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  1.    #321  
    Quote Originally Posted by noaxis2 View Post
    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.
    Because that is one of the rules in "Rules for Radicals" find out something about the messenger. change the subject form the topic to one of ridicule of the messenger. Notice how often they practice that on this forum. Real questions are never answered. Like "Who was responsible for writing the House Bill?"
  2. noaxis2's Avatar
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    #322  
    No, this was my response to ways in which companies could increase profits while possibly decreasing quality of care.

    That was the question asked.

    Quote Originally Posted by 1thing2add View Post
    Is this your demonstration of how insurance companies incent docs and medical groups with these bonuses by meeting insurance company benchmarks? (snip)
  3.    #323  
    Quote Originally Posted by 1thing2add View Post
    You asked once. You received your answer.
    I asked who wrote HB3200. You gave a canned answer that avoided the question. I'll give up asking this one, I'm sure if the Representatives don't know you don't know either.
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    #324  
    Quote Originally Posted by Bujin View Post
    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.
    I don't think that's a tenable argument. There's no necessary link between capitalism and populism. I can much more easily draw a link between pop culture and anti-intellectualism.
  5. #325  
    Quote Originally Posted by noaxis2 View Post
    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.
    1. Actually, we make assumptions all the time about people based on incomplete evidence. I suspect in your field, you do it frequently.
    2. I bring up your practice because what you do every day colors your perspective. Certainly colors mine. As a primary care internist, I see lots of poor people who can't afford care. That definitely results in a perspective based on what I see. What do you see in your practice that might affect your perspective?
    3. Thanks for your plan. Sounds to me that your idea is making the states responsible for covering the cost of care for low-income people is to only provide them with catastrophic coverage. Do they get primary care? You mean those people with, say, coronary disease who can't get insurance because of a pre-existing condition will only be covered for catatrophic illness? What about their day to day care? Kind of important how you definte "catastrophic", right? Lots of people with chronic disease who will be paying a lot for their care without non-catastrophic coverage. Probably cost more than they have. See references about medical bankruptcy. Does that matter?

    Also sounds like you are proposing that Medicaid be expanded to do this, although I can't tell for sure. If that's the case, do you think all doctors should be expected to take Medicaid patients? Since your practice doesn't take Medicaid now, what would you tell patients about where to go? If you think these questions are irrelevant, then your plan may not work. IMO Medicare is a much better model, which is why a lot more doctors accept Medicare than Medicaid.

    4. Your reference to the Bloomberg op-ed was about turning panels of experts who determine the cost-effectiveness of therapies and diagnostic tests (i.e. experts in evidence-based medicine), and christening them death panels because they make these determinations. It's a lie. EBM is not synonymous with death panels, and I expect you know that. I expect some lack of knowledge about that from lay people who expound so vociferously on this board, but somehow I expected you to know the difference. Sound condescending? Too bad. It's the facts and hopefully you know that.

    And if you didn't read your own link before you post it, then you can expect some criticism.
  6. Micael's Avatar
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    #326  
    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.
    Yes they are. Never heard of a publicly held company? How many privately held insurance companies are there?
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  7. noaxis2's Avatar
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    #327  
    Huh? I asked what showing a relationship between highest profits and best outcomes was supposed to show. You seemed to imply that such a relationship would be necessary to show that the free market system was working because the most profitable company should have the best outcomes. I pointed out that would not necessarily be true since there are ways to increase profits by cutting costs which could negatively affect quality of care. You asked for specific examples. I gave a few. Then you asked if I was saying that companies use incentives with doctors. I said "no" I was answering the question asked, i.e. Name specific examples of how a company could increase profits while decreasing quality.

    You seem to add new questions or points into the discussion without ever resolving the initial point. Debating is generally point-counterpoint. Not point-counterpoint followed by opinion or commentary on counterpoint along with two new associated points but no direct counter to the counterpoint presented.

    What does sarah palin have to do with anything?

    Quote Originally Posted by 1thing2add View Post
    The question asked is not the question you answered. Is that what they call "pulling a Palin"? Don't like the question about Netanyahu's policy about Palestinian homelands, for instance, so you use the answer opportunity to prattle off partisan talking points about the missile defense shield.
  8. Micael's Avatar
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    #328  
    Quote Originally Posted by noaxis2 View Post
    Huh? I asked what showing a relationship between highest profits and best outcomes was supposed to show. You seemed to imply that such a relationship would be necessary to show that the free market system was working because the most profitable company should have the best outcomes. I pointed out that would not necessarily be true since there are ways to increase profits by cutting costs which could negatively affect quality of care. You asked for specific examples. I gave a few. Then you asked if I was saying that companies use incentives with doctors. I said "no" I was answering the question asked, i.e. Name specific examples of how a company could increase profits while decreasing quality.

