Millions are going online to the Affordable Care Act health care exchanges that opened up for business Tuesday morning. There's been talk about glitches and other logistical challenges, but what about beyond the initial phase of signing up? There are a variety of problems that could arise once newly insured Americans try to actually visit a doctor too. Primary care doctors are already in short supply and will be stretched even further when all the insurance policies are put to use.
Dr. Lesly D'Ambola, medical director at St. Luke's Catholic Medical Services in Camden, New Jersey, describes her work as a calling.
"Nobody's getting rich working here, including me," she confesses.
And it's easy to see why. The child poverty rate in Camden is nearly 40 percent, and median household income is 58 percent below the New Jersey average rate. There are six times as many violent crimes in Camden than the state average. Camden is a challenging place to practice medicine.
The clinic helps over 1,400 patients each year and is in dire need of another doctor to share the workload. Dr. D'Ambola often stays late to see patients, whose needs vary wildly from diabetes and obesity to mental health problems. Overcrowded and understaffed, St. Luke's workers have to get creative about how they use their space, holding meetings in their cramped kitchen.
"What we really need is a new building," admits Dr. Lesly.
Dr. D'Ambola has worked at St. Luke's on Camden's State Street since 2000 and says she arrived well-prepared for life 'in the trenches.' She completed her training in an urban setting at St. Michael's Medical Center in Newark, NJ. And as Assistant Professor of Medicine at the University of Medicine and Dentistry of New Jersey, she makes sure her students get the same exposure to inner-city practice as she did.
"Camden is difficult, and it's dangerous," she tells me. "We had a lot of murders last year. Despite all the bad things you hear about Camden, a lot of good people live here."
To hear from Dr. Lesly D'Ambola, medical director at St. Luke's Catholic Medical Services in Camden, in her own words, click on the audio player above.
This final note today, cribbed from our friend John Carney at CNBC.
John blogged today about a new dress code at Barclays -- super-casual Friday, it's called. Jeans: fine. T-shirts: fine. Even sneakers: also fine.
Not fine at all, though, with some of the old-timers. "I didn't become an investment banker to dress like a perpetual teenager," said a veteran of Lehman Brothers. Said another: "It's ridiculous. Please make them stop. It's like working at a start-up but without the IPO."
Or, y'know, public radio.
For Randall Wickus, electrician, welder, appliance installer, and all-around handy dude, advertising his services can be a tricky task.
"I don't advertise in the newspaper, because that's a dying form right now," Wickus said, adding that Craigslist and LinkedIn haven't been much help either.
"If you're a white-collar guy, and do IT work or whatever, there's plenty of places for you to look for a job, lots of different headhunters," said Wickus. "But not, that I've noticed, for the blue collar industry."
James Dunbar and Patrick Cushing, who work in tech in Silicon Valley, noticed the same thing. Both men are from blue-collar familes, and when they perused job networking sites, they realized something was missing.
"There's a lot of great tools and apps that have come out recently," Dunbar said. "But nothing for people like our brothers who work with their hands for a living.
So Dunbar and Cushing created WorkHands, a job network for skilled tradespeople -- carpenters, machinists, painters, and all-rounders like Randall Wickus. Unlike traditional job sites, where you upload your resume, on WorkHands, professionals can upload pictures of projects they've worked on. And that's crucial to people who work with their hands.
"You can upload images of projects that you've worked on in the past," said Dunbar. "You can upload licenses and certificates that you've earned and list the tools that you know how to use."
Randall Wickus has been a member of WorkHands for a few weeks, and hasn't landed any work just yet, but he says he has referred a lot of his blue-collar buddies to the site.
President Obama is expected to sit down Wednesday with members of the Financial Services Forum. The group represents some of the world’s biggest banks and insurance companies -- among them Bank of America, Goldman Sachs and JPMorgan Chase.
One inevitable topic of conversation: the looming deadline to raise the $16.7 trillion federal debt ceiling. That’s the amount of money the U.S. Treasury can legally borrow to pay its bills. Congress has until October 17 to increase it or risk a potential economic disaster.
Wall Street doesn’t just want Congress to raise the debt ceiling, says Chris Krueger, Washington analyst for Guggenheim Securities.
“Ideally they would like to see Congress eliminate the debt ceiling, so we don’t continually have these situations where Congress threatens these showdowns,” Krueger says.
Whether bankers can do much about it is another question, he says. The shadow of the financial crisis still hangs over Washington, and Wall Street isn’t exactly popular with either party.
It won’t be lobbying that gets a divided Congress to work together, says Karen Petrou with Federal Financial Analytics.
“I think it’s ultimately going to be the markets that I hope don’t have to teach them a lesson, because it could be a very costly one to all the rest of us,” Petrou says.
If the U.S. government can’t pay all of its bills, Petrou predicts stock prices will drop sharply, interest rates will spike and that could slow down economic growth.
The social news and entertainment website Reddit has grown exponentially in recent years. It now accepts 19 million up or down votes every day on links to everything from celebrity advice to pornography. This weekend, thousands of the website's users will be going offline to gather in the real world for Reddit's second annual Global Day of Service. Redditors -- as the site's users are called -- plan blood donation drives in Sydney, Australia and park clean ups in Austin, Texas.
Erik Martin, Reddit’s General Manager, says Redditors meet offline often for various organized events -- as often as every day in major cities. Many of those smaller meet-ups are service-oriented too, but declaring a single day can encourage more regular engagement.
“The bigger goal is to get more people involved in something that matters in their local communities,” Martin says.
Erik Martin, Reddit’s General Manager, joined Marketplace Tech host Ben Johnson to discuss.
Click on the audio player above to hear the full interview.
On Sept. 27, 1988, Canadian sprinter Ben Johnson was stripped of his 100-meter gold medal when tests showed a performance-enhancing drug in his system. As Alex Rodriguez appeals his illegal doping ban from Major League Baseball, Frank Deford reflects on a historical moment of drug use among athletes.
The allegations have shaken people in Nairobi, who just a week ago were hailing the soldiers as heroes after Islamic militants stormed an upscale mall and killed dozens. President Uhuru Kenyatta has vowed to set up a commission to look into lapses in intelligence and security, and to investigate the accusations.
Many users trying to sign up for the new health care marketplace on Tuesday hit technical glitches and slow downs. Programmers say the tech powering Obamacare online can be very complicated. And the administration urges patience.