HEALTHCARE THREAD

Bring you healthcare? HMO or PPO?

no let's talk about healthcare, and leave the sicko thread for talking about the movie

the great indoor fight

for starters: is universal healthcare a right, or just a good idea?

NEITHER

tough crowd

Yeah, I hate threads like this.

both

i'm kidding, i'm totally in the "please fix me in exchange for ruining my credit" camp.

nevermind then

just don't come running to me when michael moore ruins healthcare

And a film could make it worse how?

jokes, lady

I don't know much about health care for a dude working in the health care (software) industry.

omg that thread waht was i thinking

i mean, if y'all would rather talk about michael moore's RELEVANCE than the issue he's actually addressing, then go ahead

I mean, I know how it works, I just don't know about a lot of the problems on the insurance side.

what country has the best system? i hear france is nice.

what country's system could realistically be applied here?

Universal Healthcare is a good idea, but I really don't see how it could work in a country as large as the US. I think it's a lot more important that we rein in pharmaceutical companies.

canadians sure seem pretty smug about their healthcare but i dont know how it would compare to the euros.

What I'm interested in hearing is actual ILXors BEEFZ with healthcare. Like, does anyone even know why they don't like it? Do they have any idea why they might think, say, Cuba or Sweden's system is better? Would any Britishes care to tell us about the NHS (ie the worst healthcare system in the western world)?

xp

i dont see why any system wouldn't be scalable?

I would like to hear from a Canadian about theirs.

I would think even the NHS, with its problems, would be better than being uninsured in the US. I have severe, chronic illnesses and have been uninsured many times. Not good. Even with insurance my monthly medical bills average $300. My job choices always center around what insurance is offered. That is life, unfortunately.

my friend gabe is facing like 10k billz after getting hit buy a car, an ambulance ride and a sleep over at the hospital.

Everyone thinks about the poor, who are completely screwed by our healthcare system. However, most middle class Americans are one major illness or accident away from being in that exact same scenario that poor folks are in, whether they have insurance or not.

Uninsured in America is the most depressing book I've ever read, but I recommend that everyone who thinks that the system is okay.

rw: w/o getting too personal, for full disclosure, you work in healthcare/ are in med school, right?

americans arent healthy compared to our universally insured brethren.

Big pharma needs an obvious overhaul but no, I don't know what could be done to improve U.S. healthcare. I would tremble to socialize healthcare should I one day become rich.

It is, you're right (xp misery). And no, you would not be better off in the NHS. See, it is precisely when patients have severe and chronic problems that socialized systems tend to fall down.

But yes, Jeff is right: we're all about one accident away from serious bills. I'm still paying off an ER visit from two years ago that involved a CT and a once-over from the EP.

gr8080: not too personal at all! yeah, i'm applying to medical school, volunteer at the hospital, will hopefully be working on an ambulance here soon, have a vested interest in healthcare as a topic (which is why i want to talk about it!)

preventive care is not being supported in this country because it's not in the interest (ha ha get it interest) of the $ providers. insurance is failing to effectively deflect the costs of medicine as it should. universal public healthcare can be run like regional utilities or it can be run like your local PD/FD/school system; a big federal solution a la NHS would be pretty disastrous here.

insurance industry, v bad.

(also: i'm not claiming that this makes me an authority in any way, despite my attitude)

a big federal solution a la NHS would be pretty disastrous here

what we have now is a disaster

TOMBOT's basically OTM here -- when people think of socialized medicine they think of free, routine checkups for babies and kids and people that just need to make sure the engine's running. also: catching things early drives down costs in a huge way because they can be nipped in the bud. socialized medicine will NOT pay for months in the ICU, however, and anyone that thinks it will is crazy

waht it doesnt in other places?

jhoshea (et al): really? tell me about it! like, srsly! there are people that are very badly in need of care, yes, but who are you thinking of when you say disaster?

The Canadian System isn't doing so great. it could be alot better except for the fact that we're facing a ghastly doctor shortage due to so many heading south to earn more bling. waiting lists is the other problem right now - there's a serious lack of facilities/equipment due to underfunding over the last few decades.

but our problems pale in comparison to the U.S.'s.

huge xpost'n

Isn't there a huge swath of people in the US who make too much money for Medicaid, but too little to afford private health insurance?

The European models seem like good ideas, but where does our country, already running a deficit, get the money to subsidize healthcare for 200 million+ people?

I have a Canadian friend who complains about long waiting lists for appointments and impersonal, assembly-line style treatment. She usually uses providers subsidized by the private insurance she has on top of national healthcare.

Also of interest, especially re: what TOMBOT said: MA passed a law requiring everyone to have insurance, and offers a state-run insurance that is low-cost to those most in need. It seems like a good idea, especially since living costs can vary WIDELY from state-to-state.

the point that needs to be made, seriously, is how much of a leech the current system is on our economy vs. publicly available "free" medical care would be to prop up. The fact that one accident can lead to a massive debt drain on yr median-income american is a hidden cost that i haven't read much about but would like to. I'm sure I'll hear plenty about it when the boomers start needing 7-day pill containers (same for pharma reforms) in a decade or so, which is when we'll get some serious change and any politician NOT supporting major changes towards more socialized medicine is going to be run out of town on a rail.

socialized systems are very good at delivering the cheap areas of medicine cheaply. but that's the thing: it's cheap here, too, you just have to pay for it out of pocket.

if you need, say, a non-emergent but v necessary surgery, you WILL wait.

If I have to pay for it out of pocket, it ain't cheap.

I mean we're all about to see the biggest uptick in voting participation since ladies' suffrage when our parents retire, and nobody else gets crankier about where their money goes than old sick people on fixed income

again, TOMBOT 8080 -- right now, the cost of healthcare is driven up by the fact that the ER will and MUST provide care to anyone that presents, no matter what they've got or they're ability to pay. and i hope it stays that way. however, when ppl default on payments, are uninsured, do a runner, whatever, providers compensate by charging more. also, remember, insurance companies basically dictate how much things cost, save for a very few boutique providers of elective care or hard-core buck the system assholes who only take cash (and there's getting to be more of them)

If I ever break a leg, I'm just going to ask to be put down like a horse.

Isn't there a huge swath of people in the US who make too much money for Medicaid, but too little to afford private health insurance?

Yes, my aunt. She's suffering from shoulder injury that worker's comp has stopped paying for and some undiagnosed liver ailment but can't afford treatment.

The European models seem like good ideas, but where does our country, already running a deficit, get the money to subsidize healthcare for 200 million+ people?

Stop fighting pointless wars perhaps?

The current system isn't that good for providers either. One of my doctors doesn't accept any insurance but the level of care is good enough that I pay full price for him. In the past with sketchier jobs, nothing covered by insurance I couldn't have afforded this "luxury".

i took a year off before my last year of college and was uninsured for a year after graduating.

the morning of my 4th day of classes that year i sliced my finger wide open, requiring a specialist surgeon to repair it and four or five months of therapy.

one month before that year of being covered was over, i fractured my wrist in a bike accident and had to get a cast.

a few weeks after graduating, and six days before my because-of-being-a-student coverage would lapse, i passed out from heat exhaustion and split my forehead open requiring an amblance ride and stitches.

its kind of scary to think of how good my timing was. if i had been only a few days off on either end of that college year, i'd be looking at $30k in medical bills instead of the <$1k co-pay.

some hueg chunk (half) of bankruptcies are related to medical debt.

americans are less healthy and get less healthcare than places w/universal coverage, many of which are far poor than us.

10% of americans have no health care.

the insurance industry is always amongst most profitable in the country.

disaster.

That's a point I've never been clear on, rw. I know about the ED "must provide care thing", and I know that many hospitals are basically writing off a whole segment of care that they give. On the other hand, uninsured/self-pay patients DO get billed, and stuff eventually goes to collections, etc.. I just wonder how far it goes and if the hospital explicity lets anyone off the hook, or just expects to not get paid ever?

xpost

sorry for the autiobiography.

xxp

w/r/t European systems, some theories I've heard (though I don't necessarily subscribe to):

-- many European countries instituted universal healthcare BEFORE many of the huge technological advances of the last 30 years, so, unlike Americans, they are accustomed to physicians NOT pulling out all the stops. whereas here, it's not unreasonable to assume that if universal coverage were provided, a large chunk of the population would clamor to keep 80some yo grannies in the ICU for weeks at a time

-- European countries have up until very recently been socially and culturally homogenous, so ppl don't have as much problem helping their neighbor. in the states, there is a very real, very mean streak of ppl that would find the idea of providing free healthcare to the "undeserving" totally appalling

intended a ? after that half

self xp

there are so many things about healthcare that are fucked, but i think one thing to start with that wouldn't require as drastic an overhaul as national healthcare, would be to drive down the costs for uninsured patients. cost of healthcare is ridiculously inflated, and this is mainly because doctors charge the insurance company one amount, and the insurance provider pays a percentage of that amount because of their arrangement with that provider. people without coverage don't have a relationship with the healthcare provider and can't "negotiate" the inflated amount, in most cases.

yikes i can't keep up

Jordan: no one ever gets off the hook, ever. my bill very nearly went to collections because the billing dept FORGOT to enter in my insurance information and let my bill sit unpaid for months

jhoshea: a not insignificant chunk of that 10% is healthy 20 somethings that don't want to pay a monthly fee. (devil's advocate)

I was once told that on medical collections (like from the ER), as long as you paid a small sum every month (even if not their minimum), it could never go into default/screw up your credit. True?

fwiw, insurance companies are almost entirely responsible for how much healthcare costs -- they control the pursestrings

not true xp

i mean, as far as i know -- fairly certain people have gone into bankruptcy because of unexpected medical bills

yeah between the anti-tax crusaders and the insurance/pharma/whoever else industries i dont really seea european style system happening here anytime soon.

but it doesnt mean we wont see improvement. all the dems plans seem pretty similar - which may indicate an emerging consensus. unlike the bill/hillary version that just came out of nowhere.

RW, I think you're right in the majority of cases, but there are hospitals that are aware that they're caring for a large indigent population and that they're going to absorb a lot of those costs. It's good publicity for them, at least.

wrt technology:

isnt that (sadly) the biggest threat to affordable healthcare?

i read somewhere that if healthcare technology and life expectancy continue to follow the same pattern of growth, it could possibly bankrupt the entire economy.

bell labs: what are the so many things, though??? like, i don't find the fact that you have to PAY for healthcare to be appalling in any way whatsoever. you have to pay for everything else in the world, why not healthcare? why should it have to be free?

also: preventative medicine is NOT that expensive, but ignoring it or being denied access to it IS.

xp Jordan they definitely DO absorb the costs---but they don't EAT them, they just get passed on

gr8080: exactly. ppl in America have come to expect the very best healthcare in the world (in the cutting-edge, pulling-out-all-the-stops sense), and suddenly making that free to everyone would cost serious $$$$

Maybe we should just require everyone to go to death acceptance therapy. jk xpost moocow etc.

I can only speak from my own experience - the care I have received on my healthcare plan here in the US was no better than the care I have received under the NHS - in terms of wait times, information, quality of staff and access to medication. I've also had fairly major surgeries/procedures in both countries. The US might not be fertile territory for a European-style plan, but that doesn't take away from the fact that Americans are being lied to about the relative/potential quality of care under alternative systems.

RW, preventative medicine IS that expensive for a lot of people. I have no insurance, so my sole provider are Doc in the Box outfits (CareNow, specifically). $105 just to walk in the door. Another $75-100 if I need a shot. Another $15-100+ if I need a prescription.

One doctor's visit for something relatively minor can easily eat up an entire paycheck.

I was once told that on medical collections (like from the ER), as long as you paid a small sum every month (even if not their minimum), it could never go into default/screw up your credit. True?

Only if you have worked this plan out with the hospital and stick with it scrupulously.

i don't find the fact that you have to PAY for healthcare to be appalling in any way whatsoever. you have to pay for everything else in the world, why not healthcare? why should it have to be free?

I'm a socialist at heart and I do believe along with a quality education this is something that should be provided at no direct cost to citizens (I realize taxes fund social programs).

another thing that you are paying for when you go to the doctor aside from medical procedures is the doctor's malpractice insurance, which is often hundreds of thousands of dollars a year...democrats seem to hate to talk about this but doctors are already getting pretty fucked over w/r/t income and expanding low-cost coverage is not going to make this any better :/

river wolf can you break down the costs of a stay in the ICU under observation? I mean is it like lots and lots of overhead for 24/7 staffing and equipment that doesn't depreciate in a helpful fashion? Because if that's generally the case then socialized systems should be able to absorb those costs really well, I would think.

i'm not too crazy familiar with the way it works stateside but don't hmo's basically add another level of cost to the overall heath care equation there?

more xposts

ppl in America have come to expect the very best healthcare in the world (in the cutting-edge, pulling-out-all-the-stops sense), and suddenly making that free to everyone would cost serious $$$$

people are getting it now and our economy isn't dead, what's the harm in cutting out the insurance companies, spanking big pharma, adding some cost effective preventative medicine and inviting the poor along for the ride?

NOT THAT I THINK THAT WILL HAPPEEN LOL

not enough ventilators

spanking big pharma,

TOTALLY. For starters, stop with the TV ads for every fucking symptom under the sun.

as an aside, some beefs with the NHS:

-- aunt waited for MONTHS before she was able to see a specialist about her bizarre illness (woke up paralyzed one morning...totally terrifying). then, when she did, no one knew what was up. they took spinal taps to get at her CSF, and she got awful, post LP headaches that lasted for weeks. i had a conversation with a PA here the other day, and dude not only correctly diagnosed her from my poor description, he also asked why they didn't give her a blood patch, which is an extremely routine treatment for post-LP headaches that is pretty much guaranteed to work. asked my uncle, and he said that when he brought up blood patches, the docs flatly refused to do it, with no explanation

-- uncle fell and broke his hip for the third time, was not given morphine for TWO DAYS. paramedics hand that shit out like candy over here, wtf

i agree that big pharma needs to be dealt with, i'm just not sure how

xp - Malpractice insurance is only 2-3% of our total healthcare cost and more a function of insurance co. profitability than anything else.

yeah shit like that happens aaaaaalll the time here too

xxp

In many cases, doctors really are paying upwards of 100k/year. moreover, the ones carrying the most are the kind we're running out of: OBs, in particular

my wife likes to yell at the TV when an ad comes on, and she claims that there is only one other country in the world that allows pharma ads. i wonder if that's true.

At least health care IT in the U.S. is improving and, I think, >>> other places :>

And make sure you don't have any behavioral health problems while uninsured, you will be blacklisted for life by insurance companies. Even under a group healthcare plan, they will fuck you over and make it extremely difficult to get a claim filed. The insurance companies want you to give up.

jhoshea: not really, dude. i mean, certainly not the morphine thing.

price caps for starters.
xpost to big pharma

http://www.sourcewatch.org/index.php?title=Direct-to-consumer_advertising

Direct-to-consumer advertising (DTCA) is the promotion of prescription drugs through newspaper, magazine, television and internet marketing. Drug companies also produce a range of other materials, including brochures and videos, that are available in doctors offices or designed to be given to patients by medical professionals or via patient groups.

The only two developed countries where DTCA is currently legal are the U.S. and New Zealand. (See Direct-to-consumer advertising in the United States and Direct-to-consumer advertising in New Zealand for more country-specific details). While banned elsewhere, the drug industry is mounting major lobbying campaigns to have DTCA allowed in Europe and Canada. (See Direct-to-consumer advertising: The Campaign To Overturn Europe's Ban and Direct-to-consumer advertising: CanWest's Bid to Overturn Canada's Ban for further details).

Fucked up.

bell labs: what are the so many things, though??? like, i don't find the fact that you have to PAY for healthcare to be appalling in any way whatsoever. you have to pay for everything else in the world, why not healthcare? why should it have to be free?

i have no problem having to pay for it, but individual health policies are NOT affordable b/c of the way that insurance works. group policies are not available to everyone, and to those who don't have access to group policies paying for procedures and hospital visits are unfairly inflated.

maybe were generous w/the morphine - but sloppy misdiagnoses, yes

xp

yeah, most of the cost of an ICU stay is the fact that you're paying for facilities as much as care. i'll see if i can find a breakdown (which may prove difficult? i had to yell at peeps to get one for my ER visit)

i'm not too crazy familiar with the way it works stateside but don't hmo's basically add another level of cost to the overall heath care equation there?

more xposts

-- The Cursed Return of the Dastardly Thermo Thinwall, Monday, June 18, 2007 4:52 PM (Monday, June 18, 2007 4:52 PM) Bookmark Link

I think the argument wrt that is that HMO's add an extra level of administrative costs/waste?

