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Old 31st July 2009, 06:04 AM   #101 (permalink)
Cliffbeer2
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Re: Healthcare

Quote:
Originally Posted by jimbo View Post
From my perspective as a patient, a family member of several patients, and as a practicing physician in emergency medicine for nearly twenty-five years, the following:

1) the idea that litigation against physicians or hospitals is responsible for excess medical care costs is not true. I agree that we physicians order a lot of tests and do a lot of things in an effort to avoid getting sued, but the most reliable figures I have been able to find show that the overall cost of med mal litigation, the things we do to try to avoid it, etc, are very small- one percent or less of the medical care spending in the USA. What frivolous suits waste is time more than money- but as someone who's done this for years and fifty thousand hours or more, I can tell you that there is quite a bit of bad medicine out there. And of course there are a lot of bad outcomes, too, but not every bad outcome is evidence of medical negligence.

2) From a purely financial perspective, it is cheaper over the long haul to regulate medical spending by insuring everyone than by having a large group of uninsured patients who we all subsidize. I see the evidence of this every day in the ED. You'll have to trust me on this one, but I firmly believe that it will serve all of us (not just the uninsured etc) better if we bite the bullet, insure everyone, and then have some leverage with which to regulate medical expenses. This is independent of politics or party persuasion. If you have one-sixth of the population uninsured and without resources, AND you have a situation where ERs are obligated to treat everyone and can
t turn anyone away, AND you have a mechanism whereby providers can refuse to treat patients in a non-emergency situation, you end up funneling everyone into the emergency care part of the system, with the kinds of predictable results that we've all seen- dismal ones.

3) Al points out that that marginal or doubtfully qualified people get into medical school. I'd differ with that. The number of people applying to medical schools is so much larger than the number accepted that at least academically, the people graduating are qualified. Whether or not they will make compassionate and effective physicians is something altogether different- but they are at least intellectually qualified. Frankly, being smart is not the essential element here- while you have to be intelligent to be a doctor, you don't have to be brilliant. What IS essential is that a good doctor is thorough, and compassionate- empathetic might be a better term- and those qualities are rather difficult to screen for or test for when determining who gets into medical school.

4) You'd be surprised at how many physicians support universal medical insurance. I do. And while my politics are somewhat liberal, they are not radical at all. As a physician, I see my job as taking care of everyone who needs it, whether or not they are able to pay. I don't think medical care should be reserved for the employed, or the young, or the old, or the wealthy. After all, we're all going to get sick and die someday; it's built in. We might as well face reality and make the best arrangements in advance that we can, shouldn't we? Such arrangements involve facing up to the idea that it's going to happen to all of us.

5) Most of the uninsured people I see in ERs are working. They are not unemployed, they are not parasites, and they are not typically people who abuse their own health. They just don't have any medical insurance.

6) One of the things that drives excess health care spending is physician greed. This is clearly documented and unfortunately quite true. Allowing the fox to guard the henhouse usually results in fat foxes and fewer hens. Our situation with respect to allowing physicians to order procedures and tests from which they handsomely profit is unfortunately no different. It's something we badly need to fix.
+1 Jim. Couldn't agree more. You're more informed than I am (you being a doc after all) but I think you've summed it up very well here.

Incidentally (you may already know this), the reason why ERs tend to treat all, including those without insurance, is because most hospitals are organized and taxed as non-profit organizations and such status requires a "charitable element" to the organization's operations - the rendering of unreimbursed medical services in the ER satisfies this US Tax Code requirement of "charitable element." It always makes me cringe when some senior hospital official makes a public statement saying that the hospital is "morally compelled" to treat those "less fortunate" as well as those more fortunate. Maybe true, but I think what's really driving it is the Tax Code requirement in order to file as a non-profit. In other words, it's convenient and self serving to suggest a moral basis when what's really going on is pure economics (as usual in life).....
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Old 31st July 2009, 06:05 AM   #102 (permalink)
Cliffbeer2
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Re: Healthcare

OK, I'll shut up now.
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Old 31st July 2009, 09:48 AM   #103 (permalink)
domtoni
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Re: Healthcare

Cliff, thanks for taking the above points.

Keeping people alive until they are 90 seems a charitable and noble thing to do. As noted, my mom's father died at 62, her mother at 67, my dad's father at 71?, my dad's mother at 87, my mom at 72, and my dad at 87. But how many of these people can we afford to keep alive?

