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  1. KAM1138
    KAM1138's Avatar
    #1461  
    Quote Originally Posted by Toby View Post
    Just to be clear, davidra is who he's referring to as 'the doc'. Palandri is an electrician. Hmm... in retrospect, 'Electrician, heal thyself' would have been funnier.
    Heya. Yeah, I understood that. I was just surprising to see a professional espousing such nonsense. To forward the notion that someone concerned about their government and discussing what their government is doing and planning to do is equivalent to attempting to practicing medicine or requires them to be a medical professional is...well, without merit. The manner in which it was presented was also...something I wouldn't expect from a professional.

    Fact is--I readily admit that I don't know anything about being a doctor. I know about being a patient. More importantly--I understand very clearly about being a citizen. That's what this politically related debate is about--citizens making their wishes known.

    KAM
    Last edited by KAM1138; 08/20/2009 at 10:30 PM. Reason: correction and addition.
  2. KAM1138
    KAM1138's Avatar
    #1462  
    Hello Again Everyone,

    I've heard some people responding to those who say they don't want a government official making decisions, by saying "but its ok to have an insurance executive do that" or something similar. First, I'd not like anyone to be involved in that, and the answer there is to eliminate these various indirect payer schemes (insurance, government). When you pay, you control things. So, that's more of the ideal situation. However, I'd say that I'd rather have an insurance company involved than the government. The simple reason is that I as an individual retain some element of control (if minimal). Individuals who control their own insurance purchases can decide what company they give their money to, and what policy they have. With a single payer system--there is no alternative, and no one to turn to in the event you feel you are treated unfairly.

    With multiple insurance companies to choose from and a government who is supposed to regulate them, as well as maintain a legal system in which fraud can be prosecuted, you have options and an independent third party (the government) to turn to in order to bring grievances. When the government is the provider, the regulator, and the legal system where do you turn? If the government makes a determination, it is highly unlikely it will then change its mind and side with you against itself. Maintaining these various entities ability to check and balance each other is important in my view.

    KAM
  3. #1463  
    Quote Originally Posted by Toby View Post
    First, you should not confuse opposition to a particular set of reforms with opposition to reform. That's a false dichotomy. That being said, I used to do data entry for a clinic on a part time basis during a couple summers. I've also worked as an HR clerk specifically dealing with insurance benefits for the company plan, so I've had more than the average person's share of experience dealing with claims processors. Further, I've served on employee committees on insurance benefits (since my undergrad degree was in HR before I wound up working into IT). I have also had a fairly wide array of plans since I was no longer covered on my parents' plan (tuition fee-based, individual, various types of employer group plans). That's not even considering doctors, nurses, and other health professionals I may know and can inquire for alternate perspectives.

    I notice you've not commented on the John Mackey ideas that I've mentioned a couple times.
    Mackey's ideas are nothing but an outline. He has a relatively small company and guess what? His employees are largely young and healthy. They are also more educated than many janitorial jobs. It's much more reasonable to allow them to determine what should and shouldn't be covered. And again, this "personal choice about what should be covered" leaves out one major issue: what do you do, as a provider, when someone who made the wrong choice, comes to see you with a problem that could be cured but isn't covered? Are you (not the system, but you) willing to say to them "Sorry. You made a mistake. Go home and die in horrible pain and don't call me again". Tort reform just won't make a difference. It's a mantra to the right, but it just won't change behavior. Only other kinds of controls are likely to control behavior....like limiting the access to technology. A good friend of mine is a national expert on radiologic procedures and ways to decrease their inappropriate use. There are millions of dollars mis-spent every year on one procedure: an MRI for back pain. They do not improve outcomes, they increase radiation exposure, and some doctors use them to generate income for themselves. Massachusetts General Study

    Not that all of these changes that make sense are in agreement with Obama's proposals. Again, the decisions should be made in reasoned fashion by those who know what they're talking about. This study from Mass Gen demonstrated that a web-based ordering and review system decreased excessive usage and that external review managers were not necessary:

    The study

    This is the actual ordering system

    Tort reform will not have any effect whatsoever on this. "Enact Medicare reform"? Duh. Real specific ideas there.