More than anything I'd like to see pharma companies BANNED from advertising to the general public. These commercials that don't even really tell you what the drug is for/talk about it in a way that makes it sound like YOU MUST HAVE IT need to stop. Bad for doctors, bad for patients. :(

CON: GB healthcare misdiagnosed my grumbling appendix for 8 months
PRO: When they finally got around to extracting my burst appendix, they did not kill me
DECISIVE PRO: They also gave me the morphine button

I think the argument wrt that is that HMO's add an extra level of administrative costs/waste?

also, plz note guys that i'm totally open on this issue at the moment. like, something's definitely wrong, but i'm not entirely sure what the solution is here in the US

xp totally, jessie: while patients should absolutely have a say in how they're cared for, they really shouldn't be telling docs they NEED to have $DRUGSEENONTV

an argument I've heard for single-payer in the US is the drastic reduction in administrative bullshit. there'd simply be one bill that the patient would never see, and entire billing depts would no longer be necessary

I don't think I'd have the guts to ask a doctor for a specific drug (but maybe that's because the drugs I'd ask for fall into the possible-fun category).

I have an aunt who always conveniently "has" whatever disease is currently being pushed by big pharma.

the flipside is: you now have one entity that decides how much every checkup, procedure, and so on, is worth. if the gov't decides that a Whipple is now worth $200, then that's how much it'll cost, period.

gr8080: exactly. ppl in America have come to expect the very best healthcare in the world (in the cutting-edge, pulling-out-all-the-stops sense), and suddenly making that free to everyone would cost serious $$$$

yeah but even if the system stays where it is it could still destroy the economy.

meaning: we as a society will need to make some hard decisions in the next decade or two as to how long we choose to keep people alive.

but then its only another generation or two before the results of the human genome project wipe the slate clean and we all look like uma thurman and ethan hawke in gattica, right?

pharma and insurance lobbies are honestly too big to expect much of anything to change w/r/t those things in particular. any universal healthcare is going to involve a low-cost basic coverage through a private insurer.

like Julianne Moore and Clive Owen in Children of Men, more like

pharma R+D should be separated from the manufacturing and marketing side. license formulas out to various companies and make guaranteed money while they compete to push their brand at the lowest cost. the end.

i'm baffled that there hasn't been a huge geeky push for open-source EMRs yet (that i know of). if EMRs get locked into proprietary software, then we're really fucked, esp if different groups/hospitals use different systems. like, what'd be the fucking point

I don't know what you Americans are getting so worked up over:

Some U.S. hospitals offer gifts for long emergency-room waits

I mean, check it. You might have an aneurysm in your artery, but dude, FREE TIGERS TICKETS.

isn't that what the generic system is for? and wouldn't it require an overhaul of patenting? xxpost to tombot

and BTW we could chuck all the life-support systems in the ocean and let boomers all just get old and die but the economy's going to be destroyed anyway by a little thing called the dependency ratio (ESPECIALLY if we implement tax-supported single payer)

isn't that what the generic system is for?

Doesn't it take like 6-7 years for a drug to become generic?

yes, due to patent laws.

I think. Some kind of fancy law.

and they're working on overhauling the patent system as we speak, but for techno stuff, i think it passed the house?

from what i understand, the wait is 7 years for generics. however, SNEAKY DRUG COMPANIES have figured out that if they REPURPOSE a drug for a different, possibly made-up disorder, then they get another 7 years

jessie: no. patents are patents. the R+D labs would make money up front for licensing implementations to big manufacturing contractors. probably another company would pay the contractor and label/market the pills as they come off the line. it's just like 21st century modern business, instead of 19th century business.

that is, if you figure out that ritalin is not only good for adhd but also wandering gaze syndrome, then you can hold onto that ritalin patent

On my current plan I've had several occasions I've waited over an hour for the most cursory of 5-minute appointments. I never had anything like this with my NHS doctor.

Only two days after coming back from a joint replacement surgery I had my insurance company calling me to question whether the last day I spent in hospital was really necessary. Just previous to this they had confirmed that the hospital and the surgeon were covered by my plan, but that they could not guarantee that the anesthesiologist or anyone else who took care of me during my hospital stay would be covered as they didn't know who they would be. To quote Wendell Pierce in When The Levees Broke, there is a special circle of hell reserved just for insurance companies.

e.g. snorg pills

however, SNEAKY DRUG COMPANIES have figured out that if they REPURPOSE a drug for a different, possibly made-up disorder, then they get another 7 years

Yep, they tweak one or two things and EUREKA

Just previous to this they had confirmed that the hospital and the surgeon were covered by my plan, but that they could not guarantee that the anesthesiologist or anyone else who took care of me during my hospital stay would be covered as they didn't know who they would be.

this is the worst---I got nailed in a similar way when it turned out that the ER doc that treated me belonged to a private group that did not accept my insurance, so i paid 50% of his bill out of pocket, while my insurance covered 80% of everything else (after hueg deductible)

i'm not even sure they have to tweak anything :-/

just need to show that it can be used for a different illness. good thing the treaty of versailles came along, or else we'd all still be paying out the nose for bayer

wait snorg pills sound kind of good. do they help clear up allergy related sniffling?

no they give you big boobies tho

Btw, much of big pharma R&D piggybacks on publicly funded university research.

it's all stupid and based on business models that are centuries old! back when people died at 55, they couldn't bring you back, and every man got a stiffy in his trousers whenever he wanted! back when children were allowed to play outside because they ate eggs for breakfast every day and were essentially bulletproof! now we're all sick all the time and everyone has a soft pecker and a glass jaw and our water is so dangerous we have to bottle it up to keep it from getting on our hands!

i could go for some scrambled eggs

we take too many antibiotics in this country

I'm sick of this thread because it's just reminding me that nobody's going to fix shit until it's time for the fucking BOOMERS to decide that WE have to eat shit and pay for their fucking drugs! fuck them! fuck'em fuck'em fuck!! fuck shit FUCK YOU OLD PEOPLE fuck fuck ass fuck shit!

i just ate 2 soft boiled eggs

we take too many antibiotics in this country

-- river wolf, Monday, June 18, 2007 9:18 PM (23 seconds ago) Bookmark Link

i've been on cipro like 3 times this year already

TOMBOT 2012: DNRs for all you fuckers

i don't have any answers (or any real gripes for that matter that haven't been covered in this thread) but I often work in a peripheral capacity with a big pharmaceutical co. and I can say without any reservation they are utter dicks. I know, I know YR MIND IS BLOWN.

i just recieved some spam w/ the subject line:

a treat for your weiner

i'm not saying YOU, bell labs, but pretty sure there's evidence that antibiotics are prescribed a bit too often

fun fact: cipro inhibits bacterial topoisomerase! try alleviating the overwinding strain on yr DNA NOW, bacteria!

i was talking to a buddy of mine about a hospital-based system the other day...like, could it be possible to buy healthcare "subscriptions" from yr friendly neighborhood hospital? or would they simply be unable/unwilling to assume the risk that insurance companies take on so happily? also: your insurance premiums don't pay for hospitals, they pay for air-conditioned high rises and CEO salaries and so on. obvious, i know, but the disconnect there is sort of crazy to me.

i am definitely on anti-biotics too often, and would love to do something about this, but i would be much less alive than i am now if i had decided to try to cut back.

then don't! i think it might be more of a pediatric issue anyway -- kids are generally in pretty rude health, and good at bouncing back from stuff. let 'em get sick, i say.

I seriously think if hospital networks would be turned into something run like a regional utility, with built-in capacities based on your historical peaks and valleys and demographic projections, you'd find that the staffing and equipment would all of a sudden be a lot more affordable in every regard. and yeah it would basically work like a subscription or a power line - welcome to the neighborhood! here's the numbers for phone, gas, electric and medicine! - all in your little change of address package from the USPS.

I mean seriously the "risks" insurance companies claim to be taking are a lot of horseshit anyway if you realize the surgeons, the expensive equipment, etc. is all there ready to work ANYWAY, it's part of a constantly operating/depreciating system, not like they have to conjure up a new surgeon and lease the room for every single tumor

OTOH I'm kind of describing how kaiser permanente works and they ain't exactly cheap though they will see you and get you fixed up lickety-split in my limited experience, plus co-pay is dinky

I seriously think if hospital networks would be turned into something run like a regional utility, with built-in capacities based on your historical peaks and valleys and demographic projections, you'd find that the staffing and equipment would all of a sudden be a lot more affordable in every regard. and yeah it would basically work like a subscription or a power line - welcome to the neighborhood! here's the numbers for phone, gas, electric and medicine! - all in your little change of address package from the USPS.

-- TOMBOT, Monday, June 18, 2007 9:29 PM (12 minutes ago) Bookmark Link

i think this is an excellent idea, in theory. because yeah: surgery is expensive because surgeons have 12 yrs of school/residency to pay off, operating theaters are expensive, support staff is numerous, instruments/ultrasounds/etc. BUT this is all sunk cost, and once its in place, its in place

i'm baffled that there hasn't been a huge geeky push for open-source EMRs yet (that i know of). if EMRs get locked into proprietary software, then we're really fucked, esp if different groups/hospitals use different systems. like, what'd be the fucking point

Yeah, um, I don't really see things getting away from proprietary software. Basically in a few years I think all the big hospitals will have decided on and implemented an EMR from one of a few large companies, and the trick will be getting those to exchange clinical information nicely. There's not a lot of trust though, even getting different hospitals who use the same EMR to share info is not easy.

(I shouldn't really be talking about this anymore)

TOMBOT let's start neighborhood hospitals

xp what's irritating is that the military has already developed a free, open-source EMR that, while not perfect, is just waiting for some industrious geeks to turn it into something

o rly?

An all-encompassing EMR is a really huge undertaking

last I used a military clinic they were still making me check my hard copy in and out, with copies of MEPS documents in it, I used the same manila folder from day one of basic on through for four years

i'll have to dig up my source on this....

they should just graft something like Ariel onto a free wiki and add two-factor authentication (second token belonging to patient)

things is you'll never get an EMR to be as fast as a doctor working from hard copy right there in the room with you

Uh, and why would that be (if they have a computer right there in the room with you)?

EMRs are really more important for continuity and longitudinal consistency, at this point. i mean, that's where they'll save money and increase efficiency.

also, boomer docs HATE computers

fun fact: the ratio of paperwork to patient contact is 3:1

because computers suck, break all the time, hang on you, and are generally what you'd expect from a device which has had over a million different engineers stick their thumb in it somewhere with approximately jack dick shit in the way of structured collaboration

also, the VA system is called VistA, but apparently it's an undertaking to reshape it for civilian use. but, thanks to the freedom of information act, it's available to anyone.

also, this? http://www.businessweek.com/magazine/content/06_29/b3993061.htm?chan=tc&chan=technology_technology+index+page_best+of+the+magazine

And paper has to be stored, found, faxed, not lost, deciphered, etc.. Come on dude, computers not being reliable is a really weak argument these days.

paper will still need to exist, cuz docs like to scribble notes like what

yeah that's what I mean. work will take place on paper. computers can store it but I don't want to sit and wait for my doctor to load up some java app and make sure he's using the right text-entry field and wait for search results and then input my symptoms by typing longhand on a keyboard and all that crap. better ways to be spending our time together, you know?

fwiw, it is precisely for this reason that bigger, county-style ERs are hiring scribes. pilot-fish with EPs all day, scribbling notes for 'em, entering it into the EMR when they get a chance. more patient contact for physicians, good work experience, less mistakes (two eyes better than one), etc.

doctors are highly trained professionals who think on their feet and solve problems. Sitting there figuring out some engineers' idea of a user interface is not, i would imagine, their idea of a rewarding pursuit

xpost aha that's hilarious rw

"we paid for these computers and this software so we can be more efficient. since our product was designed by idiot bean-counters and developers who only go to the hospital to get sick, however, none of the physicians it's been designed see any benefit in using it. let's hire a whole new class of staffers to serve as middlemen between our primary LOB and maintaining this massive computer system we just paid eight figures for!"

sorry jordan but as I work in "cyber health and security" it's my job to let everybody know that computers are basically terrible and should never be relied upon for anything critical (really though I just mean windows)

computers can store it but I don't want to sit and wait for my doctor to load up some java app and make sure he's using the right text-entry field and wait for search results and then input my symptoms by typing longhand on a keyboard and all that crap.

No offense, but shit is a lot better than that these days, and there are all kinds of ways to speed up the workflow. We're not idiots (or "engineers").

there are like 2657837890789 other industries that didnt use computers in olden days and do use them now and it was a pain-in-the-ass shocka to switch over and the computers still break but that doesnt mean it was a bad idea.

And I would think that the generation of docs coming up would be more than cool with using computers rather than paper??

dude I'll take your word for it, I work in the public sector though and all the RDB frontends I deal with other than maybe iTunes and ILX itself are generally really awful and overburdened with useless features at the expense of simplicity and speed

nah grady it was basically a bad idea because we sunk tons and tons of money into all these IT solutions for everything and now work about five to six extra hours a week instead of letting the robots do the work and giving ourselves an extra day off.

that is how I can objectively say that computing is currently a load of dried-up bollocks.

I ain't saying it's perfect, but from my perspective anyway it's pretty good and getting better. I'd like to talk in specifics but don't want to get fired, so, you know.

xpost, that is OTM

i totally concede your point, but working in conference event planning on an island in the middle of the ocean, i have no fucking clue how people did what i do before internets and cross-linked client databases and billing/scheduling programs.

but i guess the point is that they DID. and they never had weeks like the one i just had, where my server, a partner business' email server and my fax machine all went down for days at a time in isolated incidents.

probably too far off the topic now.

xp to tombot

The NHS in Britain has sunk tens of millions over several years into private contracts to create an EMR that still shows no sign of actually existing, and no sign of being something that doctors actually want. (Private Eye has done massive amounts of reporting on this debacle.)

The larger issue of what the consequences of socialized healthcare would be in the US boils down to this: with a finite pie of public healthcare money, priorities have to be set. This is the hard truth that pro-national-healthcare advocates have been afraid to tackle but which has to be addressed head-on. Keeping someone alive in a vegetative state for years at the taxpayers' expense is just not going to happen. The idea that we are all entitled to everything we want whenever we want it has to go out the window. Some things are more urgent than others. If you have a hernia, you can live with it for a few months. This is just the reality of socialized healthcare, even in the best systems (of which the NHS is not one).

French healthcare is fantastic - some say the best in the world. A lot of that is down to good management. But the general outlines of the system seem like a perfect fit for the US. Everyone has a basic level of healthcare guaranteed by their taxes. But everyone also has a kind of "top up" private health care that they, or their employers, pay for, to take care of extra things, or to get treatment more quickly, or for more extended hospital stays, etc. and it's not very expensive.

Ah, I think the Belgian healthcare is very much like the French one. Example: delivering a baby and staying in single bed hospital room: almost for FREE if you have a "hospitalization insurance" here. If you can't pay your your hospital/operation bills, they have a plan which lets you pay off per month, I think. That said, I'm not that on knowledgable about health care, just know that it's pretty good here (certainly compared to the US).

The slightly strange thing in the UK is that if you have private healthcare, you see the EXACT SAME DOCTORS/SURGEONS than if you had public healthcare. It's just that you get to see them really quickly. NHS doctors have their public practice and then their "moonlight" private practice where they make the big $. When I had my hernia operation and was seen by my surgeon for an initial diagnosis he asked, "Do you have private insurance?" and I was like "no" and he goes "hmmm" and frowns at my chart. No doubt he had already been thinking "11:00am, my office, this Saturday - that'll pay for a new putter" but once he heard my answer it was like "October some time".

Wah? I have heard of the long waiting lists, but here that's unheard of. Well, most of the time.

Waiting times aren't that long on the NHS

Oh, they can be! Depends on where you live!

It's not so bad where I live now, but in Bloomsbury... I had actually moved, registered with a new Dr, been refered and seen a specialist before I was even offered my first appointment in Bloomsbury!

Well that's privatisation and "patient choice" for you.

From initial symptoms to surgery took nine months for me. Which is absurd. But my point is that I could live with it, and fairly comfortably. There are other people who need eye surgery and cancer treatment and they deserve to be treated first. No matter what the wait time is like, that sense of prioritization - both for receiving treatment but also for what kinds of treatment is received, i.e. does the NHS sink money into THIS drug or THAT drug - i.e. bang for buck, i.e. most people helped and most suffering relieved - has to be taken on board in order for socialized medicine to be politically feasible in the US. There ARE losers in such a system. But compare that with the number of losers in the current system and it looks pretty good.

Well yes, if you're (hernia) op isn't urgent, no need to push to the front of the queue

A trhead for the issue on my mind of late! I will probably get "Assurant Health" insurance through state farm this fall, and I have read of attempts by them to not cover costs by saying something was a pre-existing condition even if it gave "previous" sign s like "headache". Still, they are being investigated by conneticut DA so maybe they will have to quit it.
I would get better insurance but I am in school so I dont think I can work full time.

