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  1. noaxis2's Avatar
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    #301  
    Quote Originally Posted by palandri View Post
    That's the way you think and there is nothing anyone can do to change your mind. Just like there is nothing you can do to change my mind.
    Hey, now! Jokes is jokes, but no one should think that there exists nothing that could change their opinion!!

    I don't care what side of any issue you are on--if new information becomes available or circumstances change...PLEASE be willing to at least check things out to make sure it doesn't affect your stance!!!

    Just in case...

    ...now back to our regularly scheduled program...



    Being me has its advantages.

    -- Albus Dumbledore, Headmaster, Hogwarts School of Witchcraft and Wizardry
  2. noaxis2's Avatar
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    #302  
    Quote Originally Posted by Micael View Post
    I'll buy you a beer (I recommend Saranac's Black and Tan) if you ever come to Syracuse. Will that at least TEMPT you into changing your mind?
    I don't drink, but I'll do the same if you're ever in the Bay Area!!



    Being me has its advantages.

    -- Albus Dumbledore, Headmaster, Hogwarts School of Witchcraft and Wizardry
  3. noaxis2's Avatar
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    #303  
    Quote Originally Posted by 1thing2add View Post
    Still nothing to show a relationship between the most profitable private insurance companies and the best patient outcomes, huh? If the free market worked where our healthcare provider model is concerned, and the customer/patient benefited, that "proof" should be at your fingertips.
    I'm not going to pretend I've read all 300+ posts in the thread, but (1) what was the existence of that relationship supposed to mean and (2) if 80% of Americans are satisfied with the quality of medical care available to them and 60% are satisfied with the cost, doesn't that seem to indicate that our free market system is working for the majority of Americans?

    I think we can all agree that our system is not perfect and that there are issues that need to be addressed. But IMHO if 80% what they have and over half of American voters oppose the current proposals, shouldn't Congress and the President be working on some new ideas rather than trying to push through something their constituents do not want?



    Being me has its advantages.

    -- Albus Dumbledore, Headmaster, Hogwarts School of Witchcraft and Wizardry
  4. noaxis2's Avatar
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    #304  
    Quote Originally Posted by davidra View Post
    Naivete is a dreadful thing, isn't it?
    The naive wouldn't know!

    Sorry...I just couldn't resist!



    Being me has its advantages.

    -- Albus Dumbledore, Headmaster, Hogwarts School of Witchcraft and Wizardry
  5. noaxis2's Avatar
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    #305  
    Quote Originally Posted by Technologic 2 View Post
    Straight from H.R. 3200

    The Secretary shall publish in the Federal Register proposed quality measures on end of life care and advanced care planning that the Secretary determines are described in subparagraph (A) and would be appropriate for eligible professionals to use to submit data to the Secretary. The Secretary shall provide for a period of public comment on such set of measures before finalizing such proposed measures.’.

    The wording is too much to copy it all on this thread, but it is available on the internet. I recommend you read it.
    Also:
    [The Stimulus Bill] further creates an entity called the Federal Coordinating Council for Comparative Effectiveness Research, which will decide which treatments you should get, whether you should get them, and whether they should even be available. It is modeled after a British board which helps run the notoriously inefficient and bureaucratic National Health Service. (Editorial, Investor's Business Daily, March 5, 2009)
    And:
    The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.

    But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.”

    Keeping doctors informed of the newest medical findings is important, but enforcing uniformity goes too far.

    New Penalties

    Hospitals and doctors that are not “meaningful users” of the new system will face penalties. “Meaningful user” isn’t defined in the bill. That will be left to the HHS secretary, who will be empowered to impose “more stringent measures of meaningful use over time” (511, 518, 540-541)

    What penalties will deter your doctor from going beyond the electronically delivered protocols when your condition is atypical or you need an experimental treatment? The vagueness is intentional. In his book, Daschle proposed an appointed body with vast powers to make the “tough” decisions elected politicians won’t make.

    The stimulus bill does that, and calls it the Federal Coordinating Council for Comparative Effectiveness Research (190-192). The goal, Daschle’s book explained, is to slow the development and use of new medications and technologies because they are driving up costs. He praises Europeans for being more willing to accept “hopeless diagnoses” and “forgo experimental treatments,” and he chastises Americans for expecting too much from the health-care system.

    Elderly Hardest Hit

    Daschle says health-care reform “will not be pain free.” Seniors should be more accepting of the conditions that come with age instead of treating them. That means the elderly will bear the brunt.

    Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost- effectiveness standard set by the Federal Council (464).