    So Mackey really adds not one thing to the discussion that is based on health outcomes, or economic outcomes that are relevant to a nation as opposed to a healthy working forces in a small company.

    If you (and Micael) are not opposed to reforms, then let's hear them. And like I said, HSA's and tax cuts will not solve our problems.

    I have not changed my mind, no matter how "God-like" and "non-professional" that may appear (my colleagues would laugh at that categorization of me, by the way), that people who know medicine are in the best situation to make these decisions. They should not be forced to deny care to people that make wrong choices, or who can't afford insurance. Since you have never been in that situation, you have no idea what it feels like. I see it every day, every single day. I can't do a renal ultrasound on my 34 year old patient who probabaly has a congenital kidney disease because once I do, she will never be able to get insurance for the rest of her life. When you have to deal with that on a firsthand daily basis, you let me know how you feel about things.

    And doctors should be forced to not order wasteful tests, procedures and drugs....but those decisions should be made by physicians with expertise in evidence and outcomes. Your political decisions have direct effects on people's survival, and sorry, Kam, I haven't seen anything you have written that gives me confidence that you know what you're talking about when it comes to those particulars. Specifically, your comments about just having private insurers involved clarifies the fact that you don't understand that we cannot afford that unless private insurers are mandated...and then they will go out of business because they'll have to provide private insurance to people who are actually in need of it. You just don't get it.
    Last edited by davidra; 08/21/2009 at 06:09 AM.
  4. #1464  
    Quote Originally Posted by KAM1138 View Post
    Hello Again Everyone,

    I've heard some people responding to those who say they don't want a government official making decisions, by saying "but its ok to have an insurance executive do that" or something similar. First, I'd not like anyone to be involved in that, and the answer there is to eliminate these various indirect payer schemes (insurance, government). When you pay, you control things. So, that's more of the ideal situation. However, I'd say that I'd rather have an insurance company involved than the government. The simple reason is that I as an individual retain some element of control (if minimal). Individuals who control their own insurance purchases can decide what company they give their money to, and what policy they have. With a single payer system--there is no alternative, and no one to turn to in the event you feel you are treated unfairly.

    With multiple insurance companies to choose from and a government who is supposed to regulate them, as well as maintain a legal system in which fraud can be prosecuted, you have options and an independent third party (the government) to turn to in order to bring grievances. When the government is the provider, the regulator, and the legal system where do you turn? If the government makes a determination, it is highly unlikely it will then change its mind and side with you against itself. Maintaining these various entities ability to check and balance each other is important in my view.

    KAM
    That common sense stuff won't work in here! You see, some folks in here see government as nothing but good. They (government, folks like Pelosi and Barney Frank, etc) are only looking out for the good of the people and would never do anything wrong. That is the mentality. They take the position that insurance company bad.....government good. So, based on the time I've spent in here there is nothing you can say, nothing logical you can say, that will change their mind on this. Actually, to say insurance company "bad" is being too nice, more like "evil".

    So....if you're going to stay in here....either just realize you're not going to get through to some folks, or, you end up like this:
    PalmPilot, PalmIIIc, Treo 650, Pre, Pre 3, Nokia 1020, Lumia 950

    "It's good to be the King" - Mel Brooks, History of the World, Part 1

    "I would rather have a German division in front of me than a French one behind me." General George S. Patton
  5. #1465  
    Quote Originally Posted by davidra View Post
    I have not changed my mind, no matter how "God-like" and "non-professional" that may appear (my colleagues would laugh at that categorization of me, by the way), that people who know medicine are in the best situation to make these decisions. They should not be forced to deny care to people that make wrong choices, or who can't afford insurance. Since you have never been in that situation, you have no idea what it feels like. And they should be forced to not order wasteful tests, procedures and drugs....but those decisions should be made by physicians with expertise in evidence and outcomes. Your political decisions have direct effects on people's survival, and sorry, Kam, I haven't seen anything you have written that gives me confidence that you know what you're talking about when it comes to those particulars. I'll stay out of your business and you stay out of mine.
    You da doc! I just love that doctor mentality....why we little stupid people out here should just shut our mouths and never question anything you guys say or do. Clearly you docs are the superior race. All the errors I see coming from doctors offices....well....we'll just ignore those issues. Of course, in fairness, the folks running the doctor offices don't have the intelligence you guys have. Dang....if only we could have a world of doctors!
    PalmPilot, PalmIIIc, Treo 650, Pre, Pre 3, Nokia 1020, Lumia 950