Tom D. sometimes I imagine you as a pensioner in an olive-green cardigan sitting in a big comfy chair with a doily on the back of it, nodding along and occasionally jabbing your walking stick in the air when you've come on to a particularly riling point

I've got a dark blue cardigan. I like that image of me, I think I will encourage it!

That pre-existing condition stuff is SUCH AMORAL BULLSH*T and should not be tolerated in a Christian nation

The reason there are problems affording healthcare is the technology has advanced beyond people's ability to pay for it. In the past people would get sick and just die, or just live with pain. I'm not saying we shoudl return to those days, but its going to be expensive any way you look at it. I have always valued my health above most things, certainly having a fancy car, or big house, or a plasma TV or whatever. You will get what you pay for with health, and you have to be part of yoru treatment. If you drink a lot, smoke, never exercise, drive without a seatblet and fast - etc - you will be paying more for healthcare!

only if you actually wind up in the hospital, though.
whereas having children is basically a guaranteed four or five-figure outlay, when even a cursory reading of the actuarial tables should tell us it's a much healthier pastime.

Look into the giant colon!

http://www.snbsurgery.com/gr/Colon1.gif

An introduction to the French system

more up to date, i think: http://www.frenchentree.com/fe-health/DisplayArticle.asp?ID=197

for a tiny glimpse of the current IT boondoggle in the UK, here's this today:

http://www.theregister.co.uk/2007/06/27/bma_choose_book

Like, does anyone even know why they don't like it? Do they have any idea why they might think, say, Cuba or Sweden's system is better?

Yeah, has anyone in your family ever been sick?
Ever had a tooth problem beyond just a simple cavity or check-up?
No insurance covers implants and other common dental procedures because, as is often the case with common procedures like chemo treatment for cancer, the insurance company simply writes it off as "experimental." It's not experimental. They've been doing implants for over 40 years and have a 95% success rate. The cost of an implant is $12 to make. It is sold to the dentist for $300. The dentist sells it to you for $1500 - $2500, possibly more. On top of that, a crown costs $1200 - $3500.

You can spend a lot for one tooth.

Now, add to the equation that dentists like to make money. Dentistry is probably a bit different from physicians. But, if you get a greedy dentist, he might convince you to refill old fillings that don't need to be refilled, charging you $400 a pop with the added knowledge that there is a good chance he will traumatize your tooth and kill it! So, not only is he making $400 off you today, but he has a good chance of making another $1800 - $3500 off you later when he charges you for a root canal and a crown on that tooth he killed.

Just think about that. A dentist's economy depends on your teeth actually coming out. He's not going to make much off routine cleanings. The "hook in tooth" method of detecting cavities is said to be about 43% accurate. That means, there's over a 50% chance that your dentist is filling non-existent cavities. In short, if you don't feel pain, never listen to that damn dentist (unless you really trust the guy).

But, on the other hand, if a dentist couldn't make enormous profits off needlessly filling cavities and other procedures, he would have no reason to mislead you. Often, a dentist might suggest a bridge option rather than a simple implant. This bridge might totally destroy two surrounding virgin teeth and cause more problems later, but so what! That's GOOD for a dentist! Besides, while an implant might run you $4500, a bridge will run you $7000 and involves much less work for the dentist.

Now, what if you're a 27 year old man like my friend who just found out he has cancer and has $1200 worth of medical bills per month?

i've never had a cavity

I spent 4 years paying off a implant and crown. Then a couple of years later, another crown fell off. That sucked.

I spent 4 years paying off a implant and crown. Then a couple of years later, another crown fell off. That sucked.

I've heard a lot of stories of supposedly 'guaranteed' crowns not actually being guaranteed when the break, fall out, etc. It's just something dentists like to say so that you'll get the work done there as opposed to the guy down the street. They never give you a written guarantee. Worst of all, they often give you a crown where its pretty much guaranteed to break without telling you. For instance, if your mouth closes a certain way that puts a lot of pressure on that crown, more than likely you're going to break that fucker one night while you're grinding in your sleep. The other thing: a lot of dentists give root canals and fills without a crown for about $800. But, a dead tooth becomes very brittle and without a crown is destined to crumble. This will eventually require a bridge for $7000 because now an implant is impossible.

Dentists don't like to even offer an all-metal crown. Wait until you're in this position. Hopefully, you won't ever be, but if you find yourself looking at a crown for a back molar, notice such a thing is never offered to you. Why? Because they're much cheaper and they don't break!

You might say I'm an anti-dentite. My family has soft teeth and many stories, personal experience and research has made me this way. :-( It's not my fault!

q for lawyers:

so in a discussion of healthcare the other day, someone made the following point: if we made healthcare a positive right (a right to...), how might that affect pediatric consent? as it stands now, it is perfectly legal for parents to deny care for the child against medical advice (AMA) if said medical care contravenes their religious beliefs. so, JWs can refuse transfusions, Christian Scientists can deny surgery, etc. As far as i can tell, this is the only situation where parents are allowed to do something so batshit insane and not lose custody (...though I have heard of some feisty docs that file for 72 holds pretty much as soon as they find out that their pediatric patients have loony-tunes religious nut parents).

ANYWAY: if we suddenly enshrined healthcare as a positive right, would that mean that parents would no longer be able to do such a thing? that is, by denying care, they'd be infringing on one of their child's basic human rights and thus abdicating their own right to control their child's healthcare decisions? have the anti-medicine religious ppl cottoned on to this, and does this underwrite any opposition to universal healthcare?

just thinkin baout things

72-hour holds

myself, i'd posit that parents and the gov't are already able to deny positive rights all over the place (kids can't buy guns willy-nilly, parents can stop their kid from printing Down With Dad Monthly Digest, etc), and that none of this would make much of a difference anyway

another question, then: how do you guys feel about pediatric consent, in general? what if parents are refusing a blood transfusion for a 5 year old? in some situations, you'd be able to ask the five year old what they want, and if they said they wanted the transfusion so they wouldn't DIE, most hospitals would go ahead with the transfusion and risk the parents' lawsuit. however, if the kid said that no, they didn't want the transfusion, how can you take them seriously? five year olds don't know anything about anything except toys and puppies? why should their idiot parents get to throw them on the pyre simply because they hold an antiquated belief about a white dude that doesn't exist?

i'm in a group with a hmong kid, and apparently these sorts of issues are causing some strife at home :-/

I doubt that a "right" to healthcare will ever be enshrined as such in a legal sense, at least not anytime soon. This is a v interesting question though and regardless of the truth of the situation I can certainly imagine certain religious types getting whipped up in a froth about being forced to euthanize their own daughters at the behest of some socialist bureaucrat

xpost that first graf is probably OTM

Right to healthcare may never be enahrined but the right to life is fairly fundamental and universal, most religions and human rights law seems to be fairly clear on this. So I guess right to life overides right to exercise your batshit religion. Where it becomes grayer is where you have a quality of life issue. Healthcare and treatment is based on informed consent and children are not deemed able to make this consent so their parents or guardians make choices for them. Where the treatment is a quality of life thing, say an operation that makes the difference between walking and life in a wheelchair then a judgement has to be made on child protection lines. Does witholding treatment constitute an abuse against that child?

See, that's the thing: in the USA that is squarely not the case, Ed! I went over some documentation for a class the other day, and parents in America are allowed by law to withhold treatment for their children if it conflicts with their religious beliefs. Jehovah's Witnesses have refused blood transfusions for their own children, and those children have died, and the parents were not found neglectful. Hence my initial question: if healthcare were made a positive right, would that right trump the parents' freedom to practice their religion (at the expense of their progeny)?

"The Spirit Catches You and You Fall Down" to thread (v. good book about the Hmong/US medical system intersect). Have you read it gbx?

isn't the policy at issue about the right to health insurance, rather than specific care? they're not the same thing, and different health insurance plans definitely don't cover the same care (just try finding affordable health insurance that covers mental health if you are suddenly unemployed), so i don't think it could directly apply to specific measures parents might or might not approve.

and yes, that is a really good book.

I haven't, actually! Well, I've read excerpts (assigned reading). As I said above, I've got a Hmong classmate (a few, in fact, MN has a large hmong population), and it's fascinating to hear him talk about the Hmong outlook on modern medicine.

so in a discussion of healthcare the other day, someone made the following point: if we made healthcare a positive right (a right to...), how might that affect pediatric consent?

in practice this basically means that doctors and other health care providers can obtain court orders that allow them to override parental consent. in canada the courts have pretty consistently decided that the child's right to the best medical care trumps the parent's (and the child's) other charter rights. however this has been frequently challenged by jw and other interested religious groups.

my brother-in-law is clerking for the scc and they've heard/decided to hear a case where a young teenager had been given a court-ordered transfusion against her wishes. the lower courts logic is that while the legislation that forces the girl to receive medical care is an infringement of certain rights, it is acceptable one. i don't know if the case has been decided yet but my bil was talking about it a couple of months ago.

this may be stating the obv but any legislative efforts to enshrine a right to health care would surely see the same sort of legal challenges in the u.s. and im not familiar enough with the constitution to know if the courts would follow similar logic

* as the candian courts have, if that wasn't clear. also further information about the case and past decisions here.

http://www.nytimes.com/2008/12/05/health/05chen.html?pagewanted=1&ref=health

critique of the mandatory 80-hour work week

what do you guys think

sounds like they need a union

srsly? i men, dunno if you're kidding, but i think most ppl would find the idea of a physician's union to be repellant

I thought the problem with NURSES ever getting better working conditions or pay was that they basically are ethnically barred from strikes or slow-downs of any kind because of patient care!! What leverage does a union have without the right to withhold the labor of its members?

i find the idea that the people in charge of my life are getting two hours of sleep a night repellent

doctors are in charge of your life????????????

Doc was like "no soda or spicy food or alchohol" and I was like "do you know who I am"

― HOOS wearing bitchmade sweaters and steendriving (BIG HOOS aka the steendriver), Sunday, December 7, 2008 3:23 PM (Yesterday)

also, did you guys read the article? it wasn't saying that the 80 hour week was too long, but that it was too short---the old-school 120 hour week provided better education/pt contact

oops xp

they basically are ethnically barred from strikes or slow-downs

um

Mwahaha.

i mean, there was that study that said that residents at the end of a long shift were basically 3-beers drunk

"in charge" i.e. they are making decisions that can kill me or not

http://www.unison.org.uk/

I feel like the article is kind of BSing it. The author doesn't know that the 80-hr week will be BAD any more than he says its proponents know it will be GOOD. Everyone is just making shit up, apparently?

Also, the author's paen to the days of yore mostly revolves around a kind of patient care that I would be surprised if residents were still being assigned to...? That seems to be his emotional argument, more so than just the sheer number of hours.

That article is LAMERS. Typical cycle-of-abuse stuff.

I am undecided on the 80 hour week thing. I mean, I get how it could be valuable to pull a 72-hour black weekend and see a guy come in sick on Friday and get worse on Saturday and then get better on Sunday without any interruptions, but on the other hand I am pretty sure that if I were on the clock for 72 straight hours I would be functionally useless somewhere around hour 50. Plus I have learned to instinctively roll my eyes whenever people start talking about "The Days of the Giants" and how much harder they had it, uphill in the snow, stethoscope and intuition and work ethic, etc.

I am uncomfortable with night float, especially. It seems like it carries a whole other kind of risk, putting someone in temporary charge of way too many patients they know basically nothing about, except for what's on the chart.

I wish there were a way to temporarily waive the 80 hours when necessary (like the sort of scenarios the Times was outlining where you have to decide what important thing you CAN'T do), but I imagine that any loophole created would be pulled on by super-competitive programs and super-competitive people until everybody was forced to "voluntarily" go long. 120 hours is nuts, even if some of that time involves sleeping.

interesting factoid from physiology professor re: norwegian healthcare. basically, he was chatting with norwegian exercise physiologists about how healthy all their children are, and the dudes said: "well, we tell our children from a very young age that being fit and active now and throughout life will save the whole country loads of money in healthcare costs down the road....don't you do this??"

do we have any norwegians in the house

dear kindergartners, being healthy now will save you lots of money in taxes down the road when you are an adult

what are taxes who is money

just fyi the scandinavian countries are socialist & its illegal to hate gay people so.............................

Yeah taxes and money aren't as interesting as the filibuster.

do we have any norwegians in the house

geir...to...thread?

i just thought it was interesting that (according to norwegian exercise physiologists w/a vested interest in people being active...) education made a point of telling children that being healthy wasn't just good for them, but that it was *cheaper*

also have you guys seen those get up and play for an hour a day ads? :(

i would love to chat w/geir re: norwegian healthcare

Maybe he'll start a poll Top Norwegian Healthcare Hits of 1972.

