Late ‘King of Pop’ collects 4 prizes; Taylor Swift named artist of the year

LOS ANGELES - Michael Jackson was made history by winning four American Music Awards on Sunday night, but he couldn’t beat Taylor Swift as the year’s favorite artist and the evening’s top winner.

The 19-year-old took the evening’s top award, giving Jackson his only loss of the night, and five trophies in all.

The victories came during a performance-filled show that closed with an S&M-themed, sexually charged performance by Adam Lambert (his performance included him shoving a male dancer’s face in his crotch).

Jackson’s trophies were accepted by his brother Jermaine, who paid tribute to his late brother by wearing glittery white glove. He accepted two of his brother’s awards, thanking “Allah for blessing my entire family” and naming each of his brothers and sisters.

He said Michael’s message is more important than any award.

“The message that Michael had will live on forever,” he said. “He saw good in everyone and he wanted everyone to do good. He always started with love.”

Jackson was named favorite male artist in the pop/rock and soul/R&B categories. His 2003 greatest-hits album, “Number Ones,” also won favorite album in both categories.

Jackson’s victories were among the highlights of the evening, which also featured a jaw-dropping performance from Lady Gaga and a special award for Whitney Houston.

Mario Anzuoni / Reuters Lady Gaga performs “Bad Romance” at the 2009 American Music Awards in Los Angeles on Sunday.

Lady Gaga, wearing a Vulcan-inspired headdress and vest filled with lights, performed songs from her new album, “The Fame Monster,” due in stores next week. She used her microphone to break into a glass case where a grand piano stood. It caught fire when she sat down to play.

The American Music Awards honor the year’s top-selling artists in eight popular genres. But even more than awards, the AMAs are about performances, and they came back to back to back Sunday.

The Black Eyed Peas, voted favorite pop/rock band, energized the crowd when they performed two of the year’s most popular hits: “I Got A Feeling” and “Boom Boom Pow.”

Dancers wearing outfits made from stereo speakers shared the stage with Fergie, Taboo, apl.de.ap and will.i.am, who wore a pompadour wig. The high-energy medley melted into a Nirvana sample at the end, with will.i.am rocking on guitar.

Rihanna returned to the AMA stage Sunday, sporting blonde hair, a skintight, white peek-a-boo bodysuit and a tattoo down the front of her neck that read “Rated R,” the name of her new album, out next week.

Janet Jackson opened the show with a medley of some of the biggest hits from her long career — all tracks that appear on her new greatest-hits collection, also called “Number Ones.”

Alicia Keys and Jay-Z dueted on their ode to New York City. Shakira was flanked by a dozen dancers in tiny black bodysuits as she sang her new single. Kelly Clarkson performed a stripped down version of her hit “Already Gone,” backed by a string quartet.

Michael Jackson has made history by winning four posthumous prizes at the American Music Awards.

The wins made Jackson, who died in June at the age of 50, the most honoured artist in the ceremony’s history with a career total of 23 accolades.

But country star Taylor Swift was the big winner on the night, winning five prizes including artist of the year.

Less successful was Jennifer Lopez, who slipped and landed on her rear during a dance routine for her latest single.

The singer was unhurt in the brief tumble and carried on with her performance.

‘Unimaginable’

Jackson was named best pop/rock male artist and best soul/R&B male artist at Sunday’s ceremony in Los Angeles.

His greatest hits compilation Number Ones also won the best album award in the pop/rock and soul/R&B categories.

Lopez took a brief tumble while performing her new single Louboutins

The late star’s trophies were accepted by his brother Jermaine, who said his sibling’s message “would live on forever”.

“He saw good in everyone and he wanted everyone to do good,” said the Jackson 5 singer. “He always started with love.”

Swift also paid tribute to Jackson as she accepted her awards by satellite from London.

“To even be mentioned in a category with Michael Jackson, who we will miss and love forever, is an unimaginable honour,” she said as she received the event’s top award.

Swift was also named best female pop/rock and country artist and best adult-contemporary artist.

Flamboyant

The 19-year-old’s debut release Fearless was named best country album.

Other awards on the night went to Beyonce Knowles, Black Eyed Peas and country singer Keith Urban.

Pop star Lady Gaga spend part of her performance at a blazing piano

Whitney Houston received an international award of excellence which she dedicated to her daughter Bobbi, music mogul Clive Davis and “everybody who supported me”.

The soul star sang a track from her comeback album at an event that also featured performances from Janet Jackson, Alicia Keys, Jay-Z and Rihanna.

Lady Gaga raised eyebrows by playing a piano that caught fire during a typically flamboyant performance.

And Colombian star Shakira was flanked by a dozen dancers in black bodysuits as she sang her new single.