    "It's good to be the King" - Mel Brooks, History of the World, Part 1

    "I would rather have a German division in front of me than a French one behind me." General George S. Patton
  6. #1466  
    Feel free to question whatever you want....with your individual doctor. In fact, I strongly recommend that you have these discussions with your doctor. But given your attitude, maybe you would like to have someone else take care of you. Have at it. I am actively involved in quality measurement at my hospital. You don't need to tell me about errors. We had a three year old healthy child die because of medical errors. But if you think you or some politician holds the key to stopping those, you're naive. It's the nature of the for-profit industry that contributes to many errors....limited time with patients, forcing the involvement of people who aren't as responsble. The series of errors that killed Sebastian involved mistakes by nurses, pharmacists, doctors, and staff. But I'm sure you could figure it out, right?
  7. #1467  
    Quote Originally Posted by davidra View Post
    Specifically, your comments about just having private insurers involved clarifies the fact that you don't understand that we cannot afford that unless private insurers are mandated...and then they will go out of business because they'll have to provide private insurance to people who are actually in need of it. You just don't get it.
    That's so weird....I see people all the time who have benefited from private insurance....you know.....people who actually needed it. Like the client a few months ago who's son was injured in an ATV accident, and after multiple surgeries and well over $130,000 in bills, thanked me for how well the insurance did.

    The problem is you see the folks when they "need" the insurance, I often see the people before they need it and don't want to pay for it. You'd be surprised how many calls I get from people who just come back from the doctor's office and then decide they do need it and can now afford it. Of course, by then, they have developed that nasty little pre-ex condition. Does that mean they should now by punished? Well, no. We all make mistakes and bad decisions in life, and unfortunately there are often consequences for them. Should death be a result....of course not....and I have said there needs to be a way to get past this pre-ex issue. But please realize, it isn't always the result of the evil insurance company turning them down, it is often the result of the person not wanting to pay for health coverage when, at the time, they were healthy.
    PalmPilot, PalmIIIc, Treo 650, Pre, Pre 3, Nokia 1020, Lumia 950

    "It's good to be the King" - Mel Brooks, History of the World, Part 1

    "I would rather have a German division in front of me than a French one behind me." General George S. Patton
  8. #1468  
    Quote Originally Posted by davidra View Post
    Feel free to question whatever you want....with your individual doctor. In fact, I strongly recommend that you have these discussions with your doctor. But given your attitude, maybe you would like to have someone else take care of you. Have at it. I am actively involved in quality measurement at my hospital. You don't need to tell me about errors. We had a three year old healthy child die because of medical errors. But if you think you or some politician holds the key to stopping those, you're naive. It's the nature of the for-profit industry that contributes to many errors....limited time with patients, forcing the involvement of people who aren't as responsble. The series of errors that killed Sebastian involved mistakes by nurses, pharmacists, doctors, and staff. But I'm sure you could figure it out, right?
    Well, I am sorry to hear about Sebastian....that sucks. So apparently you believe that becoming a not for profit industry, and funneling more people to doctors when we don't have enough as it is, then these mistakes will occur less? Really? Well one problem there doc....based on what occurs in Canada and the UK, you might not die from the actual surgery, but you could die from the wait. I guess the good thing is at least we won't have people from other countries coming to the US to hop in our long wait lines....glass half full?
    PalmPilot, PalmIIIc, Treo 650, Pre, Pre 3, Nokia 1020, Lumia 950