btw, NHS, i didn't mean to malign you so badly~~~ personal beef

~~~snip~~~thought these thoughts might relevant~~~snip~~~

any serious healthcare reform ought to be coupled with a serious overhaul to how medical degrees are paid for. i read somewhere about so-called "smart" loans, and they are dope imo.

once yr done with school, you pay off your loan not to the tune of a fixed monthly payment, but at a fixed percentage of income (likely very high). broke-ass ghetto pediatricians pay the same rate as interventional radiologists. the derms/rads dudes and ladies pay their debts off hell of quick, and don't get saddled with as much interest. the GPs/peds ppl may spend their whole career paying the shit down, but at least it's not as punitive when they're fucking 45k/year residents w/new mortgages and shit

― i like to fart and i am crazy (gbx), Tuesday, April 28, 2009 3:50 PM (13 minutes ago) Bookmark Suggest Ban Permalink

the question for society becomes: do you cap the payments after, say, 20-years? it'd mean that some of your more altruistic individuals may never pay off the balance, but on the other hand now you have pediatricians on the reservation and ppl able to go work for fucking MSF or whatever. you could probably game the interest rates/payment schedule so that ~some~ ppl get off easy at either end of the curve: overpaid radiologists paying that shit off quick (dodging interest) and penniless aid workers get a free ride. the big fat middle pays everything off at a predictable rate and the lenders get their pound of flesh or whatever.

guys i'm telling u, unless we nat'lize professional schools, this is the only way the medical establishment will be able to stomach pay cuts w/o concomitant decrease in operating costs (loans and malpractice insurance)

― i like to fart and i am crazy (gbx), Tuesday, April 28, 2009 3:55 PM (8 minutes ago) Bookmark Suggest Ban Permalink

tho, i've heard the argument that TORT REFORM isn't even ~that~ necessary for single-payer. the idea being: if something goes wrong with yr treatment, part of the reason ppl go looking for blood is not because they're just pissed at how they got ~~~betrayed~~~ by the medical establishment, it's that when things go wrong medically, they're expensive to fix! if, on the other hand, treatments were free, there'd be less incentive/payouts, leaving only pain and suffering or whatever, which, maybe if left nakedly in the courtroom, might not carry the same emotional weight if juries knew that, financially-speaking, patients were gonna be alright int he long run

― i like to fart and i am crazy (gbx), Tuesday, April 28, 2009 3:58 PM (5 minutes ago) Bookmark

hey, I live in America and can't get health insurance. That's what you get for being born with congenital heart defects. I'm not eligible for medicare either for some reason. And every time I go to the health center at school they stare at me incredulously and with disdain that I don't have insurance.

wait can't you get health insurance thru yr school? iirc it's been required at every institute of higher learning i've ever attended (3, one private, two public)

At my school its not required and is also stupidly expensive with very little benefits.

:(

worried about u viceroy

http://www.nytimes.com/2009/04/28/health/28case.html

SEBELIUS CONFIRMED at HHS.

i lost my job (twice) and am without insurance now, with no full-time prospects on the horizon but lots of freelance/self-employment opportunities. the insurance plans we can appply for are ridiculous; premiums are alright but the deductibles are like $3k per year and they only cover 30% of shit when it does happen. WTF is the point of that? I'm half-inclined to just NOT GET insurance, I don't own a home, if something happens someone (the state) will have to deal with it, it's not like I have any assets for them to take, right?

My sister got viral encephalitis a couple of years back; she's a waitress with no healthcare and was in an induced coma for a couple of weeks after she presented at ER and in her pain/rage punched a nurse who tried to shove her in an MRI machine. I guarantee you that being left-hooked by my sis is not a battle people win. 200k bill eaten by the state or whatever. My mom let her coverage lapse a few months ago; she was self-employed and paying shitloads for a $5k deductible. She's 65 next month and is looking forward to her well-earned Medicare. Or, as she says, 'another two weeks and I can fall down the stairs!'

ama comes out against public plan

i saw that last night and got so pissed off i was gonna call and give 'em a piece of my mind! but as you might expect, giving the ama a piece of your mind turns out to be not so easy to do. i have a feeling they don't care what i think.

and this thread should definitely have a link to atul gawande's article about mcallen, which is the best thing i've read about health care in ages. (i guess obama thinks so too.)

glad to see that john kerry is standing up for inefficient & unnecessarily expensive healthcare

that article was great, but kind of laughably depressing in a way - maybe a little related to the ama announcement, hmmm?

My experience with the publically subsidized insurnace in MA so far is that the cost, ease of signup, and phone support are amazing for a state plan, but actual access to care can be frustrating. I needed to get something checked out recently, even just with a nurse practitioner who would tell me either "go home" or "get thee to a hospital," and I couldn't get an appointment my insurance would cover for a minimum of two months. So I went to PP and paid out of pocket. I feel like maybe the state insurance provides help with paying for emergency care, but for primary care I'm not sure how much better it is than having none at all.

that article was great, but kind of laughably depressing in a way

yeah, what made it depressing to me was realizing that it is probably politically impossible to do some obvious things. the thesis ends up being, "if we can just make the whole country function as efficiently as parts of the country are already functioning, we could essentially solve the health-care cost problem." with the corollary that, we almost certainly can't do that, because the vested interests are so vested and so entrenched. as the ama just made clear.

It'd be great to name and shame doctors who overprescribe tests and procedures and such, but shit, so many of these people have no shame. They'll just turn it around and say "what are you, a communist?"

well also as gawande points out theres no clear diagnostic procedure on a lot of this stuff--so its inaccurate to say that choosing more tests over fewer (or surgery over medicine) is "wrong." its just that in a lot of the cases theres no clear benefit to having more tests over fewer other than the benefit to the doctors bottom line.

Dartmouth Atlas of Health Care (Medicare Reimbursements per Enrollee)

Hooray, my area is below the state and national averages.

we talked about the gawande article a little bit on the med school thread which is something i think he passes over not just the cost of attending/training but the whole um "entrepreneurial spirit" thing - i think the incentives are basically fucked up from the start and make it hard 2 fix

Research by Dr. Robert A. Berenson and Jack Hadley of the Urban Institute suggests that much of the geographic variation in health spending can be explained by differences in “individual characteristics, especially patients’ underlying health status and a range of socio-economic factors, including income.”

would like to see this research - cursory looks at the dartmouth stuff + the nyer article suggest this isnt really the case.

the ama coming out against the plan isnt a big surprise really theres weirdly or maybe not weirdly a lot of entrenched opposition to almost any changes in health care policy even on micro lvls. haha i think gawande wrote the article about the dude w/ the checklist for putting lines and how tough it was to get practitioners to take that up v. dispiriting

yeah the cost of med skool has got to be addressed the same way the cost of health care does

word up

i am, embarrassingly, a little out of touch with both the public plan and the ama's rxn to it, but thanks for reminding me that i need to re-engage with this

It'd be great to name and shame doctors who overprescribe tests and procedures and such, but shit, so many of these people have no shame. They'll just turn it around and say "what are you, a communist?"

― unicorn poop evaluator (WmC), Thursday, June 11, 2009 9:39 AM (1 hour ago) Bookmark Suggest Ban Permalink

well also as gawande points out theres no clear diagnostic procedure on a lot of this stuff--so its inaccurate to say that choosing more tests over fewer (or surgery over medicine) is "wrong." its just that in a lot of the cases theres no clear benefit to having more tests over fewer other than the benefit to the doctors bottom line.

― rip dom passantino 3/5/09 never forget (max), Thursday, June 11, 2009 9:43 AM (1 hour ago) Bookmark

another thing, too, is that over-prescribing tests and procedures is often the result of CYA medicine. many docs believe that if they don't cover all possible bases, they'll be risking litigation

haha i think gawande wrote the article about the dude w/ the checklist for putting lines and how tough it was to get practitioners to take that up v. dispiriting

Re-punctuate, please. What? "putting lines"?

i would, however, be interested in seeing the numbers. like, how many malpractice suits have been won on the basis of a doctor ~not~ ordering a particular (expensive) diagnostic test or procedure? is the "CYA sux but is necessary" argument valid (ie - should we be pushing tort reform as a means to lower healthcare costs?), or is it a strawman, albeit one believe by many practitioners?

think he means central lines

Oh right, yes, I read that essay! Thx.

We actually had a talk on malpractice including a dude who was sued and lost for failing to do a PSA test in a guy who ended up developing prostate cancer a few years down the line. He had come to believe during training that PSAs (which are not really that strong of a diagnostic test, since your PSA can go up for a bunch of different reasons, and sometimes prostate cancer will not cause a huge PSA spike immediately) were not the sort of thing you just give to every male over 50 without thinking, unless there are other potential indicators of prostate disease. But the Standard of Care in Virginia, which legally is just whatever most doctors in the area do, at the time still involved doing PSAs on every male over 50 without thinking. That was no longer the recommended practice in the leading medical journals, but it still was for the average doctor in the area. So the prosecution called in a few doctors from the area, and they said you always do a PSA, and the guy lost the suit.

But then on the other hand like 2% of the people who actually are harmed by medical practitioners end up going to court about it.

But really i think the incentives are basically fucked up from the start and make it hard 2 fix OTM. I think just about everybody would be way happier with the system if it incentivized spending more time with each patient, instead of spending your time with more patients. There's a bunch of evidence (a lot of is anecdotal, but still) that suggests being able to get a better picture of each patient and more time to deal with preventive behaviors etc. will reduce the overall frequency of visits, since you'd be better prepared to get to root causes instead of having to constantly alleviate symptoms. But you'd have to convince doctors that the system would not favor seeing patients every 10-15 minutes, and convince patients that the lines wouldn't be twice as long.

AMA is some godamned bullshit.

health care is driving me nuts. After spending my entire life with employer-paid healthcare benefits that were pretty cush, I'm now without; paying for it ourselves with private plans is only possible because they believe us to be perfectly healthy. My elderly father in law has no insurance, lung cancer, and they won't cover him with medical because his wife makes a tiny amount of money, and he's not old enough for medicare yet. My own private insurance is pending approval because I got a prescription for zyrtec (which is NOW OVER THE COUNTER) a year and a half ago. This is for a private plan that has a deductible of like seven trillion dollars.

Seasonal allergies = preexisting condition threatening coverage? Damn. It is messed up. I'm so sorry about your father in law's situation :/

But really i think the incentives are basically fucked up from the start and make it hard 2 fix OTM. I think just about everybody would be way happier with the system if it incentivized spending more time with each patient, instead of spending your time with more patients. There's a bunch of evidence (a lot of is anecdotal, but still) that suggests being able to get a better picture of each patient and more time to deal with preventive behaviors etc. will reduce the overall frequency of visits, since you'd be better prepared to get to root causes instead of having to constantly alleviate symptoms. But you'd have to convince doctors that the system would not favor seeing patients every 10-15 minutes, and convince patients that the lines wouldn't be twice as long.

― C-L, Thursday, June 11, 2009 12:20 PM (28 minutes ago) Bookmark

this, too, could be addressed by increasing the number of students going into primary care...which (~broeken record~) leads us directly to incentivizing that choice. instead of paying doctors more, just make their education cheaper, etc, etc, we've been over this

god fuck the ama.

Obama is my hero for sticking to the public plan proposal. I dunno if I'd switch to the public plan if and when it goes through (had this convo with the wife last night) but it seems absolutely imperative to me that this gets put in place.

would i still have to pay for the public plan if it exists

presumably you'll be paying for it via the proposed taxes on your healthcare benefits

Here's a point to plot, in charting the inevitable failure of Obamacare.

Remember the other week when it was revealed that the Washington Post's publisher was offering access to Post staff, members of Congress, and Obama officials in exchange for tens of thousands of dollars? In her own home? Off the record? Just a cosy little get together in which tens of thousands of dollars traded hands, no biggie. It's the kind of thing Dr. Morbius imagines in his worst fever dreams, except that it's all true.

Well I remember that too, but what I didn't know was who was to have been invited to the first of these soirees - Kaiser Permanente and Jim Cooper, among others.

Let’s make sure we understand who would have been at that dinner:

- Lally Weymouth, patrician publisher of the Post.

- Jim Cooper, the red-state Democrat (Tennessee) who played a large, leading role in defeating the Clinton health plan.

- Kaiser Permanente, one of the insurance giants which wants to undermine Obama’s health plan.

- Kaiser Permanente’s checkbook.

- Presumably, Ceci Connolly, the Post’s top reporter on health care.

here is our sob complainy story for the third time: I got laid off in April, could not afford cobra coverage for myself/wife/kid, and we determined that it was cheaper to just pay for private Blue Shield insurance for each of us; premiums were doable (around $70/month per person), deductibles are high ($2900 a year...still liveable). Copay thing was not really clear, there is a max on it per year, you still have to pay a portion, but I'm not sure what it is, $40 I think. Whatever. We mainly got this because I have a three year old and he tends to fall down a lot, etc.

Two months after signing up, my wife finds a lump in her breast. Takes another month for them to conclusively determine that this is breast cancer. Doctors are pretty good, plan is all in place; they need 'preauthorization' for mammograms, MRIs, CT scans, god knows how much blood work, all of which Blue Shield gives. Okay, fine. Do the procedures. They bill insurance. Suddenly, blue shield freaks the fuck out. They refuse to pay, saying she needs to fill out more paperwork (which they finally send to us); it's "authorization for release of health records", which we didn't have to fill out when she applied. They're trying to determine if this is a pre-existing condition so they can drop her. Meanwhile, chemo is supposed to start in a week but suddenly they've gone silent, haven't authorized anything. Fuckers.

What happens if you fill it all out and then OOPS forget to send the authorization sheet? Whatever you do, you need to get hold of those records before them so the loss adjuster cannot bamboozle you.

Any further communications you put forward must mention that time is of the essence, that further delays could be seen as willful obstruction or detrimental to the health you paid them to insure in good faith and that time delays on their part will, ironically, raise the cost of care.

we don't have any of our health records, they are in the hands of however many doctors we've seen in the past....for instance, all of her stuff from about 2002 until 2007 was with Kaiser (an HMO system), most of it relating to pregnancy and birth. Anything since (there hasn't really been anything since) is with the same doctor who sent her for a mammogram, who presumably should have found this lump six months prior during her annual, but didn't for some reason. Anything before 2002 we don't even know who the doctors were, can't remember, spread all over the place randomly.

(while writing this post, apparently blue shield gave the authorization...but now e have switch to a different oncology office because the one we were at was staffed by retards who have repeatedly screwed things up and now we don't trust them)

Jesus - I think with what's going on you have a little bit of a right to be complainy, akm!

oh and apparently they didn't give the authorization. so we're not sure why they set a date, when two days ago they said they couldn't until they got authorization....URHGHGHGHGHG

OK just treat this as a diary of your treatment so it's completely time dated and you'll be able to document their runaround fully. Good luck.

You might be able to find a patient advocate to hammer on Blue Shield through one of the resources here: http://www.cbcrp.org/links.php

Are you fucking kidding me, Obama?

r.i.p.

what happened

Sigh.

I just wrote a letter to the President and to my Congressman. (Unfortunately, I know my Congressman would support single-payer if it was up for discussion, so my letter was more like: Keep up the good work, and convince Obama to stop being such a fucking idiot.)

If he pussies out like this when it comes to environmental reform I'm never coming back.

Fuck man, I really thought that this would be the one issue where dude would not give in like this. I expected milquetoast centrism on a lot of stuff, but I thought he would have a total blood-grudge on healthcare and fight tooth and nail for a public option.

Well he never said a public option was more or break from the beginning so it's not like he's actually changing his tune. Just saying it now makes him seem like he's kow-towing to these shits.

White House Appears Open to Insurance Co-ops
The Obama administration sent signals on Sunday that it has backed away from its once-firm vision of a government organization to provide for the nation’s 50 million uninsured and is now open to using nonprofit cooperatives instead.

I don't even know what to say.

I feel like crying.

http://i32.tinypic.com/op1n5y.jpg

MORBIUS -- NOW MORE THAN EVER

Satan laughing spreads his wings

All right now!

i don't get the gnashing of teeth here - obama has always insisted on the nice-to-have-itness of a "public option" which, not being an actual single-payer scheme, i was never convinced of the merits of in the first place

Am I also right in my very brief understanding of this issue that in fact a (small) majority dont want any kind of public healthcare? In the end too, any govt has to do the democratic thing*. Which in this case sucks. Still completely boggled at anyone being against getting free healthcare and subsidsed medications via their taxes.

*nb I am also aware BigPharm would be lobbying very very hard for none of this to ever happen, I guess.

I think you're wrong. IIRC, the majority wants public healthcare.

Yeah, I think even the people who are protesting against it would be for it if they weren't getting brainwashed and lied to by the only news sources they expose themselves to.

govt has to do the democratic thing

See, no, that's why we're a republic and have elections at certain intervals instead of polling each issue. The percentage of Americans who want public healthcare oscillates wildly depending on whether the predominant meme is that public healthcare means totally free everything forever hooray or that it means that Barack Hussein Obama will personally strangle your grandmother.

xpost

I'll post this here, too, b/c it fits. It's a FB email from my brother's republican friend, who is...well, a bit susceptible to the fear-mongering, shall we say:

We seem to be digressing, although I must admit that I do enjoy reading your perspective.

You've brought up issues on; misinformation, scare tactics, pundits, lies, the politicos, etc. I can't disagree with you, but my original point was that you generally seem to reference the "right" regarding these issues. I'm well versed on the claims against the current administration and its supporters. It goes both ways.

For every skewed poll or statistic that favors the conservatives, I can reference one that favors a liberal perspective. For every misrepresentation, lie, inaccuracy that the republicans make public, you can find one that the democrats have thrown out there. You've referenced the "death panel", but there's also Harry Reids "evil-mongers", "teabaggers", "mob-rule tactics", "fringe righty lunatics", etc. For every conservative yahoo there is a liberal to match. The liberals are trying to goad people into believing things that are clearly untrue just as much as any conservative. To believe anything different is illogical.