Nominees were determined by radio airplay and retail sales, with the eventual winners decided via online voting.

Last year’s ceremony saw R&B singer Chris Brown, Rihanna’s former boyfriend, receive three prizes including artist of the year.

One side is for patients with insurance, the other for those who pay up front

Two doors into medical care on the Upper East Side of Manhattan. The door on the right leads to quicker service and personal attention from a doctor. The other leads to longer waits and more uncertainty. As it turns out, they’re the same place.

NEW YORK - In America, you get what you pay for. Those who pay more get better service. That’s the way it is in restaurants, and in health care, too.

But imagine a restaurant with one kitchen, one chef, but two doors and two price lists. That’s the model of health care that some doctors are practicing.

In New York City, msnbc.com heard of doctors locating their practices on corners, so they can have one door where they take insurance and another door offering services for patients who pay cash up front for each procedure.

We visited one of these clinics with two doors, to see how it works. The result is a glimpse into a two-tiered system of health care, a system that could be coming to a street corner near you.

On Manhattan’s fashionable Upper East Side, the door on 77th Street says Lenox Hill

Radiology. It’s a busy place, with 20 or 30 people typically waiting in chairs. It takes insurance.

But if you walk a few steps down the block to Madison Avenue, and one block up to 78th Street, you’ll walk through the door of New York Private Medical Imaging. The waiting room has only four chairs, usually empty. It takes cash, checks and credit cards. You can try to recoup some of your money later if you have insurance.

Both doors ultimately lead to the same area of changing rooms and scanning equipment. The same technicians perform PET scans and MRIs on the same machines. The employees are warned, in a written policy, not to tell the patients about the other door.

As Congress spars over how to fix the nation’s health care system, w e’ve seen more doctors reject the managed care dominated by insurance companies, pushing patients to pay $1,500 to $2,000 a year for “concierge” service with more of the doctor’s time and attention. At least those patients know what they’re choosing.

But another group of doctors has set up their own segregated system, taking insurance from patients who come through one door, while collecting higher fees from patients who can afford to pay up front.

A test
To see how it works, msnbc.com sent two reporters, Linda Carroll and Helen Popkin, for their routine mammograms on the same afternoon to document their experiences. And later we returned to interview doctors on both sides.

The purpose: to determine if both women received the same care. And if there were any differences, were they meaningful or superficial?

At the Lenox Hill clinic, on the insurance side, Helen waited 15 days to get an appointment. On the day of her mammogram, she stood in line at the reception desk in a crowded waiting room. An elderly patient wandered the reception area in her hospital gown, pleading for someone to help her. In the changing room, Helen’s gown was the usual thin seersucker. The technician was friendly and efficient, though Helen didn’t see a doctor. She went home not knowing whether she was healthy or not, and waited nine days for her results. But it was good news, a clean bill of health. Though the list price was $350, Helen’s insurance paid the clinic $140 and she paid nothing, because her health insurance covers preventive care such as mammography.

At the Private Imaging clinic — the boutique side — Linda was able to get an appointment in two days. She was greeted immediately in the private reception area. She changed into a comfy spa robe. Her technician was also friendly and efficient, then the doctor read the scan after a few minutes, reassuring her, “Your mammogram’s negative. Nothing to worry about. See you next year.” Linda walked out carrying a copy of her X-rays. Linda wrote a check to the clinic for $350; if she’d had the same insurance plan as Helen, Linda’s net cost would have  been $210.

How it got to be this way
Dr. Carmel Donovan used to be on the insurance side of this setup, at Lenox Hill Radiology. Her husband and son still manage both sides. Eight years ago she put in the second door and a separate reception desk, incorporating as New York Private Medical Imaging.

The first factor that drove her out of managed care, Donovan explains in her Irish immigrant accent, was the declining rate of insurance payments. “It costs $100 to do a mammogram, but reimbursement was down to $50. Then it went down to $29 for a chest X-ray for a child. Impossible!”

David Friedman / msnbc.com Two doctors in the same place with different methods: Dr. Carmel Donovan, left, doesn’t take insurance, and emphasizes taking time with the patient. Dr. Marc Liebeskind, right, works in managed care and sees his patients “digitally,” meaning he reviews their scans without meeting them.

The second factor, she said, was time — time to talk with patients and their doctors, time to read the scan with care.

“On the managed care side, it was just — you couldn’t talk to people, because you have to produce!” Donovan said.

“You see, they see over 500 patients a day. And you have this pressure. You have to just get stuff right out. You see, it’s impersonal.”

Talking with patients allows her to explain what she found, or to reassure them that she found nothing. And she says that conversation can help her with a diagnosis. Say a child comes in with a possible fracture of an arm, but from the X-ray it’s not clear.

“So I come in, I put my hand on there, and if they jump, I know that there’s a fracture.”