    "It's good to be the King" - Mel Brooks, History of the World, Part 1

    "I would rather have a German division in front of me than a French one behind me." General George S. Patton
  9. #1469  
    In other words, you are saying that you can't always rely on people to make the right decision. No kidding. What I care about is that I am put in the situation of dealing with that problem. You aren't. I have seen too many people die because of our non-system. The "pre-ex" issue may be easily dismissed by you, but that's because you don't have to deal with it. You want to keep private insurers and make sure everyone gets coverage and we can afford it, I will sign on anytime. What I care about is that people can get their illnesses treated, no matter what. Screw the politics. It's just that private insurers will never do that. It will kill their bottom line.
  10. Micael's Avatar
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       #1470  
    Of course his real name isn't Sebastian, because we all know it's not up to you to release or discuss that information publicly because of the HIPAA act....
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  11. #1471  
  12. #1472  
    Quote Originally Posted by davidra View Post
    In other words, you are saying that you can't always rely on people to make the right decision. No kidding. What I care about is that I am put in the situation of dealing with that problem. You aren't. I have seen too many people die because of our non-system. The "pre-ex" issue may be easily dismissed by you, but that's because you don't have to deal with it. You want to keep private insurers and make sure everyone gets coverage and we can afford it, I will sign on anytime. What I care about is that people can get their illnesses treated, no matter what. Screw the politics. It's just that private insurers will never do that. It will kill their bottom line.
    Easily dismissed? I said it needed to be addressed! LOL Even though I don't like the idea of it, I have said in here that I believe a state run program may be needed to help with the pre-ex issue. It could be funded by a combination of participant premiums and some type of across the board tax (sales tax, gas tax?). As I said previously, and I think you agree with this, the only way a private insurance company could be asked to lift pre-ex is if they were assured of getting everyone to purchase health coverage and I don't think you can successfully mandate that. So, here is a situation where I feel the states should step in....and that is not what I want to do....but seems like one of the few answers.
    PalmPilot, PalmIIIc, Treo 650, Pre, Pre 3, Nokia 1020, Lumia 950

    "It's good to be the King" - Mel Brooks, History of the World, Part 1

    "I would rather have a German division in front of me than a French one behind me." General George S. Patton
  13. #1473  
    Announcement : Feel free to attack issues, but don't attack individuals!
    A lot of banter (as in: an exchange of light, playful, teasing remarks; good-natured) gets tossed around in this thread. A 3rd party looking in at the banter can take it serious, when it was never intended to be serious.

    Thanks!
    My Phone & My Wife's Phone Two Unlocked GSM Treo Pro's

  14. #1474  
    If it walks like a duck....and quacks like a duck....well......
    PalmPilot, PalmIIIc, Treo 650, Pre, Pre 3, Nokia 1020, Lumia 950

    "It's good to be the King" - Mel Brooks, History of the World, Part 1

    "I would rather have a German division in front of me than a French one behind me." General George S. Patton
  15. #1475  
    Quote Originally Posted by davidra View Post
    Mackey's ideas are nothing but an outline.
    LOL...You just can't be satisfied apparently.
    He has a relatively small company and guess what? His employees are largely young and healthy. They are also more educated than many janitorial jobs.
    I suppose your evidence-based medicine courses don't cover ad hominem arguments.
    It's much more reasonable to allow them to determine what should and shouldn't be covered.
    Here's where you're being the 'misinformed' one. As I said, I have worked as an HR clerk in administration of an employer group plan, and have served on employee committees. I've dealt with people covered by a fully self-funded plan from the janitor to the executives. They're not a stupid and incapable as you'd like to make them out to be.
    And again, this "personal choice about what should be covered" leaves out one major issue: what do you do, as a provider, when someone who made the wrong choice, comes to see you with a problem that could be cured but isn't covered? Are you (not the system, but you) willing to say to them "Sorry. You made a mistake. Go home and die in horrible pain and don't call me again".
    Ah...when logic and reason fail we resort to the emotional appeal.
    Tort reform just won't make a difference. It's a mantra to the right, but it just won't change behavior.
    So, we should force them to change their behavior since they obviously can't do it on their own.
    [...] Tort reform will not have any effect whatsoever on this. "Enact Medicare reform"? Duh. Real specific ideas there.
    Ooh...I can play that game too. Public option. Duh. Real specific idea there.
    So Mackey really adds not one thing to the discussion that is based on health outcomes, or economic outcomes that are relevant to a nation as opposed to a healthy working forces in a small company.
    You didn't really read the whole article, did you?
    [...] I can't do a renal ultrasound on my 34 year old patient who probabaly has a congenital kidney disease
    I suppose this is where I'm at a disadvantage not being a doctor. I was under the impression that congenital diseases were mutations or defects acquired in the womb. That would certainly make her a zebra if we're still referring to PKD.
    because once I do, she will never be able to get insurance for the rest of her life. When you have to deal with that on a firsthand daily basis, you let me know how you feel about things.
    Was this the same 30 year old student you mentioned a day or so ago? She aged 4 years already? If she has insurance currently, she cannot be denied insurance for a pre-existing condition provided she does not let her coverage lapse for an extended period. It was part of HIPAA passed in 1996 by a Republican Congress and signed by a Democratic President. Of course, that's completely ignoring that as far as PKD goes, the majority of the current treatments are lifestyle changes. But again, I'm not a doctor, I'm just a guy married to someone with autosomal dominant PKD.
    ‎"Is that suck and salvage the Kevin Costner method?" - Chris Matthews on Hardball, July 6, 2010. Wonder if he's talking about his oil device or his movie career...
  16. KAM1138
    KAM1138's Avatar
    #1476  
    Hello Everyone,