I'm sure the threat of violence is always an issue to some extent. It wasn't to long ago that Black Panther members were showing up at voting booths with billy clubs. I just find it hard to believe that Obama's secret service has experienced an "explosion" since September. I've got to believe that the Bush secret service were kept on their toes.

I don't think its that people are averse to change, it's just that people are concerned with the cost of that change. We are a very young country considering. We've led the world in scientific discovery, medical advancement, economics, wealth, invention, industry, the military, you name it. People are free to have and do whatever their minds and bodies will allow. We've known a lifestyle that many countries (far older than ours) have never even dreamed of, yet we are in need of change? And not just "tweeking", but drastic change. In addition, we are currently in debt. We'd have to finance this change with more debt and no real guarantee of success. Pretty soon the Chinese will be determining what we can and cannot spend money on.

I am aware that the health care bill didn't pass at "rocket" speed, but the attempt was there. People are justifiably concerned when a brand new administration and an inexperienced President try to pass a bill that is monumentally important and expensive, in a very short period of time, and it's well known that most never even read the bill let alone understood it.

With a public option, no matter how you slice it, sacrifices will have to be made. You'll have to have some degree of mandate, rationing, and regulation. There are significant wait times for "elective" procedures such as knee, shoulder, or hip replacement surgeries in countries like Canada and the UK. One of my "Facebook" friends has lived her entire life, and is a firefighter in Ottawa, Ontario. She is also an advocate of NHC. She can tell first hand the ups and downs of a single payer system. She will tell you that Canadian doctors salaries are capped, that some of the best Canadian doctors come to the States to practice medicine, and that she had to wait 9 months to have her knee reconstructed (not that she heard of this happening, she actually went throught this). Still, for whatever reason, she feels that NHC is a good thing.

You had mentioned before that you'll be losing your health coverage soon so this is a personal issue to you. If I was on my own and needed to have a knee reconstructed, I could wait for the surgery if necessary. The suffering would be tolerable if the suffering was my own. When you decide to add to the population, you'll better understand what I'm about to say. If, God forbid, something happened to my little girl and she needed to have her knee reconstructed, I would be willing to sell everything and pay anything to eliminate her suffering. I can't begin to tell you how it would kill me to have to watch her suffer while waiting for surgery under a public option when I was willing and capable of paying for something better for her, only to have it taken away. When dealing with yourself, it is a personal issue. When you have a wife and two kids that you're concerned with protecting, providing for, and whose lifes are far more valuable than your own, the issue of health care becomes monumentally more important.

Sorry about the length, I was trying to respond to multiple messages.

My response was about the same length, so there we go.

I can't begin to tell you how it would kill me to have to watch her suffer while waiting for surgery under a public option when I was willing and capable of paying for something better for her, only to have it taken away.

See this is the kind of not getting how it works I keep seeing. But again, I dont think I'm really aware of what the US proposal would be, and I do understand y'all couldnt suddenly change completely to a system like the one we have, it'd be chaotic.

As in, perhaps I'm misreading your bro's friend there, but he seems to think public care = no choice on also choosing private care.

We have both, and many people get insurance *and* use medicare.

that's the scare tactic; that either the public option will be the *only* option due to either Obama's thugged-out brownshirts forcing you to take it, or because all the private insurer systems would be bankrupt since the horrid gubmint obamacare would be so popular.

Aha! Now it's all making sense.

Does anyone say that private healthcare creates incentives for research and that a public option would diminish that? I myself don't think they're related because I still naively believe that academics is all about prestige...

I've seen that argument made once so far, but it doesn't seem to have legs.

NIH does vast majority of health research here, doesn't it?

good assessment from 538: http://www.fivethirtyeight.com/2009/08/life-after-death-of-public-option.html

I think you're right. Basic research is government funded, but there was an article in the NYT about risk aversion in NIH funding and I don't know if the effort to control costs would create even more disincentives for research that has not already been proven. But so much cost control could be done in implementation that I think that research and how it is funded might be a separate question. I don't know if this has already been mentioned but it seems like one of the big improvements that could be made is to move away from a fee for service model and to have salaried doctors instead. I also think electronic health records could bring a big improvement because I've noticed that doctors' offices do not necessarily do a good job of transferring records.

an open-source EMR standard would probably save the industry billions of dollars, but no one ever listens to me

I'm reading that the President still supports a public option, and Sebelius was possibly speaking out of turn. I'm so upset right now that I'm hoping it's true:

http://www.cbsnews.com/stories/2009/08/16/ftn/main5245252.shtml?tag=stack

I'm one of the fortunate folks in Seattle to be covered by Group Health (on a private, individual policy since I'm self-employed) - they were profiled in a recent NYT article. The way they handle records electronically is terrific, and their doctors/nurses/pharmacists/technicians all communicate directly with us via email. An open EMR standard seems absolutely key to me too, but no doubt there's a hundred companies out there pushing their proprietary HIPAA-approved solutions on already overburdened administrators.

I guess if they can get the "no refusing ppl who have pre-existing conditions" thing in, they'll still have fixed one of the most flagrantly uncivilized aspects of the whole mess, but yeah, this feels really depressing today.

Seems so very dangerous to give a cookie of reward right now to the whole town-hall shout-down model of discourse.

Last year there was a magazine profile of Naomi Klein where she was saying she could not get on board with Obama bcuz he's really just slightly modified more-of-the-same. She was basically saying how the disillusionment for all the young ppl who were believing in Obama as a herald of change, when they see what he actually does in office, was going to be super harsh and damaging. I got really steamed reading that. Right now I'm trying to shout down a little voice in my head saying "Naomi Klein OTM".

The Congressional switchboard is 202-224-3121. The full Medicare, single payer bill (backed by nearly ninety legislators) is H.R. 676. The go-to citizen group for your sustained engagement is singlepayeraction.org.

http://counterpunch.org/nader08182009.html

Jaq OTM re: Group Health. I actually don't hate dealing with them!

healthcare as a civil right

http://www.newsweek.com/id/212162

letter to The Nation last week:

The Public Option: Doomed to Fail

Cambridge, Mass.; Washington; Chicago

Regarding your editorial "Public Option Now!" [July 20/27]: a public option won't fix the mainstream Democrats' flawed healthcare reform proposals. Only a single-payer reform would make universal, first dollar coverage affordable. It would save about $400 billion annually on bureaucracy and rein in costs over the long term through global budgeting and rational health planning.

Even a public plan option far more robust than anything on the table in Washington would forgo most of these savings, making comprehensive coverage unaffordable. While a public plan might cut into private insurers' roughly $10 billion in yearly profits (which is why they hate it), that's only 10 percent of their overhead. They spend much more tracking eligibility, collecting premiums, marketing to healthy (profitable) patients, demarketing to avoid the sick, and shifting costs to patients and providers. A competitive public plan couldn't match the efficiency of Medicare, whose integration with Social Security allows automatic enrollment, disenrollment and premium collection.

Moreover, a hybrid plan would forgo hundreds of billions in administrative savings because hospitals and doctors would still have to maintain armies of administrators and billing clerks to joust with hundreds of insurers.

A kinder, gentler public plan would quickly fail in the healthcare marketplace. Insurers compete by not paying for care. Competition in health insurance is a race to the bottom, not the top. A public plan that did no marketing would soon be saddled with the sickest patients, whose high costs would overwhelm any administrative efficiencies and drive premiums to uncompetitive levels. Similarly, eschewing private insurers' schemes that shift costs to patients and other payers would be a crippling competitive disadvantage. To survive, a public plan would have to imitate private plans' bad behaviors.

A healthcare system dominated by private insurers cannot provide families with the affordable coverage they need. A public clone of private insurers won't help.

DAVID U. HIMMELSTEIN, MD
STEFFIE WOOLHANDLER, MD, MPH
SIDNEY M. WOLFE, MD
QUENTIN YOUNG, MD
MARCIA ANGELL, MD

more like stiffie woodhandler

doctors otm

yeah, THOSE doctors. For every MD I know that's for single-payer or gov't option, I know four more that are against it.

u know five doctors?!

I wish I knew that few! ;)

i know a lot

it's all doctors all the time up in this bitch

there are rallies everywhere tomorrow, it seems.

Coordinated w/Kennedy funeral or w/the other Boston tea party I'm thinking of?

NYC:

http://www.examiner.com/x-15182-Manhattan-Political-Buzz-Examiner~y2009m8d27-Rally-for-health-care-reform-in-Times-Square

!!!!!!! YAY.

We might be attending that. Thanks for the heads up.

glad the San Francisco Examiner's on top of local NY protests wtf is that all about

that is a diff Examiner? some all-purpose site for goings-on in diff cities

someone make SINGLE PAYER ONLY signs

not entirely relevant, but:

was at a party, chatting with my friend ben about healthcare in africa (he had just returned from tanzania), and we were discussing how tricky translation and compliance can be. like, i definitely did a little sign of the cross inside when i gave a woman some phenobarbital for her epileptic 4 year old, with instructions through a translator. drugs like that are not to be messed with, esp with pediatric pts, but it's what the doctor ordered, so... also, it's not uncommon for some pts to take much more than the daily prescription, with the idea that more is better. so two weeks scrips last only a few days, people get sick from the medicine and come to distrust it, etc.

anyway, as we're discussing this, some guy at the party is basically "that's why we shouldn't send medical aid to africa!" thought he was joking at first, but it soon became clear that he was totally serious.

like i said, not entirely relevant to this thread (mostly just couldn't believe this guy existed), but i think it does highlight a certain attitude common among people against universal healthcare (which is a form of domestic aid). that is: there are some people that just don't ~deserve~ medical care.

and i guess i'm not sure how to counter that argument without punching people in the neck

Shoot WHERE was I just reading something about a study that followed two medical programs in Africa and found that the much "simpler" one was failing b/c it didn't trust people enough to teach them anything about their care, and the more difficult one was succeeding by telling people what the drugs were, what they would do, etc, and people were taking them correctly EVEN THOUGH the drugs made you feel worse for a while before you got better.

btw about A THOUSAND ppl showed up for that NYC rally, ie we're all doomed.

movin to canada, iirc

that is: there are some people that just don't ~deserve~ medical care.

if basic moral appeals don't work (heh) there's sort of a higher barbarism in appealing to larger economic or nationalist impulses: sick people at the end of their rope will go to the ER, if they are uninsured we are all paying for it anyway, the hospital charges the rest of us or the state, in effect. having a lot of sick, unhealthy people around is a huge productivity drag, making a constant depressive effect on growth (i think, ha). a majority of bankruptcies are now medically caused, so saved capital that could be put to real use is being sucked up by medicine and disappearing. the way the system is structured now, we are already--all of us--paying out the nose for the uninsured and unwell; altering the insurance regime is meant to get them OFF your checkbook, not on it. it's not a gift to "them", it's for YOU.

movin to canada, iirc

I am actually doing this!

Well, we've got some good news.

http://www.nytimes.com/2009/09/03/business/03health.html?partner=rss&emc=rss

Pfizer Pays $2.3 Billion to Settle Marketing Case
WASHINGTON — Top aides in the Obama administration announced a $2.3 billion settlement on Wednesday with the pharmaceutical giant Pfizer Inc. over the company’s illegal promotion of its now-withdrawn painkiller, Bextra.
It is the largest fine ever levied for fraud in the Medicare and Medicaid programs.

Pfizer, which is acquiring a rival, Wyeth, had reported in January that it had taken a $2.3 billion charge to resolve claims

Good thing Pfizer's paying out of the largest fine fraud ever isn't interfering with them buying out their competition. Their official statement was that Pfizer 'regretted' their actions, so just try and picture an incorporeal entity regretting its actions.

ug, Georgia Republicans making an amendment that basically states that Obama's Health Care Bill doesn't have to effect us (if it gets passed). Is this happening all over the country?

from another site: "In contrast to national proposals, their proposed plan will emphasize patient-focused and cost efficient choices for Georgians."

meanwhile my family doesn't have any health care atm

W House advisers apparently split btwn $20 billion rearranging-deckchairs cheapo bill and lameass but wider bill. I think you know where to write.

Man fuck this state I'm moving to Sweden.

at the risk of repeating myself, if the US can't even get a dollar coin introduced i'm not sure why we all thought it could create a national health insurance program

Sacagawea what?

HOPE

has anybody been pushing for reform with the argument that public health care --> support for the self employed & young entrepeneurs --> stronger economy / core capitalist principles

and if not then why the fuck not?

because of the death panels

I'd like to know who all these people are who are so happy with their insurance companies and their health plans. are they people who have never been sick?

based on one network news feature I saw, they seem to be Medicare beneficiaries with 54-inch waists

They all have somebody holding a gun on their wife and kids at the other end of the phone while they're taking the survey. xp

https://www.youtube.com/watch?v=z8IeZHZRwC4&eurl=http%3A%2F%2Fhollywood%2Delsewhere%2Ecom%2F&feature=player_embedded#t=316

well that didnt seem to work....

http://www.youtube.com/user/PBS#play/uploads/2/z8IeZHZRwC4

I really think Obama needs a power point presentation for his speech on Wednesday.

And a pie chart

from a nytimes article today:

Critical players in the health care industry remain at the negotiating table, meaning they are not out whipping up public or legislative opposition.

what does this mean?? are senators actually negotiating directly with existing health insurance corporations?

I certainly hope so, they've paid good money to.

of course they are "negotiating" with existing companies. Senators never do anything without lobbyist approval.

you think the average senator knows enough about anything to actually write legislation?

Kind of makes you wonder who got to visit the White House this year, dunnit.

i just find it stunning that news reports casually mention congresspeople negotiating with the very same industry they're in the process of reforming and it's in passing, like duh of course that's how it works

btw don supposedly obama's going to open up the books on who visits the white house although it hasn't happened yet, and doesn't speak at all to who is visiting senators

http://www.whitehouse.gov/issues/health_care/plan/

Plan's up. Dig in.

Offers a public health insurance option to provide the uninsured and those who can’t find affordable coverage with a real choice. The President believes this option will promote competition, hold insurance companies accountable and assure affordable choices. It is completely voluntary. The President believes the public option must operate like any private insurance company – it must be self-sufficient and rely on the premiums it collects.

Ok in the realm of life as a grand unpleasant comedy, I am no longer listening to this speech because my gf just badly cut her finger while listening and chopping vegetables. They are not playing the speech in the emergency room.

shiiiit!!! hope everything is ok

if everything gets settled before 10-ish i'll gladly buy y'all a drink

http://img35.imageshack.us/img35/8442/deathn.jpg

http://img195.imageshack.us/img195/7131/whatve.jpg

obama killlllllin it in this house right now

btw don supposedly obama's going to open up the books on who visits the white house although it hasn't happened yet, and doesn't speak at all to who is visiting senators

btw yes he is going to open the books, but only from (last I heard) April of this year on but maybe not even until September. And he had to get sued to do it.

the plan on the website is very, very, very, very, very, very short on details.

the five plans in congress are very very very long on details. a lot of them really shitty! plenty to go around.

oof kinda awwwkward kissy kissy with hillary there

Ok in the realm of life as a grand unpleasant comedy, I am no longer listening to this speech because my gf just badly cut her finger while listening and chopping vegetables. They are not playing the speech in the emergency room.

Yikes! Hope she's okay.

awwwwwwww i'm sorry don. who was it in particular you were interested in? maybe the records are in sandy berger's pants lol!!

BBC has a republican spinmeister on right now talking about the president's "untruths" (example: "there is no actual money in the medicare trust fund!")

You're the one who was interested in insurers meeting with Senators dude.

i just find it stunning that news reports casually mention congresspeople negotiating with the very same industry they're in the process of reforming and it's in passing, like duh of course that's how it works

srsly, have you never caught my convos w/ El Tomboto?

Well, they can't not meet with them lest they be accused of 'shutting out' the lobby from the debate, and if they do meet with them they can at least look like they've listened before rejecting the lobby's ideas as bad/self-service/status quo.

ok no longer at the emergency room, fingertip reattached, willing to state that IMHO there is a certain lack of efficiency in health care since we were there for uh 4 hours or so i think?

i just find it stunning that news reports casually mention congresspeople negotiating with the very same industry they're in the process of reforming and it's in passing, like duh of course that's how it works

right. in most industries (hi dere energy) the lobby just dictates terms.

total bummer JJ, sorry :(

Doug Henwood:

"A friend pointed out to me earlier today that the market capitalization—the value of all the outstanding stock—of the publicly traded health insurers is about $150 billion. Add a little premium to sweeten the pot and you could nationalize the lot of them for about $200 billion. The total administrative costs of the U.S. healthcare system, which are greatly inflated by all the paperwork and second-guessing of docs’ decisions generated by the insurance industry, are about $400 billion a year. Those administrative costs are about three times what a Canadian-style single payer system would cost. So that means we’d save about $250 billion a year by eliminating the waste caused by our private insurance system.

"In other words, the nationalization could pay for itself in well under a year.

"Will Obama propose anything like that? Of course not. Instead, he’s going to propose that Americans be required to buy insurance, probably with some government subsidies. So instead of euthanizing the private insurance industry, Obama & the Dems are going to provide them with tens of millions of new customers—compelled to buy their product by law, and with some degree of public subsidy. That’s lunacy."

http://ipaccuracy.wordpress.com/

For some reason I'd assumed that actual cost of a single payer system wasn't really a critical stumbling block. Most opponents seem to dislike the idea on principal ("it's socialism! It's the nanny state!"), or because they think it will negatively affect patient care/choice. I'd thought it was well known that we're already paying for the uninsured, and that virtually any public program would likely be cheaper.