Nursing home costs today in Chicago are somewhere around $60,000 per annum. Costs here in the UK are very similar. I insured myself for nursing home care in the states, and the insurance will pay for 3 years and that's it.

Here in the UK and if you need care and can't afford it (which most people can't), the local government takes your home, sells it and spends / keeps the proceeds from the sale.

Here in the UK, pension companies will guarantee (with its standard policy) a pension for 5 years. If you continue to live, they continue to pay. If you fall dead within the first 5 years, then the companies pays out the 5 year obligation. If you paid more in than you will get out, that goes into the pot. Social security works in a very similar way.

People are living too long (thanks to the medicine), not working long enough (thanks to ageism), have not saved enough for old age (thanks to consumerism), and some have not done a good job keeping themselves healthy (thanks to no exercise and fast food).
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Old 31st July 2009, 10:17 AM   #104 (permalink)
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Re: Healthcare

In the UK if you need a care home and can't afford to pay but own your own property then the local council work with you. You can keep all of your state benefits you get and the council will help towards the payment of the care home. Whatever the difference that needs to be made up for the care home is loaned to you with a charge being put against the property. (Known as deffered payment) They dont just take your home and keep the proceeds !!!!
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Old 31st July 2009, 10:18 AM   #105 (permalink)
domtoni
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Re: Healthcare

Thanks for correcting the error Paul, but that was the info I had been given.
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Old 31st July 2009, 12:37 PM   #106 (permalink)
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Re: Healthcare

A small data point...

I attended a discussion ssession with the CEOs of the two largest health care providers in my area (Raleigh and Durham, North Carolina) -- the CEO of Duke Health Care, and the CEO of Wake Med.

Both were in favor of some form of basic national health care. Their point was it woudl allow them to plan and control costs and revenue better. Right now, they average collecting 33 cents on every dollar they invoice, and often times just don't know when they perform care how much they will receive in return.

So you can bet that risk is "built" into the price.

There are a lot of pros and cons to health care reform, but it seems to me that if the business folks (not doctors or insurers) are saying a standardized system that allowed better cost and revenue planning would help them, then that is pretty strong evidence that our existing "market" system isn't really working.
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Old 31st July 2009, 01:54 PM   #107 (permalink)
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Re: Healthcare

A small bit of drift, but very interesting.

I think a 10th Amendment fight is coming...

Will Florida Ban National Health Care?|Tenth Amendment Center
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Old 31st July 2009, 02:10 PM   #108 (permalink)
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Re: Healthcare

Quote:
Originally Posted by JeffYoung View Post
A small data point...

I attended a discussion ssession with the CEOs of the two largest health care providers in my area (Raleigh and Durham, North Carolina) -- the CEO of Duke Health Care, and the CEO of Wake Med.

Both were in favor of some form of basic national health care. Their point was it woudl allow them to plan and control costs and revenue better. Right now, they average collecting 33 cents on every dollar they invoice, and often times just don't know when they perform care how much they will receive in return.

So you can bet that risk is "built" into the price.

There are a lot of pros and cons to health care reform, but it seems to me that if the business folks (not doctors or insurers) are saying a standardized system that allowed better cost and revenue planning would help them, then that is pretty strong evidence that our existing "market" system isn't really working.
Maybe a different view?

This, to me, is like the big oil and energy companies supporting the cap and trade proposals. On the outside it may appear that these companies want the best for the environment and the people. Reality is that a cap and trade system will monopolize the energy markets, and guess who will be the ones left holding all the cards(read pollution credits)?

Same thing here. The insurance companies know better than to fight Washington, so they line up in favor of it and also line up to be one of the few authorized insurance providers through the government plan. If the proposal goes through, they score. If it doesn't they score. It's a no lose prospect for them. Why wouldn't they support this?

As we have been saying, FOLLOW THE MONEY!!
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Old 3rd August 2009, 07:21 AM   #109 (permalink)
domtoni
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Re: Healthcare

Correction from my comments on UK nursing home costs.

An English friend noted that:
- the council (or local government administration) doesn't take your house, sell it and then use the proceeds to pay for your care, and keep the balance if you die the following day.
- the council forces the person to sell his house and use the proceeds to pay for his care.