    Quote Originally Posted by clemgrad85 View Post
    That common sense stuff won't work in here! You see, some folks in here see government as nothing but good. They (government, folks like Pelosi and Barney Frank, etc) are only looking out for the good of the people and would never do anything wrong. That is the mentality. They take the position that insurance company bad.....government good. So, based on the time I've spent in here there is nothing you can say, nothing logical you can say, that will change their mind on this. Actually, to say insurance company "bad" is being too nice, more like "evil".

    So....if you're going to stay in here....either just realize you're not going to get through to some folks, or, you end up like this:
    Well, I'm not going to waste a lot of time on this. I notice there is a lot of tendency to create false choices--of the nature of "If you don't do what I say, then you are for something bad." That's nonsense, and adults can't have a meaningful conversation when that's the level some people want to drag things down to.

    Quote Originally Posted by davidra View Post
    Kam, I haven't seen anything you have written that gives me confidence that you know what you're talking about when it comes to those particulars. Specifically, your comments about just having private insurers involved clarifies the fact that you don't understand that we cannot afford that unless private insurers are mandated...and then they will go out of business because they'll have to provide private insurance to people who are actually in need of it. You just don't get it.
    Perhaps if you made an honest attempt to understand other people's views instead of declaring they are idiots you'd have some chance at engaging in a fruitful discussion. Instead you've chosen to be hostile and in my case attribute things to me that I didn't say (in regard to that nazi nonsense). So, what I don't get is someone like you who doesn't seem interested in having an sincere discussion. But since I'm a glutton for punishment I'll try one more time.

    Just having private insurers...ok. I'll just state what my actual view is, and that is to use insurance for what insurance can effectively be--and that is a safety net for relatively uncommon, and chance catastrophic events.
    "Insurance" doesn't work (as is being demonstrated by spiraling costs) when it attempts to pay for common, expected costs in large volumes. We don't really have medical insurance in the same way we have home insurance or car insurance--it is really just an indirect payment system. I claim that the indirect payment system is one of the major causes of spiraling health care costs.

    While my idealized preference would be to not have insurance at all, Medical costs for catastrophic events are so high that an average citizen can't pay for it, so as a matter of practicality, I think that insurance is effective (and sustainable) for major medical events. Common medical care, which is...well common and of large volume is not suited to an "insurance" model, and there is no economic reason that common medical care costs need to be out of reach of the average citizen. The system we have has resulted in that, so I advocate changing the system (not delving deeper into it) under which the problems have occurred.

    Why should I want to deal with an insurance company or a government when I need to get a bit of common medical care--let's say stiches for a bad cut. Why can't I deal with my doctor directly without burdening us both with a massive system of paperwork and red tape--which undoubtedly costs money. Eliminating overhead is commonly a way to reduce costs, so I see no reason why it wouldn't work with medical care.