Maybe I'm naive.

naive re: other people's knowledge, possibly

Am I wrong re: cost tho? Like, everything I've read---likely biased---would indicate that if saving money on healthcare was at all a priority, then SP makes the most sense.

seems that way acc to what I've read.

Discussing cost, unfortunately, leads directly to discussing "rationing" and death panels, I guess.

Which is dumb, since all he savngs would come from elimnating admnstration and the profit margin, not from killing Stephen hawking.

Has the US ever nationalized an entire industry of this size during a time of relative peace?

I thought Obama explained very well why single-payer isn't on the table - he talked about American culture, the myth of self-sufficiency, skepticism of government, etc. He confronted that head-on.

Haven't watched the speech yet!

http://www.joewilsonisyourpreexistingcondition.com

Add a little premium to sweeten the pot and you could nationalize the lot of them for about $200 billion.

sounds true enough (but being kind of business/finance illiterate, i dunno if market cap is the right measure for what it would cost to buy all the private insurers outright.)

which brings us to the legal authority to do it, which means congress, which means politics, which means ideology. i really hated obama's shout out to "rugged individualism" and all that cowboy mythopoetia, but it looked to me like an admission of the plain truth: yeah short of a meteor hitting us or a zombie outbreak, we are unlikely to see nationalizations.

anyway, thanks for the tip on that henwood and co. blog

however...

Gwendolyn Mink 9:05 pm on September 9, 2009 | 0 | # |

It is so intellectually dishonest to cloak himself in Kennedy’s mantle of social justice, when there is little justice in this plan. If he would stop being so grandiose the conversation might be more productive. This speech says that health care reform has been defeated. What remains possible, maybe, is some regulation of health insurance practices. What has been placed on the table tonight will have to be overturned if we are ever to meet our moral obligation to provide health care as a fundamental right (Kennedy’s words). It’s so much harder to undo partial and stratified policies so we really should either insist on much more comprehensive measures or insist on redefining the President’s goals.

i disagree with this pretty strenuously. you hear this a lot from the left, that any half-measures are worse than nothing because they become ossified and you can't do better. but i don't think history bears this out. the classic example is social security, which was really minor and anemic at the start, by our standards, and covered hardly anyone. i mean, the single-payer route is routinely called "medicare for all," which seems to indicate that existing Medicare (for the old) is the partial measure -- should LBJ not have instituted it then?

goole really, you hated the rugged individualism thing? I thought it was great - putting your opponents' arguments and mindset in the best possible light. It was so intellectually honest. I don't know whether Obama particularly agrees with or believes in those myths himself, but he acknowledged their power and allure.

xpost yeah i think anything that substantively moves this issue out of where it's been stuck for decades has to be counted as real change, even if it's nowhere near what it needs to be. i mean, just the fact that it is apparently a bipartisan view now that excluding "pre-existing conditions" is sort of evil is a worthwhile move in the right direction. (and of course, the republicans who now state that as an "everyone-agrees" principle did nothing about it while they were in charge. and would immediately revert to doing nothing about it if given the chance. which is all the more reason to pass what can be passed now.)

i'm sympathetic to all the bitching about the plan that's going to come out of this, and i've done a fair amount of it myself. but we have built ourselves into a trap over decades and decades with the system that we have and nobody -- not even some fantasy dr. morbius president -- would be able to suddenly convert it to a single-payer system, or anything close. we can all be pissed off about having a horribly uninformed population and massively powerful leech-like vested interests, but being pissed about it only gets you so far. anything that passes will to some degree change the way we think and talk about health care, and that's important.

yeah I'm pretty bitter about the way we're paving this cowpath but whaddyagonnado?

PS how is this not already someone's username: not even some fantasy dr. morbius president

ok no longer at the emergency room, fingertip reattached, willing to state that IMHO there is a certain lack of efficiency in health care since we were there for uh 4 hours or so i think?

― A DOG, A BARREL... RIDICULOUS! (jjjusten), Thursday, September 10, 2009 12:23 AM (14 hours ago)

you mean the waiting room or the whole process?

Sliced fingers are pretty low on the totem pole, is the thing. And when ppl are using the ED as a primary care clinic, yr gonna get backups, too.

yeah prob 3.5 hours in the waiting room - and i totally get the priority thing, i actually was using that to keep K calm - like if you were in big trouble youd already be in there, but what spooks me is that the waiting room was mostly open, and you know it was a weds early evening so i shudder to think how long the wait is on a weekend night

What it looks like to me is that Obama is doing about what, back in July, I hoped he'd do right around now.

He's let the Congress draw up their five different bills, so everyone in Congress has had a chance to arm wrestle one another over their pet ideas - especially the Democratic committee chairmen. By now, each member of Congress now understands they are to weak to force their will on the rest of the Dem caucus, and that compromises will be necessary. He's let the opposition show all their cards.

Meanwhile, Obama has been able to watch from the sidelines and see who to placate, who to flatter, who to cut deals with and who to flog into line. Now he needs to plant himself firmly at the head of the party and make the necessary power plays to put a bill on his desk by early December.

I think he can do it.

Anybody care to take a stab (sorry) at explaining how the "required" to have health insurance thing is supposed to work... I mean, I'm sure cops aren't going to be pulling you over asking to see your proof of health insurance, right? I know Obama compared it to driving insurance, but lots of people don't have that either (I didn't for at least a year, when I used to drive, for instance). That's the only part of the speech that confused me or seemed weird / impractical...

Massachusetts to thread, pls.

is MA considered a success or a failure? because I've seen both claimed. I'm relatively certain that people calling it a failure probably haven't had to live in a state like california with a pre-existing condition and no employer-sponsored health care, though, like my family, so fuck them.

It was so intellectually honest. I don't know whether Obama particularly agrees with or believes in those myths himself

Big whaaaaaaa?

feh i know defuse your enemies and all but that tame the west marlboro man randian stuff is complete bullshit. every "rugged individualist" needs a stable legal environment or he's a bandit. the cowboys were all EMPLOYEES for chrissakes.

that was his point!!

by the way has anyone explained how costs will come down without a public option?

i was stunned to read today that alabama's cutoff for medicaid is ELEVEN PERCENT of the federal poverty level. so if your family brings in three thousand dollars a year you're too rich to qualify. that is so fucking disgusting

i mean, that's the mindset this reform is up against - fuck em and let em die in misery

Taxes are socialism and only steal money from the best & most hardworking/moral Americans and redistribute it to the lazy(& shiftless) undeserving poor.

Etc.

Baucus is such a fucking joke. Months and months and he throws out a compromise bill with NO public option AND no Republican support?! WTF way to legislate jackass. I'mma let you finish, but now let's actually pass a bill...

how will costs come down with any option? Has anyone explained that?

Also:

Alabama Medicaid Eligibility:
http://www.medicaid.alabama.gov/documents/apply/2A-General/2A-1-Eligibility_Summary_1-2-09.pdf

As an FYI: For low-income families: "Meets federal income requirements but is well below the national average. Covers only the poorest of the poor (11.5% of FPL)."
(http://www.medicaid.alabama.gov/documents/apply/2A-General/2A-3_Eligibility_Group_Chart_2-2009.pdf)

oh wait Tracer, here's what you're looking for...to your delight, the CBO speaks to the plan! Don your rose-colored glasses my friend!

http://gregmankiw.blogspot.com/2009/09/cbo-on-baucus-plan.html

is MA considered a success or a failure? because I've seen both claimed. I'm relatively certain that people calling it a failure probably haven't had to live in a state like california with a pre-existing condition and no employer-sponsored health care, though, like my family, so fuck them.

A success. Mostly.

93% of Massachusetts residents are insured. This is a 6-7% increase. But, an odd trend has emerged: 10% of the insured population has skipped necessary care (e.g. filling prescriptions or finding a primary care physician).

This is a result of high deductible insurance that many residents have bought from our exchange because it’s the cheapest. Because it’s the cheapest, patients pay 20% of their hospitalization and specialization bills.

It’s true. Massachusetts disincentives necessary care.

It was a worthwhile compromise to shelf incentive realignment for passage. But its explosive cost has now warranted further legislation to create better incentives for doctors. This will levitate much of the cost problem.

Anybody care to take a stab (sorry) at explaining how the "required" to have health insurance thing is supposed to work... I mean, I'm sure cops aren't going to be pulling you over asking to see your proof of health insurance, right? I know Obama compared it to driving insurance, but lots of people don't have that either (I didn't for at least a year, when I used to drive, for instance). That's the only part of the speech that confused me or seemed weird / impractical...

It’s a simple process. Resident’s are required to provide their health insurance information when filing their state taxes. It’s true that Massachusetts will never be able to insure every resident. But, we’re doing okay (i.e. only 2.6% of residents are uninsured).

However, a significant number of people that are uninsured in Massachusetts have received exemptions for financial reasons.

Has the US ever nationalized an entire industry of this size during a time of relative peace?

Emergency Economic Stabilization Act of 2008 and Public Law 110-343

http://www.cnn.com/2009/HEALTH/09/18/deaths.health.insurance/index.html

The story is about people who die from lack of insurance. The CNN.com front page uses the following picture of two the people in the story:

http://i2.cdn.turner.com/cnn/2009/HEALTH/09/18/deaths.health.insurance/art.double.split.jpg

Weird pet symmetry there. The story itself is very depressing.

my old paper in knoxville has a good set of essays about health care, highlighting different things wrong with the system. one woman watched her dying daughter get way more aggressive (and expensive) treatment than would do her any good, instead of the palliative hospice-type care she needed. then there's the self-insured musician who wants to have a baby, and a guy who is basically probably going to die because he can't afford the heart surgery he needs.

i don't understand why these kinds of stories haven't been more front and center in the debate, and i think it's a real failure on the democrats' part that they haven't.

^^^^^ agreed!

After a half-day of animated debate, the Senate Finance Committee on Tuesday rejected efforts by liberal Democrats to add a government-run health insurance plan to major health care legislation, dealing the first official setback to an idea that many Democrats, including President Obama, say they support.... [sic]

The committee on Tuesday afternoon voted, 15 to 8, to reject an amendment proposed by Senator John D. Rockefeller IV, Democrat of West Virginia, to add a public option called the Community Choice Health Plan, an outcome that underscored the lack of support for a government plan among many Democrats.

Mr. Baucus voted no, as did Senators Thomas R. Carper of Delaware, Kent Conrad of North Dakota, Blanche Lincoln of Arkansas, , and Bill Nelson of Florida, joining all 10 Republicans in opposition.

I just spent 20 minutes in line at the public option at the USPO.

But even if that's (the money-purging operation that is the USPO) beside the point, a move of good faith would be to start saving $500B a year on Medicare before saying those savings will fund a public option

Wow. Now if only the corporate concern with a public option was inefficiency, you'd have a rock solid argument.

Free healthcare but a 20-minute wait? No thanks!

free healthcare while you wait for old ladies to pick out their commemorative stamps

Having just visited Sweden and talked with a dozen or two people, I found they had VERY little negative to say about their system. After explaining US insurance costs (on average well over 20x what they spend) and the results of being unable to pay these (going into debt, losing your house) they just looked at me, baffled, and asked "Why on earth is it like that?" I really didn't want to get into it so I just left it at that. The US is basically batshit crazy.

this is gonna go through reconciliation is my bet. The Finance Committee's "compromise" bill is a joke that isn't going to garner any more support than any of the other bills, and ALL the other House and Senate bills include a public option. Obama is gonna twist some arms, say fuck you to the Republicans, and do it the hard way. Lots of other stuff has been passed via reconciliation, including basic shit the American people now take for granted, like COBRA. Republicans will bitch and moan, but since they're already being totally uncooperative and negotiating in bad faith about EVERY single piece of legislation, Obama, Reid, and Pelosi have nothing to lose by going the reconciliation route. When your opponent is already being as difficult as they possibly can be, they can't threaten you with being even MORE difficult.

http://hotair.com/archives/2009/09/29/rockefeller-schumer-push-public-option-amendment-in-senate/

what are you doing reading ed morrissey?? the weaker schumer version of a public plan went down to defeat anyway.

Rockefeller and Schumer claim that any overhaul without a government option won’t work. However, they also have not offered any explanation as to how they will pay for the addition of a public option. [haha] They also do not explain how Americans, now opposing ObamaCare in greater numbers than ever, [hahaha] will reward the centrists for selling out to a big-government solution. They already saw the evidence of the backlash in hundreds of town-hall meetings and Tea Party protests over the summer. [hahahaha]

Schumer and Rockefeller have shown their dismissive attitude towards the constituents who sent them to Washington. [hahahahaha] How many more are infected with this hubris? Probably not enough to pass this deficit-exploding monstrosity, and if anything, the pair may have pulled the string that causes this to unravel more quickly than ever. [ha oh man]

I just spent 20 minutes in line at the public option at the USPO.

boy i've never heard of anyone waiting 20 minutes at a doctor's office. nosirree. never sat there for an hour thumbing through 6-month-old issues of newsweek and sports illustrated. nope. nuh-uh. never had to call back the office four times to get them to submit the claim to the right insurance company. never! or had to call the insurance company three times to get them to pay. model of efficiency, that's our private health care system. yep.

ive never waited in line at fedex either

maybe fedex should go into healthcare

They're perfectly positioned to send patient records all over the country -- in fact, the world! Who needs an electronic system when we have cheap jet fuel?

The vast right wing conspiracy raises its beautiful head

those polls are awfully all-over-the-map though. so much that aggregating them doesn't really make any sense, especially since the different polls are probably asking the question differently. and also especially since there isn't actually a "plan" yet to favor or oppose. you can safely say there's a lot of uncertainty, but that's about it.

yeah, I think if you ask people about the general outline of fairly liberal health care reform, but don't mention Obama or Congress, you get much more positive numbers.

Actually, the outline of the president's plan (and I'll leave the shenanigans such as regarding abortion funding and healthcare to illegals out of this) is well documented and has been pimped mercilessly by the president and Congress. What should alarm Obama is that the highest approval in all those polls is 51%, with most below even a plurality. Or maybe we should assume that once the details--thousands of pages of edicts ready to be interpreted by an agency, politicians, the New York Times, and those zany NetRoots--are released and the pols can pimp The Real Thing, more than 51% of the country will sign on.

I'm not sure if that's winning the battle to lose the war or vice versa, but at this point I think we need to seriously start blaming the VRC and its gestapo army (BigPharma, BigInsurance, Goldman Sachs, etc). And Reagan.

i still am not clear on what's going to keep costs down Don.

i think it doesn't work without massive government negotiating power over premium prices and drug prices. anything else is just going to be the equivalent of the government putting this bloated obese patient on life support.

at this point I think we need to seriously start blaming the VRC and its gestapo army

blaming them for what? are you assuming a health care bill isn't going to pass? i think that's a wrong assumption.

Nothing is going to keep costs down Tracer. You can't insure 47 million more people (or is it 30 million, since we are not going to count illegals, right? Right?) for less. You can't force overall costs to go down when it goes against economic fundamentals. You might be able to reduce the cost per patient level (and even that is a grand experiment in cost shifting and draconian, state-run price fixing) but the overall cost is going to go up. It's time for Obama to trot out the truth and admit that massive tax increases are the best way to fund this. Anything else is at best dishonest and worse, outright lying. And as the bill stands now, there's very little fundamental reform even occurring.

I think a healthcare bill likely will pass, but it's going to be half-assed as far as "reform" goes and will cynically serve as a lubejob on the slippery slope towards a single payer system.

No – it will cynically serve as a slippery slope towards keeping the system more or less as it is.

True. I just remembered that 85% is a large majority.

wealth reform
http://www.taxfoundation.org/publications/show/25271.html
For the top 5 percent as a whole (minimum family market income of $358,193), the average net amount of income taken in 2016 would increase by nearly $20,000, from $167,761 to $187,550 per family. The primary beneficiaries of this additional income redistribution would be middle-income families between the 40th and 60th percentiles. [. . .] We estimate that the average amount of income redistributed from the top-earning one percent of American families would increase by $88,729.

"redistribution" = red meat

47 million more people (or is it 30 million, since we are not going to count illegals, right?

Are undocumented people even included in the 47 (or so) million to begin with? I didn't think so, but then I didn't specifically look.

http://factcheck.org/2009/09/thirty-million-uninsured/

None of the numbers (30 mil, 47 mil) are talking about undocumented migrants. Beware of correspondents who use terms like 'illegals'.

. Beware of correspondents who use terms like 'illegals'.

― edward everett horton hears a who (suzy), Wednesday, October 7, 2009 9:23 AM (38 seconds ago) Bookmark Suggest Ban Permalink

otm

Nothing is going to keep costs down Tracer.

whatever bill emerges will not do enough to keep costs down, because the things that would do that (and that do it in every other industrialized country) would eat into the profits of insurance companies, drug companies and hospitals. but some of the things in it will have some cost-containment effects.

what i love is the blank conservative insistence that there is basically NO WAY to contain costs, despite the plainly available evidence that everybody else does a better job of it than we do. it's the rhetorical equivalent of covering your ears, closing your eyes and going LA LA LA LA LA LA....

Best reason not to use "illegals", IMO:

Most people don't understand that "illegal immigration" is in fact only a civil misdemeanor -- which, as legal infractions go, places it on the same scale as speeding or illegal parking. Instead, we've managed to work it up in our minds that being undocumented in the United States is a big-time crime, and thus the undocumented are criminals. --Dave Niewert at Orcinus

So anyone who's ever broken the speed limit on the freeway would likewise be an "illegal driver". If we're not going to switch, wholesale, to that terminology, then don't apply it only where desired for effect.