I was also told that legislation is pending that would allow the person who needs nursing home care to keep his house, pass it onto his heirs and the government will pay for care.
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Old 3rd August 2009, 02:50 PM   #110 (permalink)
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Re: Healthcare

Quote:
Originally Posted by crash33 View Post
As we have been saying, FOLLOW THE MONEY!!

It has been flowing from my house like a firehose...
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Old 3rd August 2009, 03:12 PM   #111 (permalink)
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Re: Healthcare

The most level-headed response to the proposed "health care" bill comes from Tom Price on the House floor: YouTube - Rep. Tom Price admonishes govt-takeover of healthcare
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Old 3rd August 2009, 04:26 PM   #112 (permalink)
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Re: Healthcare

Quote:
Originally Posted by Scott Calabro View Post
A small bit of drift, but very interesting.

I think a 10th Amendment fight is coming...

Will Florida Ban National Health Care?|Tenth Amendment Center
And, as the past has shown, even if the Supreme Court upholds these kinds of rulings (which,
in reality, rarely happens), the Feds can just impose their will by limiting Federal funds - just
as they did with the national speed limit, blood alcohol levels, drinking age, etc.

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Old 3rd August 2009, 08:36 PM   #113 (permalink)
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Re: Healthcare

THANK YOU Tom Price!!! What kind of idiots would take a 1000 plus pages of a completely new package of legislation plus all of the ammendments that will find there way onto the bill and expect an informed vote as to the viability of the bill? If you believe that the goverment is good at running things and controling costs, you are a dreamer. Look at the Post Office, HUD, Dept. of Energy (who have been lowering our dependence on foreign oil since Carter authorized them--not), Dept of Education etc. The problems with placing the government in charge of most things is there ability to perform!
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Old 3rd August 2009, 09:01 PM   #114 (permalink)
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Re: Healthcare

Tom Price, a voice of sanity! Thank God they are not all lost in space!
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Old 3rd August 2009, 09:04 PM   #115 (permalink)
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Re: Healthcare

The people in CA ought to make a serious effort to vote that idiot Pelosi out of office next election!
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Old 3rd August 2009, 10:03 PM   #116 (permalink)
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Re: Healthcare

I thought this was interesting.

From Salon


AUGUST 3, 2009 9:57AM
Why Republicans need health care to fail


Over the past 30 years the Republicans have been working to promote their agenda and none of it seems to be for the betterment of America. They have worked hard to push the cutting of funding for infrastructure repairs to promoting their crusades in the oil lands. Now we are discussing heath care reform and the Republicans are pulling every dirty trick out of their playbook to stop it, from the classic propaganda of high taxes and the destruction of the middle class to trying to claim senior citizens will be encouraged to commit suicide.

But why are they fighting so hard? I have three answers and none of them will be very popular with the conservative element.

Reason number one, money. Lets be perfectly honest, Republicans claim they are for the common man and main street businesses but ever action only benefits mega corporations. Consider this, Cleve Killingsworth, CEO of Blue Cross received a pay increase of 26% pushing his salary, including a million dollar year end bonus to $4.3 million dollars*. How many people had to be denied coverage or life saving treatments in order to boost profits high enough to pay that kind of salary? And you know the lobbyists on K street make sure a chunk of those profits are funneled to their favorite memebers of Congress.

Reason number two, power. Corporate America has become the new feudal system. They control their employees with the threat of unemployment and the loss of benefits. As long as the unemployment rate remains high and insurance costs are out of control people will remain at a job, even a bad one, for financial reasons. High insurance rates are just another control mechanism and again, corporate America makes sure members of Congress are well compensated for maintaining the status quo.

And reason number three, the "gotcha" factor. Since 2005 the Republicans have been on a downhill slide. From Katrina to the Cheney shooting and the endless scandals of the "do nothing" Congress the Republicans haven't had a win in years. They suffered a humiliating defeat in both 2006 and 2008. They now have such a void in leadership that Sarah Palin, the clown princess of the Republican party, is actually at the top of the 2012 nominee list. They have no real plans or programs so the best they can do is try to tear down those of the Democrats in order to claim victory. The Republicans are desperate for some kind of win and they couldn't care less how the rising cost of health care affects the average American or to paraphrase South Carolina Senator Jim DeMint, they want the issue to be President Obama's Waterloo.