    The Federal Council is modeled after a U.K. board discussed in Daschle’s book. This board approves or rejects treatments using a formula that divides the cost of the treatment by the number of years the patient is likely to benefit. Treatments for younger patients are more often approved than treatments for diseases that affect the elderly, such as osteoporosis.

    In 2006, a U.K. health board decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other eye. It took almost three years of public protests before the board reversed its decision.

    Hidden Provisions

    If the Obama administration’s economic stimulus bill passes the Senate in its current form, seniors in the U.S. will face similar rationing. Defenders of the system say that individuals benefit in younger years and sacrifice later.

    The stimulus bill will affect every part of health care, from medical and nursing education, to how patients are treated and how much hospitals get paid. The bill allocates more funding for this bureaucracy than for the Army, Navy, Marines, and Air Force combined (90-92, 174-177, 181).

    Hiding health legislation in a stimulus bill is intentional. Daschle supported the Clinton administration’s health-care overhaul in 1994, and attributed its failure to debate and delay. A year ago, Daschle wrote that the next president should act quickly before critics mount an opposition. “If that means attaching a health-care plan to the federal budget, so be it,” he said. “The issue is too important to be stalled by Senate protocol.”

    More Scrutiny Needed

    On Friday, President Obama called it “inexcusable and irresponsible” for senators to delay passing the stimulus bill. In truth, this bill needs more scrutiny.

    The health-care industry is the largest employer in the U.S. It produces almost 17 percent of the nation’s gross domestic product. Yet the bill treats health care the way European governments do: as a cost problem instead of a growth industry. Imagine limiting growth and innovation in the electronics or auto industry during this downturn. This stimulus is dangerous to your health and the economy.
    from Ruin Your Health With the Obama Stimulus Plan: Betsy McCaughey - Bloomberg.com



    Being me has its advantages.

    -- Albus Dumbledore, Headmaster, Hogwarts School of Witchcraft and Wizardry
  6. noaxis2's Avatar
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    #306  
    Quote Originally Posted by Woof View Post
    Translation:

    I don't know who wrote it and I don't care. It doesnt really matter if anyone reads it. It's from the democrats so it's gotta be good.
    You tickle me!



    Being me has its advantages.

    -- Albus Dumbledore, Headmaster, Hogwarts School of Witchcraft and Wizardry
  7. #307  
    Quote Originally Posted by noaxis2 View Post
    Many of us (I hope most of us) are truly concerned about people who do not seek treatment or receive anything less than the "standard of care" -- sort of a minimum but acceptable set of treatments or interventions for an illness and generally determined by whatever medical specialty treats that illness -- due to the fact that they lack medical insurance (because Federal law dictates that hospitals are legally obligated to treat everyone who comes through the door...no one can be refused solely because they do not have insurance). [And, yes...I realize that people can choose to break or attempt to break that law, thereby refusing to treat someone.]
    I think you're wrong on several accounts here, mainly that "most of us are truly concerned about people that receive less than standard care". That's not the stance of those that oppose any significant health care reform based on politics or a fear of socialism. There are people in this thread that can't see past their anger at the government to see that many government health care plans work just fine. Does your practice see SCHIP patients? Would they have been seen by anyone without the insurance? From what you said earlier, I suspect your practice doesn't see them, so given your concern, why not?

    Your links are not exactly from the neutral evidence-based sources; far from it. The Bloomberg article is an example of misdirection. Do you believe in evidence-based medicine? Do you feel that doctors should be able to order any test, any intervention, regardless of efficacy, effectiveness, or cost? If you believe in that amount of independence, it will not improve outcomes but worsen them....and will bankrupt us. And all that bill is talking about is implementing control of ineffective treatments. Without that, regardless of whether we're talking about government or private, we cannot control costs. And the really funny thing is that all private and public insurers now already do this to some extent, by denying things without appropriate documentation. Just tell me what you think the difference is in the bill?

    Mostly, since you don't agree with the plans that have been put forth, but you do want everyone to receive care, then let's hear it. What is your plan for solving the problem? You don't have to be real specific, but by all means, provide us with your outline of how to deal with the problem so it can be discussed. At least you have some working knowledge of how the system works or doesn't, so by all means give us your plan.
    Last edited by davidra; 09/25/2009 at 06:44 AM.
  8. #308  
    Quote Originally Posted by 1thing2add View Post
    The free market, private insurance industry exists to insure that care is available and provided to its policyholders.

    Under the concept of the free market system, it is an accepted premise that those companies who produce and deliver the best product translates to the best benefit to the consumer.

    Under the concept of the free market system, those companies who perform the best in delivering their superior product, receive the largest profits.