She said that even the parts of her practice that appear superficial, the robe and private waiting room, contribute to better health care. She tries not to have the patients wait long, “because that’s anxiety producing.”

The rescan
Although the actual mammogram itself seemed identical for Helen and Linda, there was one subtle difference.

After a quick quality check on Helen’s scans, on the insurance side, the technician said the pictures were sharp, and sent her on her way.

The technician did the same with Linda, the boutique patient, and also said the scans were sharp.

But when Linda’s radiologist examined Linda’s X-rays a few minutes later, she said one of them was blurry, and sent the technician back to repeat it.

That couldn’t have happened on the insurance side. By the time Helen’s radiologist looked at her X-ray, days later, Helen would be long gone. If the radiologist thought one of her scans was blurry, the doctor would either have had to rely on the information at hand or call her back for another appointment.

35 seconds
A few minutes after Linda’s mammogram on the boutique side, a radiologist, Dr. Mona Darwish, knocked and walked into the changing room.

“Hi, I’m Dr. Darwish, how are you?” she said cheerfully. “Your mammogram’s negative, OK, so nothing to worry about.”

Linda asked a couple of questions about a previous mammogram, and the doctor reassured her again. The conversation went back and forth. They laughed together, the tension broken.

“See you next year,” Darwish said.

The entire conversation took 35 seconds.

That personal contact was not available to Helen or the other patients on the insurance side.

All Helen heard was the technician’s rushed dismissal, “OK, your doctor will get the results in seven to 10 days.”

As it turned out, while Darwish is on the staff of the insurance side of the clinic, she reads the mammograms for patients on both the insurance and boutique sides.

So, although our two patients went through separate doors, they had their scans read by the same radiologist.

But only Linda, the boutique patient, got to meet the doctor and get an immediate result.

If Linda’s mammogram had shown something unusual, Donovan said, Darwish would have spent a lot more than 35 seconds with her. But first the doctor would have called Linda’s primary care physician to discuss who would deliver what information.

On the insurance side, when Helen’s doctor got her results nine days later, it was only a written summary, not copies of the scans. Helen said a previous mammogram had left her with questions, but she didn’t get a chance to ask those questions this time around.

Meeting the patients digitally
One of the 20 radiologists on the insurance side at Lenox Hill, Dr. Marc Liebeskind, said he and his colleagues offer equally good health care as the boutique side, although they don’t meet most of their patients.

David Friedman / msnbc.com Dr. Marc Liebeskind reads 80 to 100 scans a day, without meeting most patients. “You don’t want to be saying the tumor is getting smaller because I like Bessie. You want to be able to say the tumor is getting smaller because I can objectively measure its volume.”

“I”m meeting most of my patients digitally,” he said.

Instead, Liebeskind reads scans in a tiny office of computer monitors.

“I read all day long. I read from morning to night. We do close to 125,000 cases in this facility each year. The more the managed-care reimbursements drop, the more we have to do.” That works out to 80 to 100 scans a day for him.

Comparing his work with Donovan’s, he said, “The quality of care is identical. The equipment is identical. The technology is identical. It’s not a matter of quality, so much as it is a matter of luxury. It’s the patient experience that’s different. I think the quality is identical.”

Premium-pay medical practices grow as doctors seek more control, cash

ANAHEIM, Calif. - When Bob Goodrich’s longtime doctor started providing premium care only to patients who paid a $1,600 annual fee, the 63-year-old felt he had no choice but to write a check.

His wife, Marjorie, 64, was sick with a serious adrenal disorder and nervous about having to switch doctors. And she was drawn to the longer appointments, personal attention and 24/7 access that Dr. Susan Debin promised the new “concierge” arrangement would provide.

But with already-high monthly insurance premiums and constant cash outlays for co-payments and deductibles, the family couldn’t afford two elite medical memberships.

So Goodrich, a retired parks director, gambled that his own high blood pressure wouldn’t get worse. He paid the fee for his wife — but not for himself.

“I’m old school,” he said. “The women and the

children go in the lifeboat first.”

The Goodriches’ dilemma is becoming more common as a growing number of doctors enact their own brand of health reform. These physicians are opting out of the system, with some doctors dumping insurance companies altogether and others forcing patients to pay thousands of dollars in cash to keep the care they’re accustomed to.

Doctors often tout this model as “concierge” care — you get more if you pay more. But for some patients, the flip side of this arrangement feels more like pay more or get less.

“It did leave me up the creek,” said Lilly Manning, 74, of Vienna, Va., who left her doctor of 15 years after he began charging patients $1,500 a year to remain in his practice. “I don’t think it’s right. I think a doctor should take anybody.”