The Republicans are desperate to regain power in America. They have proven they will do anything to re-seize control of the government. Well anything but actually help Americans, after all that would be socialism!!!!!


Why Republicans need health care to fail. - ocularnervosa - Open Salon

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Old 4th August 2009, 12:33 AM   #117 (permalink)
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Re: Healthcare

Quote:
Originally Posted by imsa View Post
I thought this was interesting.

From Salon


AUGUST 3, 2009 9:57AM
Why Republicans need health care to fail


Over the past 30 years the Republicans have been working to promote their agenda and none of it seems to be for the betterment of America. They have worked hard to push the cutting of funding for infrastructure repairs to promoting their crusades in the oil lands. Now we are discussing heath care reform and the Republicans are pulling every dirty trick out of their playbook to stop it, from the classic propaganda of high taxes and the destruction of the middle class to trying to claim senior citizens will be encouraged to commit suicide.

But why are they fighting so hard? I have three answers and none of them will be very popular with the conservative element.

Reason number one, money. Lets be perfectly honest, Republicans claim they are for the common man and main street businesses but ever action only benefits mega corporations. Consider this, Cleve Killingsworth, CEO of Blue Cross received a pay increase of 26% pushing his salary, including a million dollar year end bonus to $4.3 million dollars*. How many people had to be denied coverage or life saving treatments in order to boost profits high enough to pay that kind of salary? And you know the lobbyists on K street make sure a chunk of those profits are funneled to their favorite memebers of Congress.

Reason number two, power. Corporate America has become the new feudal system. They control their employees with the threat of unemployment and the loss of benefits. As long as the unemployment rate remains high and insurance costs are out of control people will remain at a job, even a bad one, for financial reasons. High insurance rates are just another control mechanism and again, corporate America makes sure members of Congress are well compensated for maintaining the status quo.

And reason number three, the "gotcha" factor. Since 2005 the Republicans have been on a downhill slide. From Katrina to the Cheney shooting and the endless scandals of the "do nothing" Congress the Republicans haven't had a win in years. They suffered a humiliating defeat in both 2006 and 2008. They now have such a void in leadership that Sarah Palin, the clown princess of the Republican party, is actually at the top of the 2012 nominee list. They have no real plans or programs so the best they can do is try to tear down those of the Democrats in order to claim victory. The Republicans are desperate for some kind of win and they couldn't care less how the rising cost of health care affects the average American or to paraphrase South Carolina Senator Jim DeMint, they want the issue to be President Obama's Waterloo.

The Republicans are desperate to regain power in America. They have proven they will do anything to re-seize control of the government. Well anything but actually help Americans, after all that would be socialism!!!!!


Why Republicans need health care to fail. - ocularnervosa - Open Salon

IMSA
IMSA, You obviously didn't listen to this, http://www.youtube.com/watch?v=SD_YOlUBoIk Mr. Price's interest is in the American people, and the healthcare bill that is being crammed down our throats. I would bet that over 90% of the politician haven't even read the entire bill. Do you have a clue as to what is in the bill? Or are you talking strickly along party lines? If I thought this was for the good of the American people, I wouldn't have a problem, democrat or republican. I've always voted for the person that I thought would do the best job, not the party!

Last edited by Al Wohlstrom; 4th August 2009 at 12:39 AM.
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Old 4th August 2009, 01:09 AM   #118 (permalink)
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Re: Healthcare

Or are you talking strickly along party lines?

Pot calling the kettle black?

IMSA
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Old 4th August 2009, 02:31 AM   #119 (permalink)
A Tenth
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Re: Healthcare

Here's an interesting discussion on health care and the insurance industry Al. Why don't you watch it and get back to me.

Bill Moyers Journal . Wendell Potter on Profits Before Patients | PBS

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Old 4th August 2009, 03:06 AM   #120 (permalink)
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Re: Healthcare

Quote:
Originally Posted by imsa View Post
Or are you talking strickly along party lines?

Pot calling the kettle black?

IMSA
What part of this did you not understand?
"If I thought this was for the good of the American people, I wouldn't have a problem, democrat or republican. I've always voted for the person that I thought would do the best job, not the party!"
Do you honestly think the healthcare bill is good for us? Do you know what's in it? If your answers are yes, you have a problem! Another question, what do you think of Reed and Pelosi? I think I know your response!
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