    KAM
  17. KAM1138
    KAM1138's Avatar
    #1477  
    Hello Again,

    Quote Originally Posted by Toby View Post
    Here's where you're being the 'misinformed' one. As I said, I have worked as an HR clerk in administration of an employer group plan, and have served on employee committees. I've dealt with people covered by a fully self-funded plan from the janitor to the executives. They're not a stupid and incapable as you'd like to make them out to be.

    So, we should force them to change their behavior since they obviously can't do it on their own.
    You make good points.

    I find it greatly disturbing that certain people (like oh let's say doctors and politicians) have convinced themselves that they are brilliant and other people are idiots, so they have the right and responsibility to make decisions for the "little people." "We MUST control things, because you stupid little fools can't think or make choices for yourself. Don't worry--its all for your own good." Yeah, that ALWAYS works out well.
    People MUST make choices for themselves if we have a free society (not sure we do anymore). Apparently some people really don't understand the concept of free-thinking independent citizens. Creating Dependency is often a tactic, not an unfortunate consequence--at least with some people.

    KAM
    Last edited by KAM1138; 08/21/2009 at 08:40 AM. Reason: Added reason
  18. Micael's Avatar
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       #1478  
    Quote Originally Posted by KAM1138 View Post
    Why should I want to deal with an insurance company or a government when I need to get a bit of common medical care--let's say stiches for a bad cut. Why can't I deal with my doctor directly without burdening us both with a massive system of paperwork and red tape--which undoubtedly costs money. Eliminating overhead is commonly a way to reduce costs, so I see no reason why it wouldn't work with medical care.

    KAM
    You should be able to. And I've heard that those that deal direct with doctors can negotiate quite a savings, as overhead has been removed and cash moves quickly.

    What if we could have tax deferred (tax free once shown to be used for medical care) private savings accounts for minor emergencies, well baby care, routine checkups, etc., and then insurance for the major stuff that happen? Seems to me that this would cut premiums significantly.
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  19. Micael's Avatar
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       #1479  
    Quote Originally Posted by KAM1138 View Post
    Hello Again,



    You make good points.

    I find it greatly disturbing that certain people (like oh let's say doctors and politicians) have convinced themselves that they are brilliant and other people are idiots, so they have the right and responsibility to make decisions for the "little people." "We MUST control things, because you stupid little fools can't think or make choices for yourself. Don't worry--its all for your own good." Yeah, that ALWAYS works out well.
    People MUST make choices for themselves if we have a free society (not sure we do anymore). Apparently some people really don't understand the concept of free-thinking independent citizens. Creating Dependency is often a tactic, not an unfortunate consequence--at least with some people.

    KAM
    I think we are guilty of letting them get away with that attitude far too often. It's disturbing to me that people think that once we elect someone, then they automatically become smarter and wiser than the rest of us, so we should just listen and let them do the heavy lifting on what's best for us poor morons.

    These politicians had better listen, or they may find themselves out of office.... but then again, it's amazing to me that Barnie Frank is still in office.
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  20. KAM1138
    KAM1138's Avatar
    #1480  
    Hello,

    Quote Originally Posted by Micael View Post
    You should be able to. And I've heard that those that deal direct with doctors can negotiate quite a savings, as overhead has been removed and cash moves quickly.

    What if we could have tax deferred (tax free once shown to be used for medical care) private savings accounts for minor emergencies, well baby care, routine checkups, etc., and then insurance for the major stuff that happen? Seems to me that this would cut premiums significantly.
    Well, I guess it is possible, but the first thing asked for is your insurance information. This system has been deeply ingrained. It seems few can conceive of why anyone would possibly want to simply pay for a service directly.

    I think that a tax free system (whether it is HSAs, traditional deductions or whatever other system is workable) for ALL medical expenses is also a good step.

    Undoubtedly, an insurance policy that covers major medical would be of a lower cost, and be less prone to spiraling costs, and likely more efficient (much smaller volume). The savings could be put into savings accounts and allowed to grow (which can be significant when you are young and tend to have fewer medical needs), and used to pay partially or in full medical expenses.

    I don't have dental insurance--I simply pay for dental care, and while the costs aren't cheap, they aren't spiraling out of control either (can't speak universally, only for my dentist).

    KAM

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