, gas for her car, rent, utilities, etc.) totaled $25,000 – if she were a corporation her net income would be $5,000 – she would little or no taxes at all.
Not saying it should be that way, just showing how corporations work. Most of what is not written off on taxes is passed onto consumers.
Not knocking corporations, but consumers deserve most the credit for paying taxes – which they rarely receive credit for.
Ross – if so little income was derived from the corporate income tax I am sure they would get rid of it.
Ross wrote: “Put another way, if a single mother made an annual salary of $30,000 and essential expenses (groceries, clothes, vacations, gas for her car, rent, utilities, etc.) totaled $25,000 – if she were a corporation her net income would be $5,000 – she would little or no taxes at all.”
A corporation cannot deduct those kinds of expenses! I pay all those things, but I cannot deduct any of them. If I had to wear a specific uniform for work, I could deduct that, but I can’t deduct a suit of clothes that I bought for work and use only at work. I can’t deduct groceries for my corporation even though I make regular trips to stock the refrigerator at my office. I can’t deduct gas that I use to get to my office at work. I can’t deduct the cost of my car that I use unless that car was bought specifically and only for work. I could not use such car to drive myself home after work. Yeah, I can deduct the electricity I use at my office. I’ll give you that. But to suggest my net income is only $5,000 after all my deductions? Nope. I have a big tax bill. Every month it is my highest bill, bigger than the mortgage to my home.
Justice Holmes
Free speech, remember? There may be a difference but we are guaranteed the RIGHT by the Constitution to hate anyone we want. We may not be able to discriminate against them in businesses, but we can say or write anything we want about them as long it isn’t slander/libel. So that baker HAS to write that on the cake if the customer wants her to, even if she doesn’t agree with it. Oh, I forgot, you Liberals believe only you deserve freedom of speech.
Ross … even better, the reason the GSA got in to some much trouble over that Las Vegas fandango was their own rule, enforced on everyone else in government, that you may not even furnish coffee and donuts to any gathering that is made up of less than 51% of persons outside your offices. They tried to say since it was a general GSA wide gathering everyone was from “outside” the office. Whoops.
You just must know that due to my periodic experiences in emergency responses while sleeping the back of a truck eating PBJ’s culled from some bodega still open, their troubles delighted me. Dang it, I once had the mayor’s wife (dressed scantily and quite pretty) in a large coastal city offer me a Martini at 10:00 AM no less, while I worked on a piece of machinery near-by….had to turn that one down. Life just isn’t fair! 🙂
Trooper York:
For example in the state of Florida, some religious schools accept federal ADA grants to teach disabled children.
If some of those school officials find out the parents are gay, they permanently kick the disabled child out of that school – a genuinely traumatic experience for a disabled child in grade school. The school is punishing the child for the non-crime and non-wrongdoing of the parent – pretty evil stuff!
The gay parents pay federal taxes like any other Florida taxpayer. Why should they have to pay taxes to be treated like a 2nd Class citizen?
The government is not intruding on the religious institution when it fines it $11,000 per offense – the school accepted the taxpayer money and there are strings attached when you take taxpayer dollars – you can’t be a bigot!
Ross – those gay parents and their children will be just as well served at a public school which will also get the ADA money. What is the problem? I lost a job at a Catholic school because I was living with my soon to be wife, but not yet married. Those were the rules, so I did not take it personally.
Paul C said …
Any business that makes a profit pays taxes on the profit (assuming there is one) at the end of its fiscal year. What remains can be dispersed to shareholders or partners.
In a normal world. However, one day if our betters enact a national VAT tax businesses will owe & pay the tax even if there are no profits in a given year…and they will take it “from” their shareholders and partners purported equity.
It seems to me that this lady is a true Christian. One who refuses to insult anyone based on her beliefs. Can’t remember the scripture, but it says if you call someone raca you may be guilty of hell. So the question is are “those” Christians violating this Christian bakers religious freedom rights?