5,000 concierge doctors — and growing
As many as 5,000 doctors nationwide have opted for full or partial concierge practices. Surveys suggest that number could quadruple within the next few years.

The result, critics say, is a segregated system that offers extra access for extra cash, even as it escalates a looming health care crisis for everyone else. And there’s nothing in the current health reform bills being considered in Congress to stop it.

“These practices exacerbate a fundamental problem in our health care system, which is this health care chasm between the haves and the have-nots,” said, Laura Weil, director of the health advocacy program at Sarah Lawrence College in Bronxville, N.Y., and an analyst of concierge care.

Here’s how concierge medicine works: Doctors charge anywhere from $1,500 per person per year up to $25,000 or more for a family. This fee acts as a retainer on top of all the insurance-covered services.

In some programs, those who don’t pay are forced to leave the practice. In others, they’re likely to see a nurse practitioner, a physician assistant or a newer, different doctor hired to handle the traditional patients.

The move to smaller, premium practices will worsen an already dire shortage of primary care doctors, creating an elite group of well-compensated physicians who see fewer and fewer upscale patients, dumping the rest on their increasingly harried colleagues, critics contend.

The U.S. is short by between 40,000 and 50,000 primary care doctors now, a figure that’s expected to top 125,000 by 2020, according to the American Academy of Family Physicians. That means people who don’t want or can’t afford concierge plans will have a harder time than ever finding a doctor.

But proponents of direct-pay and concierge care say the new models are the result of frustrated doctors defecting from a broken medical system, one that forces physicians to see too many patients for too little pay and with too much red tape.

Plus, plenty of patients are eager for this kind of personalized care — and are willing to pay for it.

“This is a multi-tiered health system and has been for a number of years,” said Darin Engelhardt, president of MDVIP, a network of some 300 concierge doctors based in Boca Raton, Fla. “What we’re offering is simply a choice along the health care continuum.”

Premium care for the price of a latte
Engelhardt and others reject charges of elitism, saying that paying extra for medical care is no different than affording other amenities of modern life, like a $4 daily latte or a fancy cell phone plan.

“Unless someone is prepared to suggest that a cell phone is an elitist instrument,” he said. “I don’t see it.”

Researchers catalog life in pitch-black zone once thought to be ‘barren’

NEW ORLEANS - The creatures living in the depths of the ocean are as weird and outlandish as the creations in a Dr. Seuss book: tentacled transparent sea cucumbers, primitive “dumbos” that flap ear-like fins, and tubeworms that feed on oil deposits.

A report released Sunday recorded 17,650 species living below 656 feet, the point where sunlight ceases. The findings were the latest update on a 10-year census of marine life.

“Parts of the deep sea that we assumed were homogenous are actually quite complex,” said Robert S. Carney, an oceanographer at Louisiana State University and a lead researcher on the deep seas.

Thousands of marine species eke out an existence in the ocean’s pitch-black depths by feeding on the snowlike decaying matter that cascades down — even sunken whale bones. Oil and methane also are an energy source for the bottom-dwellers, the report said.

The researchers have found about 5,600 new species on top of the 230,000 known. They hope to add several thousand more by October 2010, when the census will be done.

The scientists say they could announce that a million or more species remain unknown. On land, biologists have catalogued about 1.5 million plants and animals.

‘Least explored environment’
They say they’ve found 5,722 species living in the extreme ocean depths, waters deeper than 3,280 feet.

“The deep sea was considered a desert until not so long ago; it’s quite amazing to have documented close to 20,000 forms of life in a zone that was thought to be barren,” said Jesse Ausubel with the Alfred P. Sloan Foundation, a sponsor of the census. “The deep sea is the least explored environment on earth.”

More than 40 new species of coral were documented on deep-sea mountains, along with cities of brittlestars and anemone gardens. Nearly 500 new species ranging from single-celled creatures to large squid were charted in the abyssal plains and basins.

Also of importance were the 170 new species that get their energy from chemicals spewing from ocean-bottom vents and seeps. Among them was a family of “yeti crabs,” which have silky, hairlike filaments on the legs.

Expensive equipment
In the mid-Atlantic, researchers found 40 new species and 1,000 in all, said Odd Aksel Bergstad, an oceanographer with the University of Bergen in Norway who was reached by telephone in the Azores islands.

“It was a surprise to me to find such rich communities in the middle of the ocean,” he said. “There were not even good maps for the area. Our understanding of the biodiversity there was very weak.”

More than 2,000 scientists from 80 countries are working to catalog the oceans’ species.

Researching the abyss has been costly and difficult because it involved deep-towed cameras, sonar and remotely operated vehicles that cost $50,000 a day to operate, Carney said.

Once the census is complete, the plan is to publish three books: a popular survey of sea life, a second book with chapters for each working group and a third focusing on biodiversity.