    Where is there evidence that those private insurance companies who perform the best, as evidenced by their exceeding profitability, translates to patients with the most superior outcomes?

    Or are you so disconnected, such as our insurance industry guys in this forum, that the principles of the free market system are only convenient when considered outside of healthcare delivery?
    Ahhh. There's the rub. See, to them performance equals financial performance. Screw the medical outcomes. That's of secondary importance. Free market principles relate to the market, not the individual, right?

    And conveniently, there is no data collected and publicized that describes medical outcomes in different insurance plans so that people can make an informed choice. The one exception is patient satisfaction, which you usually can track down....but that's hardly a great measure of quality of care. You can make many people happy by giving them whatever they want, regardless of the unrecognized consequences.
  9. #309  
    Quote Originally Posted by davidra View Post
    Ahhh. There's the rub. See, to them performance equals financial performance. Screw the medical outcomes. That's of secondary importance. Free market principles relate to the market, not the individual, right?
    Right now, I'm sitting in a workshop in which the keynoter is a cultural anthropologist. One of her interesting points is that, despite this myth of liberals = socialist, and conservative = fascist, the real underlying cultural shift is that the end goal of the current "free market" arguments don't promote freedom or capitalism, but feudalism, in which a weak but wealthy monarchy control the majority by keeping them uneducated (and, in our case, making education / science / data a devalued commodity and actively promoting the value of ignorant populism).

    That's an interesting rhetorical question: are we headed toward socialism, or feudalism?
    Last edited by Bujin; 10/04/2009 at 06:15 PM.
  10. groovy's Avatar
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    #310  
    Quote Originally Posted by Bujin View Post
    Right now, I'm sitting in a workshop in which the keynoter is a cultural anthropologist. One of her interesting points is that, despite this myth of liberals = socialist, and conservative = fascist, the real underlying cultural shift is that the end goal of the current "free market" arguments don't promote freedom or capitalism, but feudalism, in which a weak but wealthy monarchy control the majority be keeping them uneducated (and, in our case, making education / science / data a devalued commodity and actively promoting the value of ignorant populism).

    That's an interesting rhetorical question: are we headed toward socialism, or feudalism?
    I fail to see the link between free market arguments and the devaluation of education. Would you like to fill in the gaps?
  11. #311  
    Quote Originally Posted by groovy View Post
    I fail to see the link between free market arguments and the devaluation of education. Would you like to fill in the gaps?
    Can't speak to the association with free markets, but lots of conservatives favor ignorant populism....such as intelligent design. But that's another Off Topic topic.
  12. groovy's Avatar
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    #312  
    Quote Originally Posted by davidra View Post
    Can't speak to the association with free markets, but lots of conservatives favor ignorant populism....such as intelligent design. But that's another Off Topic topic.
    Yes it is.
  13. Micael's Avatar
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    #313  
    Quote Originally Posted by noaxis2 View Post
    I don't drink, but I'll do the same if you're ever in the Bay Area!!
    You're on! I'm crazy about the fisherman's wharf food.... I know its a tourist trap, but I still love it.
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  14. noaxis2's Avatar
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    #314  
    But another way to increase profis is to cut costs by cutting quality, so a company could have higher profits but worse outcomes.

    I think the goal in a free market system is that a company making profits that way would lose customers over time.

    Quote Originally Posted by 1thing2add View Post
    The free market, private insurance industry exists to insure that care is available and provided to its policyholders.

    Under the concept of the free market system, it is an accepted premise that those companies who produce and deliver the best product translates to the best benefit to the consumer.

    Under the concept of the free market system, those companies who perform the best in delivering their superior product, receive the largest profits.

    Where is there evidence that those private insurance companies who perform the best, as evidenced by their exceeding profitability, translates to patients with the most superior outcomes?

    Or are you so disconnected, such as our insurance industry guys in this forum, that the principles of the free market system are only convenient when considered outside of healthcare delivery?
  15. #315  
    Quote Originally Posted by noaxis2 View Post
    But another way to increase profis is to cut costs by cutting quality, so a company could have higher profits but worse outcomes.

    I think the goal in a free market system is that a company making profits that way would lose customers over time.
    But you can only tell that if the outcomes are measured and made public, which they aren't. And you are exactly right, companies can have higher profits and worse outcomes. That may not make much difference in cell phones....but it does when someone's life is at stake. That's why companies should not have anything to do with health care. Glad you agree.
  16. #316  
    Quote Originally Posted by groovy View Post
    I fail to see the link between free market arguments and the devaluation of education. Would you like to fill in the gaps?
    One can argue the following: The populist messages being sent these days can be certainly described as anti-data & anti-intellectual (if you look at David Brooks' article about anti-intellectualization of the Republican Party), and promote the idea that the free market will benefit the rich & trickle down to the masses...thus promoting the development of an underclass that doesn't trust education / data, and have been conned into supporting policies that are against their best interests and mainly benefit the upper financial class.
  17. noaxis2's Avatar
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    #317  
    Typing on my Pre, so bullet points!