There are other really good reasons, for instance like not dehumanizing people in a way that leaves a door open for extra-legal actions against them. But, sad to say, most of those arguments don't find any traction with people who want to do precisely that.

Also the term 'illegal immigration' is kind of an oxymoron and should be 'illegal migration' - 'immigration' suggests legitimacy of status.

despite the plainly available evidence that everybody else does a better job of it than we do. it's the rhetorical equivalent of covering your ears, closing your eyes and going LA LA LA LA LA LA....

oh, dear.

FWIW, I used the term "illegals" because that's the favorite descriptor among the VRC.

is VRC some lol way of referring to.... the gop? i'm lost

don do you have any ideas for cost containment that don't involve limiting the profit side of the equation? isn't that really one of the core debates? whether a "health care system" exists primarily to provide health care or profits? if it exists to provide health care, obviously we're not doing a very good or efficient or cost-effective job. if it exists to provide profits, then hey baby we're #1, and why mess with what's working?

yeah, this is the thing

i'd be curious to know how much of our annual healthcare expenditure is on pharmaceuticals. given that Big Pharm is the single most profitable industry in the entire world, I'd hazard that eating into their annual gains would be a pretty cheap way for the gov't to bring down costs

Just want to say that even with my awful insurance paying about $3K, my daughter's tonsillectomy is costing me about $4500. It was outpatient surgery, done and back home in about 90 minutes! WTF health care industry, I hate you so much.

do you have any ideas for cost containment that don't involve limiting the profit side of the equation?

The concept of economic scarcity needs to be addressed.

isn't that really one of the core debates?

The core of the debate, it would seem to me, is how we as a country can (must?) deliver healthcare for all citizens. While the debate could be cast as a moral one, it has the unfortunate position of intersecting with economics. Either we upend the entire system and remove the profits from every level entirely, or we're in a quasi-statist system that will continue to follow more predictable laws of economics and create a sense of injustice. Given the concept of scarcity, I don't see how we can grant healthcare to all citizens unless we declare it an outright right. And even that road is fraught with incredible hurdles in implementation.

whether a "health care system" exists primarily to provide health care or profits?

Seems to me that profits have the potential to be an incredible force of motivation, so I don't know how you can eliminate them entirely or even ration them. Typically, those seeking profits will avoid non-profitable endeavors.

if it exists to provide profits, then hey baby we're #1, and why mess with what's working?

I don't know the answer to this, but if we limited profits (really, this is a hugely slippery money due to accounting standards but still) to an inflation-type target (let's say 3% just for the hell of it), I wonder if the "excess" profit could cover 45 million more people.

I think we should mess with what's working. I just think that we should be honest about it.

Can we unpack the whole scarcity business a bit? Just what are we running up against not having enough of? Doctors? MRIs? Penicillin? Hospitals? Gurneys? IV bags? What?

Seems to me that profits have the potential to be an incredible force of motivation

but the motivation is to deny health care

Well, if people stopped using the ER for basic care, that would probably help resolve one of the scarcity scare-tactics -- ie "Haven't you ever waited in the ER for 6 hours while bleeding/vomiting/dying?? Do you want that time to DOUBLE?"

u beat me to it ^ xp

who the fuck uses an ER for basic care

"illegals"

Er. People without health insurance who can't get preventative care until something goes v wrong?

if something goes v. wrong tho, is that really "basic care"? I guess I should ask how you're defining that.

they are really people who never got basic care in the first place, but whatever

Well, when I didn't have dental insurance, I didn't get any cavities filled...and then I had to go to the ER with an abscess & infection that was taking over my face and could have shut down my kidneys or etc. But okay, suggest a different term than "basic care" then.

see that's not basic care at all to me, that's a reason to go to the ER. of course, the underlying factor is, you didn't have dental insurance

like abscess/infection taking over one's face=why you go to ER

guys ppl use ERs for "urgent care" all the time

like colic-y babies and sprained wrists and stuff

so wait does basic care mean urgent care here? if so i am down with people using an ER for that

xpost also i am down with using the er for colic-y babies and sprained wrists too

it'd be cheaper if there were more urgent care clinics available!

For pete's sake, then pretend I said "using the ER instead of basic care" and maybe we can bypass this?

i thought basic care (as you defined it Laurel, and forgive me for jumping to conclusions) meant like, tummy aches and head colds and bad splinters and stuff

getting nailed for an "easy" thing done by an ER doc is sometimes just because that's how much ER docs ~themselves~ cost.

but if the urgent care clinic is close, off to the ER and yr billion dollar bill

I didn't define anything, actually.

I'm down with people using the ER to die.

bad splinters

i once drove an uninsured friend to an emergency room because she had gotten a splinter in her eye somehow. it was a legitimate emergency -- it was painful and needed to be cleaned out and so forth -- but nothing that couldn't have been handled at a regular gp's office, if she had had a gp.

Typically, those seeking profits will avoid non-profitable endeavors.

sure. but that's really the heart of the resistance to a strong public plan -- the fear that it will render health care unprofitable, at least at anything close to its current wildly renumerative level. which seems like a fine idea to me.

i heard mary landrieu on tv a few weeks back debating jay rockefeller on the public option, and landrieu's main objection had nothing to do with quality or levels of care -- it was that the insurance industry would be hurt. she was just saying this openly, like it was a legitimate argument that we should all be concerned about.

This is Repbublican reponse to EVERYTHING though: industry = good, government-run anything = bad. It makes me wonder why they don't argue for free-market competition in the police and fire department sectors.

They're pretty close, Dan:

Erick Erickson, the managing editor of RedState.com and a city councilor in Macon, Georgia, has called for the abolition of Macon’s police force if it votes to unionize.

The Macon Telegraph reported on Monday that some 130 police officers on the city’s municipal force want to unionize because of “officers bearing the burden of rising insurance costs, a loss of incentive pay and the city not having a pay scale.”

“I’m thinking I’ll have the City Attorney draft me legislation to dissolve the police department and contract with the Sheriff to provide public safety services,” Erickson wrote on the blog Peach Pundit.

“You didn’t read that incorrectly,” blogs Zaid Jilani. “Councilman Erickson’s response to the possibility of Macon’s cops forming a labor union is to abolish the police department.”

It makes me wonder why they don't argue for free-market competition in the ... fire department sectors.

this has already happened in several western states - which predictably resulted in out-of-work private fire dept employees deliberately starting wildfires (subsequently resulting in millions of dollars in damages and miles and miles of destroyed public lands)

You make it sound like such a bad idea.

I eagerly await the crime sprees initiated by out-of-work private police dept employees

http://news.yahoo.com/s/ap/20091007/ap_on_bi_ge/us_ap_poll_health_care

surprised you guys are bothering to argue with Don

"I don't want my tax money to pay for some pill-popper to fake some injury and go to the hospital when I don't ever go to the hospital," said Newcomb, adding he can afford to go to the doctor and pay $60 for a checkup.

i wonder who exactly he thinks is currently paying for the pill-popping injury-faking hospital goers?

This guy shares the common delusion of the lo-info conservative in thinking that the roughly $20k a year they pay in taxes somehow pays for all the welfare in America.

"I don't want my tax money to pay for some pill-popper to fake some injury and go to the hospital when I don't ever go to the hospital,"

classic fox news/soap operatic paranoia, i love it. ps it doesn't cost $60 to see the doctor, dickhole

also pill-poppers have MEDICAL CONDITIONS, just not those you approve of

it doesn't cost $60 to see the doctor, dickhole

if you don't have health insurance it probably does. (also if you have to pay for all the hidden costs in the stupid current system from all those pill-popping injury fakers.)

eyo "cost" is not the same thing as "what patient ultimately gets charged at time of service"

The core of the debate, it would seem to me, is how we as a country can (must?) deliver healthcare for all citizens. While the debate could be cast as a moral one, it has the unfortunate position of intersecting with economics. Either we upend the entire system and remove the profits from every level entirely, or we're in a quasi-statist system that will continue to follow more predictable laws of economics and create a sense of injustice. Given the concept of scarcity, I don't see how we can grant healthcare to all citizens unless we declare it an outright right. And even that road is fraught with incredible hurdles in implementation.

Thing is, 'scarcity' in the field of health care is a massive bubble that keeps expanding and has far more to do with insurance monopolies all profiting by denying care than it does with running out of doctors or vaccines or sterilized needles or latex gloves or any other such nonsense.

And if granting affordable health care to everyone in the US created a real scarcity in physicians/nurses/etc. then hey, isn't that a good thing? Doesn't that create tons of new jobs?

it doesn't cost $60 to see the doctor, dickhole

if you don't have health insurance it probably does

It's more like $120/10 minutes where I am - that's with (privately purchased incredibly high deductible) insurance at a health co-op.

What interests me, due to my own medical history, is a rationale where those with pre-existing conditions are in and of themselves valuable in a situation where their care can be managed and documented and shared as teachable moments further along. People who present with ailments at early stages - at whatever stage of life - are not just about take take take from those who are paid to care. I mean, in my case, I'm alive because of an innovative procedure 35 years ago and it should interest any doctor/oncologist how that pans out over time. That way of doing things seems A-OK whenever I'm in a hospital setting in the UK and suddenly I'm being observed by 10 med students because of this one note in my file.

And if granting affordable health care to everyone in the US created a real scarcity in physicians/nurses/etc. then hey, isn't that a good thing? Doesn't that create tons of new jobs?

The problem is funding those jobs (and facilities etc.)

The problem with funding healthcare is that it is very difficult to measure the matters of economic scarcity. Insurance companies use actuarial data to mitigate it, which is why they enter contractual obligations with reimbursement parameters. Those parameters are often disputed, but the vast majority of the time those parameters result in agreed behavior between parties. Without actuarial science, the business of insurance wouldn't be feasible.

The downside of scarcity is rationing. Rationing occurs in many forms in any healthcare system, but the more comprehensive the coverage, the larger the rationing because of the larger intrusion of scarcity. If it were as easy as simply hiring more people and building more facilities and stocking more rubber gloves, countries with a single payer system would do that. They don't. A single payer system simply rations care when scarcity is pronounced. And this doesn't even get into issues of longterm care or preventative medicine or mental illness or rehab or anything like that, areas that have TONS of holes in insurance coverage. Nobody wants to touch that stuff.

Nobody seems to want to admit that gold-plated healthcare is going to be really, really fucking expensive.

True it won't be easy. But I mean the market can be flexible. I'm mainly reacting to those who use the rationing scare tactic as a reason not to do anything. As if we've reached the limit of doctors/hospitals that can physically exist.

Dandy Don, what steps would you recommend in order to lower (or at least control) health insurance costs?

go keith o

Dandy Don, what steps would you recommend in order to lower (or at least control) health insurance costs?

Assuming you want me to confine this to the current system, I'd focus on increasing productivity via efficiencies in the delivery system (standardization and modernization of record keeping, open interstate commerce to health insurance, modernize tort laws, address the massive duplication of services, etc.) I'd also probably use the state to encourage a wide variety of experimentation. On some level, you have to address the massive cost shifting that goes on.

I really don't think radical reform is even remotely possible.

http://www.nypost.com/p/news/regional/state_slaps_dr_do_good_SkzPo06w424s4Jf7BXzk2K

ewwwwwwwwwwwwwwwwwwwww

http://www.dailymail.co.uk/news/article-1218927/Plumber-shattered-arm-left-horrifically-bent-shape-operation-cancelled-times.html#ixzz0TMFn8yTp

that dudes beef ought to be with the ppl that aren't giving him disability or whatever. shortage of beds is clearly a problem, but HTN is a clinical thing, so I'll defer to he surgeons on that.

http://tpmdc.talkingpointsmemo.com/2009/10/conservative-and-liberal-democrats-warm-to-public-option-compromise.php

hmm

xpost you realise that in britain we pay less in taxes per person for a health service that covers 100 per cent of the population than you do for one that covers just 25 per cent on medicare/medicaid etc? your plumber could get private health insurance and stfu and he'd still be better off than in the us system. us govt alone spends more than the entire public and private expenditure on healthcare in britain.

shortly to be called the 'northern option' if implemented amirite

xp

Oh man that is some gnarly bone healing. It is cool we are not getting British health care, then!

PS seriously you can rebreak that and it will go back to sort of looking like an arm again, sort of. Dude got canceled for surgery because he is a surgical risk, because the current system of healthcare everywhere does not like to see bad stats. Even in America he would have to find some dude willing to deal with a significantly less than zero risk of developing a blood clot and dying of a Pulmonary embolism or stroke, because surgery + smoking + hypertension is a triple high risk of thrombosis. Not to say that having a horrible calcified arm is justified, but basically it is not in the economic interests of public or private medicine to give a shit about the dude's arm.

PPS I know an American dude who can't raise his shoulder past 90 degrees because his insurer wouldn't approve him for physical therapy until eight weeks after a total joint replacement at the shoulder, despite all known medical evidence and logic stating "Hey you need to get some passive ranging of that joint as early as is possible, or else it is going to scar up immediately, and is never going to go past 90 degrees and the patient will never regain function."

^^^^ science

really good

https://www.youtube.com/watch?v=DHma3ZQRVoA

At least he can fix things in hard-to-reach places.
- Alan, Warrington, 09/10/2009 10:25

rating -13

(comment from plumber arm dude article)

shouldn't laugh but

Mr Tickle....is that you?
- DJ, Middlesbrough, 8/10/2009 12:57

so our shit private blue shield insurance finally coughed it up and started paying my wife's chemo and treatments after spending two months investigating her for a pre-existing condition. However, I'm now left with the outrageous deductible and "co-pay deductible" that I feared when we signed up for the plan; about $10k owed to the hospital. I am broke beyond broke. What are the chances the hospital is going to let us skate on this?

threaten to declare bankruptcy on their asses

It is probably unlikely that you will get it free, but it's usually possible to work out some reduction, or some kind of installment plan payment system, as long as there is some offer of good faith in there. If you call the hospital billing people now and explain, "there is no way I can pay this without declaring for bankruptcy", they are more likely to be receptive to a program where they at least might get some money out of it. I can't say for sure, since all the financial stuff I've ever dealt with was at an outpatient facility with way less money at stake, but we had people who got discounts, people who paid a little chunk of their bill away, people whose bills we floated for a while, stuff like that. Call them and explain that you are more than happy to pay for the care your wife received, you just can't do so as quickly and thoroughly as they need. It probably won't be any fun, though.

Well there's a point you just don't give a shit, I guess. You can't pay them, and your recent brush with losing your health (or someone else's) probably makes the hospital's phone calls seem like a bunch of crap that you don't give a shit about. As long as you can work w them to avoid bankruptcy, what are they gonna do??

C-L otm: hospitals are usually very, very receptive to payment plans: it ~will suck, but piecing out that 10k (ow) over a couple years (not unheard of) will hurt a lot less than being expected to do it in one go.

What are the chances the hospital is going to let us skate on this?

Most hospitals earmark millions of dollars each year to write off or reduce debts. Never hurts to ask.

The healthcare industry alone has six lobbyists for every member of Congress and more than 500 of them are former congressional staff members, according to the Public Accountability Initiative's LittleSis database.

Just to be certain Congress sticks with the program, the industry has been showering megabucks all over Capitol Hill. From the beginning, they wanted to make sure that whatever bill comes out of the Finance Committee puts for-profit insurance companies first -- by forcing the uninsured to buy medical policies from them. Money not only talks, it writes the prescriptions.

In just the last few months, the healthcare industry has spent $380 million on lobbying, advertising and campaign contributions. And -- don't bother holding onto your socks -- a million and a half of it went to Finance Committee Chairman Baucus, the man who said he saw "a lot to like" in the two public option amendments proposed by Sens. Rockefeller and Schumer, but voted no anyway.
http://www.salon.com/opinion/feature/2009/10/10/lobbyists/

Dad's deductible went up this year from $1000 to $1500. And the way it's going, it looks like next year I'll be paying extra around tax season because I can't afford to get health care because of a recent layoff. That's interesting because while I figured my tax dollars were going to be used to subsidize the health insurance industry, I was kind of hoping to get health coverage for my troubles. It's kind of an absurd situation that I can't do much about other than laugh a little.

I watched that whole PolicyTalks_ChangeCongress youtube from yesterday. It was good. I posted it in the biz/economics section of ChristianForums.com

oh and that sucks Adam and akm.

Background: The industry hates the idea that's emerged from the Senate Finance Committee of lowering penalties on younger and healthier people who don't buy insurance. Relying on an analysis by PricewaterhouseCoopers, insurers say this means new enrollees will be older and less healthy -- which will drive up costs. And, says the industry, these costs will be passed on to consumers in the form of higher premiums. Proposed taxes on high-priced "Cadillac" policies will also be passed on to consumers. As a result, premiums will rise faster and higher than the government projects.

http://www.salon.com/opinion/feature/2009/10/13/insurers/

He suggests using this public admission of greed to the dems' advantage and holding it up as a shining example of why we desperately need a public option. I agree with him but frankly I don't see that happening. From day one the insurance industry has controlled how this 'debate' pans out along both party lines. For the American public, the only negotiable thing left is to figure out how far we need to bend over.

pricewaterhousecoopers has backed off from their AHIP report, the thing was rigged basically

no comments on the baccus bill getting out of committee with snowe's support? so we're at the point now where if the democrats really wanted to force a public option amendment into a reconfigured bill, they can pass it without republican votes, correct?

also, apparently none of this will take effect until fucking 2014 which is fucking bullshit.

The Democrats can do whatever they want. They probably will.

I wonder how they'll be dealing with the union issues. Such as in New York, where "the union-hospital alliance has been so successful in aligning itself with politicians, Democrat and Republican alike, that not only has 1199 been largely untouched by the downturn, but New York spends as much on Medicaid as California and Texas combined."

wow dandy don, that article is garbage. unions have "upset the madisonian system"? gimme a break.

what part of it did you read Tracer? Or are you unfamiliar with the effect of public sector unions on the economy and in particular, healthcare?

For the thousandth, millionth time: apart from unions, how else do people propose to collectively bargain to ensure the worth of their labor is recognized? Anyone? Although the article is in the WeekLOL Standard, I read too, and I agree w/Tracer: stinky garbage. The only way the hypothesis of the writers (!!! they needed two) works is by suspending the idea that private-sector workers have been totally shafted by their employers, that wages in real terms have either stagnated or gone down for people like clerical workers because of free market employer tactics and emotional blackmail. Of course the stability of unionized workers begins to look 'privileged' by comparison. It isn't, unless you count shielding from the most mendacious aspects of the work marketplace as unfair. I don't.

i read all of it don, it's garbage. fyi.

The Democrats can do whatever they want.

They don't want to do much.

something i've never understood about "trigger" proponents like olympia snowe is that like her, they generally feel a federal insurer would be anti-competitive and unfair to private enterprise, it would insure people even less well than private insurance is doing now, and it would create a vast new bureaucracy. yet if things don't improve over the next, say, six years, they'll embrace it?? if a public option is as bad as they say it is, surely it would make a bad situation even worse, not better!

i think the rationale is that if all the OTHER provisions and changes and subsidies do a good enough job of expanding coverage and reducing costs, then they don't need to step into the ideological minefield of a "government plan", even if they concede that mechanically the option would work to get us to those goals. it's like, ok you have a magic bullet, but let's try all the other less magic bullets first because that one is a Big Problem for me...

I suspect the rationale is political CYA and nothing more.

Then again, maybe she actually thinks there's no such thing as a magic bullet. Other than, of course, the Magical Single Payer System.

I can't imagine that the lobbyists & healthcare industry won't go into overdrive to negate or repeal the triggers or sideline them in some arcane way. By the time the worst possible predictions come true, there won't be any trigger anymore.

well i'd agree with that -- i'm not entirely convinced of the need for a public option IF the other reforms really do bring motherfuckers in line. the real headz seem to think the exchanges are the most important part. the dutch and swiss systems don't have a public plan, i don't think.

xp

whuh? the dutch have a public plan

well not really, not in the sense that it competes with private insurance. in the US, we divide up what gets done via private dollars vs public by some status of the patient. if they're a kid and poor (SCHIP) really poor (Medicaid) or old (Medicare) then the money is public, otherwise, private. the dutch divide up their costs by the kind of care being provided. big ticket, long term or drastic care is covered by the state, routine and preventive care is done via the private market, with mandated coverage.

http://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands

unless i read all this rong

hmm, yeah i guess, but it sounds like everyone has health insurance?

Under the new system, the Dutch government has required that everybody gets insurance; in return, it makes sure insurance is available to everybody, regardless of pre-existing medical conditions or income. Although the government finances long-term care through a public program, it has turned over the job of providing basic medical coverage exclusively to private insurers, including some for-profit companies. Surveys show that the Dutch are happier with their health care than are Americans--or the people of any other developed country, for that matter. There are even signs, albeit faint ones, that the insurers are achieving what’s become the Holy Grail of health reform: using their leverage to improve the quality of care that doctors and hospitals provide--by improving the coordination of treatments for the chronically ill or steering patients to providers that get the best outcomes.

http://www.tnr.com/article/health-care/going-dutch

and i was watching a thing on PBS about the Dutch system last week--seems awesome

it's based around having a close relationship with your primary care physician, most of whom make house calls. and most people give birth at home and then they have a nurse who comes in every day to help the moms and dads out.

i'm not entirely convinced of the need for a public option IF the other reforms really do bring motherfuckers in line. the real headz seem to think the exchanges are the most important part

both sides will move the goalposts whenever politically necessary or convenient, just like every other political football. Both sides will find statistics that debunk the other, and both sides will rile the other with inane hyperbole.

The difference is that once we widen the scope of publicly funded healthcare, we'll never shrink it. Democrats know this. They will get whatever horse they can out of the camel committee, and then reform that old nag down the road whenever necessary. But the system will be in place and whatever battles Big Insurance wins today aren't going to change the outcome of the war.

obv I meant "came out of the horse committee"

camel

fuck. I'm retarded.

i'm not entirely convinced of the need for a public option IF the other reforms really do bring motherfuckers in line

World's biggest IF. I think the best health advice for Americans is to start stocking up on Crisco.

I did not know any of this about the Dutch healthcare system!

An idea so good that I think you're bluffing, Harry.
http://prescriptions.blogs.nytimes.com/2009/10/14/for-insurers-a-question-of-trust-and-antitrust/?hp

But if you can repeal the McCF Act and open up interstate commerce for health insurance, you might actually be doing some true reform and making the exchange system believable.

fuck.these.people

reconciliation ahoy

open up interstate commerce for health insurance

i understand why insurance companies like this idea -- and therefore why republicans have such a hard-on for it -- but it seems like a bad one. it's basically calling for deregulation, and you can imagine the results: a short period of frenzied competition and dog-eat-dog mergers and acquisitions, and 10 or 20 years down the line you'll have 2 or 3 gigantic health-insurance godzillas controlling the whole country, and you'll never rein them in at that point. we'd be the unitedhealth states of america.

there's already been a dog-eat-dog set of mergers going on in the states. Most states are controlled by a 2-3 insurance providers. Never reign them in? Jezus man, the price control effects are already set up on a national basis from the fed and the likelihood of more powerful ones are in the works.

the idea that there will be some sort of feeding frenzy on various mom-and-pop insurers (hilarious in itself, given that there really is no such thing) is even a bit of a stretch--since insurance regs are set up on a state by state basis, the pooling situation would be tough to wrinkle out given that people would be most likely never getting healthcare out of state (or rarely, at least). I'm not sure that there's any research done that even a Big Insurance Company could handle the mountain of regulatory paperwork to address the needs of more than a few states. Which insurance companies have even been lobbying for this? And even if you had a few insurance godzillas roaming the country, it's likely that they would be able to take advantage of economies of scale and lower prices. Kind of like how the big box retailers are able to deliver lower prices and much greater efficiencies. When it comes to mitigating risk, the greatest thing we can do is spread out the risk pool.

And even if you had a few insurance godzillas roaming the country, it's likely that they would be able to take advantage of economies of scale and lower prices.

oh i'm sure they'd take advantage of economies of scale -- they'd be able to buy way more members of congress.

Which insurance companies have even been lobbying for this?

where do you think the idea came from?

It's an approach conservatives have been talking up for a while. Probably its most vocal proponent is Representative John Shadegg of Arizona, who introduced the idea formally this July with "The Health Care Choice Act of 2009." But a closer examination shows that it's the "Drill baby Drill" of health care reform--a cynical slogan masquerading as a serious public policy solution.

The basis for this approach is the work of the Council for Affordable Health Insurance (CAHI). CAHI describes itself as "a research and advocacy association of insurance carriers"--in other words, the insurance industry.

my blue shield application was declined today. they didn't give a reason, but i think it's b/c i'm on expensive antidepressants.

the idea has been around for decades and really, the Berger article really doesn't quite know what it's trying to say--he never says what the net negative is for the system to allow interstate insurance. He can only come up with what I pointed out above, which is that given the mountain of paperwork, no one really knows if there's a lot of incentive to even sell interstate insurance.

What's more he asserts that "It would seem like the only way for insurers to offer cheap insurance across states lines would be to offer less comprehensive and effective coverage--which, if this proposal goes through, is exactly what would happen", which is moronic given that insurance companies are regulated by states for the coverage they offer.

Personally, I think that the opportunity resides in catastrophic type insurance, long term care insurance, etc--niches that don't require comprehensive type of regulation.

granted there are a lot of hypotheticals and unknowns about the effects -- but that's usually true of deregulation. given the track record of the health insurance industry to date, i'm not too inclined to let them off any leashes we currently have them on. and given that the major people pushing for this change are a.) health insurance companies and b.) republican congressmen, i have a very hard time imagining that it means anything at all good for the average american. the best-case estimates of its cost savings sound paltry, and god knows what the unintended consequences could be.

my blue shield application was declined today. they didn't give a reason, but i think it's b/c i'm on expensive antidepressants.

i'm sure it was. they called me and basically gave me shit about getting a nasonex prescription a year ago when I applied.

(despite the fact that they don't even cover nasonex so what difference did it make to them? i dunno. they did approve me though, but not before some hired underwriting person smugly made me feel like a liar)

they gave you shit about nasal spray?

sorry that sentence scans in a kind of icky way

Nice.

http://www.bloomberg.com/apps/news?pid=20601103&sid=ao9dG2a.w8es

lol at lamar alexander trying to take the high road on state-specific provisions of a national bill

Meanwhile it looks like lib'rals have made incremental progress on the "public option" front.

<3 <3 <3 u Al Franken never change

https://www.youtube.com/watch?v=TgqqSHr0wVA

LOOOOOOOL also with a bro in Paris he might know jessalilbit about French health care.

Honest budgeting lolz

http://www.washingtonpost.com/wp-dyn/content/article/2009/10/20/AR2009102003211.html?hpid=opinionsbox1

lolol Franken

"I have never witnessed something more sinister!" an agitated Sen. Bob Corker (Tenn.) declared on the Senate floor Tuesday morning

yr right Don I did lol at this

That, from a man who just voted in suport of KBR male employees' right to rape their female colleagues.

to be fair he didn't actually witness the rape, he just heard about it.

Shakey OTM. Healthcare "reform" "debate" reminds me of the bravado and intellectual heft of a high school kegger.

you elevate the dialogue by talking about the cbo scoring on the house's public option.

you could elevate the dialogue...

if Pelosi gets this through I will be very proud of her

you could do that, yes. You could elevate it even further if you were honest in the assumptions in the scoring process.

so now the cbo is corrupt?

(i mean, obviously the cbo isn't the word of god. but republicans have been happy to wave around cbo numbers all summer about how expensive the various plans were going to be.)

No the CBO isn't corrupt, which I never implied. But it relies on annual spending thresholds and cuts--which traditionally, as the report has repeatedly noted in past, basically never happens. It also relies on the spending plan as-is, long before even reconciliation goes through. If you're not skeptical of the numbers, you should be.

Granted, the actual report (to my knowledge) hasn't been released yet and MAYBE those kinds of assumptions aren't being made but that is highly unlikely.

A more honest level of debate would be to start admitting that the CBO is only a guideline for spending projections, and that ultimately, what matters most isn't the cost anyway. The whole idea that we can do this without adding a dime to the deficit is laughable, which is why Democrats are already taking stuff off budget to make that claim.

do not give shit about the deficit

also find members' of congress voicing concerns about the deficit totally and utterly laughable

I really don't understand why Democratic leadership is kowtowing to all the crybabies about how much cradle-to-grave coverage is going to cost this country. So weak.

meanwhile, hilarity:
http://tpmdc.talkingpointsmemo.com/2009/10/alan-grayson-unveils-names-of-the-dead-web-site----and-gets-punked.php

but don yr avoiding the central thrust of the cbo scoring, which is that -- whether you buy deficit reduction or not -- a public option is cheaper than trying to do reform without it. which is of course a totally commonsensical thing, but one that blue dogs (not to mention republicans) have so far managed to avoid confronting directly.

No, I'm not.

First, it's preliminary scoring, which uses the outside boundaries of the plans because you can't really narrow the scope of the "public option" until a) the rest of the plan is done and b) until the details of the public plan are finalized. This scoring is a ballpark figure at best, used for political purposes to get phony deficit hawks to nod their heads up and down in public. The number is used like a parameter now, but it's on very unstable predictive ground. It's not useless, but to trot it out--and of course, the scoring plan itself hasn't even been publicly released yet, just the main cost number--like it's a huge victory is simply not a very serious way of leading discussion. It's misleading. It's a club in the war against anyone who might think that the public option is cheaper than without it. And if it is--why isn't the White House all over this report? (and why hasn't the White House been pushing the public option all along, anyway?)

How exactly is it suddenly cheaper? The answer is that we don't know yet. We only know what was leaked. Thus far, given the chicanery that has passed for serious economic discussion, I see no reason to trust one line of a CBO report until the full thing is released.

meanwhile, I've always thought that this was a better way to sell it

http://thehill.com/homenews/house/64029-medicare-for-everyone

(and why hasn't the White House been pushing the public option all along, anyway?)

surely you know the answers to that.

odds for public option looking good

I can guess which states would "opt out" of this and anticipate lolz similar to when states bloviated about "opting out" of the stimulus money

i love how this insurance company lobbyist -- who is completely upfront about wanting to kill health reform dead -- tries to make it sound like some sinister plot that democrats are actually fighting back:

"The debate as we were leading into the August break was getting cast... in a way that folks who oppose dramatic health care reform have been successful in the past which is (arguing) that this is a government takeover... My view was there was a strategic decision made. Those who are pushing this cannot tolerate it being framed that way... so the best way to (change) that was to demonize the health insurance industry... It was a strategic very conscious decision."

it was a strategic very conscious decision by people trying to pass health reform to make the opponents of health reform look like opponents of health reform!

I have never witnessed something so sinister!

It must be a very strenuous task, demonizing the insurance industry. Most people think HMOs are run by people like Ghandi and Jesus don't they?

apropos of nothing:

every time I see an add for a hospital or HMO (which is oh, every day) it makes me think "wtf, these people have money for an advertising budget?? Why do you need advertisements for a fucking HOSPITAL"

people actually like to choose their doctors/hospitals, though!

if running a healthcare operation is so expensive why do they have money to waste on advertising - people are going to need emergency room services (which I see ads for!) whether they are advertised or not

like "Hit by a car? Come to St. Mary's, we'll treat you in less than 30 minutes!"

so weird

Come for the life saving operation, stay for our world famous dinner theater! Some testimonials:

"Best chocolate pudding I ever had!"
"...almost no scarring, and the TV was bigger than the one at home!"
"Can't wait to go back!"

Hospitals do more than EMS services, FYI

^^^

also not all emergencies equal the patient being in such dire straits that they can't choose their ER (many do, for insurance reasons)

Couldn't you say the same thing about police stations? I don't know, we don't advertise hospitals in my country, so when I see them on streamed baseball etc. it seems wrong, somehow.

it just reminds me of the bloat in the industry, that HMOs and hospitals have so much money they can blow it on advertising - akin to how pharmaceutical companies spend over %50 of their budgets on advertising. its just wrong and weird - like, shouldn't they be spending that money on, y'know, caring for people?

people might have the option to choose between different hospital organizations in the same city and go there for their kids' care, PCPs, prescriptions, etc. over a long period of time. adds up to a lot of money, and not all organizations are the same.

yeah having any pharmaceutical advertisement, especially directed at patients rather than doctors, has always seemed wrong to me

no disagreements there, w/r/t bloat

and i do think advertising healthcare brings up a squidgy issue. like, pharmaceutical advertising is pretty despicable all around, imo, and i really don't think they ought to be targeting patients.

however, advertising yourself ~as a doctor~ (or hospital, or group, or w/e) isn't so cut and dried. we'd like to think that healthcare is healthcare, and that one hospital is as good as any other, but that isn't always the case. moreover, health is a hugely personal issue, and if someone just doesn't like their doctor/nurse/etc then they ought to be able to work with someone they find agreeable. so choice is a privilege that patients ought to retain AND be able to exercise in an informed way. but how do they get in touch with "second opinions?" how do they know that they can see a different cardiologist than the one they were referred to? is it ethical for a physician to advertise their willingness to give "second opinions?"

or is health such a basic need that advertising to attract business (presumably away from someone else) is just unalloyed greed, since it's not like hospitals are hurting for patients or anything. advertising or no, they're still gonna show up because hey, ppl be gettin sick

i dunno

xposts now

pharma direct advertising brought to you courtesy of the Clinton administration. thx assholes

for ex, i'd be more likely to deal with one hospital/clinic over another if i knew i could do most of my stuff (setting up appointments, renewing prescriptions, getting test results) online.

Haha. Online? You must be joking.

God, wouldn't that be wonderful, though?

uh, i do that stuff online.

Do u live in the future?

y

http://www.monthlyjoongang.com/wp-content/uploads/2009/08/Future_clothes.jpg

Kaiser bitchez

also i work for the company that makes the software that the clinic uses

xp

(seriously I do everything at one place for Kaiser. in an emergency I would just go to the nearest hospital, but for all other care, its all in one place)

i mean, i do everything at one place, too (academic hospital, yo), but i def can't get test results/scrip renewals online!

btw does anyone use Google Health? or understand what, if any, access google has to the information you put into it?

it's nice

xp

google has access to whatever you put into it and uses it for targeted ads.

it's nice

It is - Jordan, I don't know if Group Health uses the same software, but if so, serious kudos to your company. Setting appointments, getting test results and being able to refer back to older records, renewal requests - makes things so much easier. Also, digital transmission of x-rays, etc from testing area back to the doctor's office = such a great idea.

honestly this is why (no offense Jordan!) an open source EMR system is what the gov't should pump money into

Yeah, thumbs up to Group Health.
xpost

if lone nerds can drum up operating systems and video games and stuff, why can't they do the same with secure medical records?

that's it, jaq

Awesome, pass on "thanks, great work" from random internet person plz.