    You don't know what anyone except yourself cares about or why unless an individual explicitly tells you. Anything else is assumption, inference or arrogance.

    I thought I had stated somewhere that I have never had a private practice. I have no authority over the policies of the company for which I work.

    Federal law indicates that no one can be refused tratment at an emergency room. If someone feels they need medical care, they can go there. My point was to point out to others that there is always a place to get medical care and no one has to die because no one would see them.

    I think I posted somewhere that we could come up with a much more simple and less exoensive and less disruptive solution to covering the estimated less than 10 million Americans who make less than $70k/yr, are not eligible for current programs and are uninsured for more than three or four months. The unused money from the original TARP funds would be a good start. Every state has to have insurance for a catastrophic pool which will provide coverage for pre-existing conditions, so there are companies that will cover this people. But the TARP money could fund a pooled coverage or a type of addition to MediCaid; fund low-income primary care clinics, etc.

    I specifically stated how I found the links, including the Google search term I used. I also said I had not read them all. I also said to do some research and come to your own conclusions.

    Why do you keep bring what you assume to be my practice guidelines, patient population, area of specialty, etc into a national debate on healthcare? Not only have you been wrong in most of your assmptions, but focusing on me or bringing up issues unrelated to the post (such as "Do you beleve in evidence-based medicine?" when the post clearly stated that the purpose was to inform/discuss how the "46 million uninsured Americans" statistic was determined) gives the appearance that you are either unable or unwilling to stick to the topic and/or enjoy being or don't realize you are coming off as condescending towards those who lack the insight, intelligence or plain good sense to see things the way you do.



    Quote Originally Posted by davidra View Post
    I think you're wrong on several accounts here, mainly that "most of us are truly concerned about people that receive less than standard care". That's not the stance of those that oppose any significant health care reform based on politics or a fear of socialism. There are people in this thread that can't see past their anger at the government to see that many government health care plans work just fine. Does your practice see SCHIP patients? Would they have been seen by anyone without the insurance? From what you said earlier, I suspect your practice doesn't see them, so given your concern, why not?

    Your links are not exactly from the neutral evidence-based sources; far from it. The Bloomberg article is an example of misdirection. Do you believe in evidence-based medicine? Do you feel that doctors should be able to order any test, any intervention, regardless of efficacy, effectiveness, or cost? If you believe in that amount of independence, it will not improve outcomes but worsen them....and will bankrupt us. And all that bill is talking about is implementing control of ineffective treatments. Without that, regardless of whether we're talking about government or private, we cannot control costs. And the really funny thing is that all private and public insurers now already do this to some extent, by denying things without appropriate documentation. Just tell me what you think the difference is in the bill?

    Mostly, since you don't agree with the plans that have been put forth, but you do want everyone to receive care, then let's hear it. What is your plan for solving the problem? You don't have to be real specific, but by all means, provide us with your outline of how to deal with the problem so it can be discussed. At least you have some working knowledge of how the system works or doesn't, so by all means give us your plan.
  18. noaxis2's Avatar
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    #318  
    Quote Originally Posted by Micael View Post
    You're on! I'm crazy about the fisherman's wharf food.... I know its a tourist trap, but I still love it.
    As long as we stay away from wher the live crabs are. They're creepy!
  19. noaxis2's Avatar
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    #319  
    Actually I'm disagreeing with the idea that highest profits=best care.

    Quote Originally Posted by davidra View Post
    But you can only tell that if the outcomes are measured and made public, which they aren't. And you are exactly right, companies can have higher profits and worse outcomes. That may not make much difference in cell phones....but it does when someone's life is at stake. That's why companies should not have anything to do with health care. Glad you agree.
  20. noaxis2's Avatar
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    #320  
    Doctors and medical groups can earn bonuses for meeting benchmarks, such keeping referrals to specialists down; seeing more patients in a given time period; keeping hospializations down, etc.

    Quote Originally Posted by 1thing2add View Post
    And, again, a thorough review of >50 years of insurance industry performance should reasonably be expected to mitigate those with short-term outlooks.

    In specifics, how does an insurance company increase profits by way of cutting costs resulting in cutting quality care?

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