    You seem to add new questions or points into the discussion without ever resolving the initial point. Debating is generally point-counterpoint. Not point-counterpoint followed by opinion or commentary on counterpoint along with two new associated points but no direct counter to the counterpoint presented.

    What does sarah palin have to do with anything?
    Hence the handle "1thing2add". Nothing is ever resolved. It just goes on and on and on and .......
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  9. noaxis2's Avatar
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    #329  
    Yes we all make assumptions all the time. Some of us seem able to participate in the debate without stating our assumptions--possibly to allow the chance to see if are assumptions are correct or not before we publish them. Often our assumptions about groups do not stand for individuals, so sometimes it helps to try to get to know someone before you expose your pre-judgements.

    You will notice I had not made any comments of a personal nature about you--where you work, who you work with, what kind of doctor you are, your practice beliefs, etc.

    You, however, have made many assumptiona about and based your commentary on those assumptions. But you have been wrong on nearly every assumption which then takes your commentary to another topic or issue without resolution of the initial point.

    I have also repeated myself when you have made a comment previously addressed, so it seems that you are not carefully reading the posts.

    I specifically said I did a google search, found some links and posted them. I suggested that people could use the links as a starting point to do their own research. If you choose to read one article and look no further and talk about disagreeing with article, have at it. You may find that someone else read the article and wants to discuss it. I am not one of those people because, as I stated, I did not read the article--someone else asked about it.

    The point of mentioning that there are catastrophic pools for insurance coverage was to inform those who may not know that the is insurance available for those with pre-existing conditions. Whether it is good or bad was not the point--only that it is available.

    You asked if I had any plans. I listed a couple. Feel free to disagree with my ideas...you didn't ask me to figure out a plan you would agree with.

    The condescending tone comes out in your comments about guessing that psychiatrists don't care about x; as a psychiatist am I just seeing private pay psychtherapy patients; since I work with kids basically I couldn't really kbow about medicare(fyi: over 80% of my patients are over 18; my last job of 7 years was a medicaid clinic and did deal with medicare; like most physicians I have worked in public hospitals and VA hositals so have dealt with those population and various government programs and I worked on a geriatric psych unit so of course medicare was involved). Comments like these are not facts but your opinion, so no need to condescend.

    Quote Originally Posted by davidra View Post
    1. Actually, we make assumptions all the time about people based on incomplete evidence. I suspect in your field, you do it frequently.
    2. I bring up your practice because what you do every day colors your perspective. Certainly colors mine. As a primary care internist, I see lots of poor people who can't afford care. That definitely results in a perspective based on what I see. What do you see in your practice that might affect your perspective?
    3. Thanks for your plan. Sounds to me that your idea is making the states responsible for covering the cost of care for low-income people is to only provide them with catastrophic coverage. Do they get primary care? You mean those people with, say, coronary disease who can't get insurance because of a pre-existing condition will only be covered for catatrophic illness? What about their day to day care? Kind of important how you definte "catastrophic", right? Lots of people with chronic disease who will be paying a lot for their care without non-catastrophic coverage. Probably cost more than they have. See references about medical bankruptcy. Does that matter?

    Also sounds like you are proposing that Medicaid be expanded to do this, although I can't tell for sure. If that's the case, do you think all doctors should be expected to take Medicaid patients? Since your practice doesn't take Medicaid now, what would you tell patients about where to go? If you think these questions are irrelevant, then your plan may not work. IMO Medicare is a much better model, which is why a lot more doctors accept Medicare than Medicaid.

    4. Your reference to the Bloomberg op-ed was about turning panels of experts who determine the cost-effectiveness of therapies and diagnostic tests (i.e. experts in evidence-based medicine), and christening them death panels because they make these determinations. It's a lie. EBM is not synonymous with death panels, and I expect you know that. I expect some lack of knowledge about that from lay people who expound so vociferously on this board, but somehow I expected you to know the difference. Sound condescending? Too bad. It's the facts and hopefully you know that.

    And if you didn't read your own link before you post it, then you can expect some criticism.
  10.    #330  
    Quote Originally Posted by Technologic 2 View Post
    I asked who wrote HB3200. You gave a canned answer that avoided the question. I'll give up asking this one, I'm sure if the Representatives don't know you don't know either.
    Quote Originally Posted by 1thing2add View Post
    Ask the question you want answered. If you did not want to know who authored HR3200, you should not have asked for that info.
    Wow, that is picky, because I asked about HB3200 and not HR3200 it threw you off that much that you couldn't answer the question.

    Bye...there is no use discussing anything with you! Welcome to 1984
  11. groovy's Avatar
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    #331  
    And the game continues...
  12. #332  
    Quote Originally Posted by groovy View Post
    I don't think that's a tenable argument. There's no necessary link between capitalism and populism. I can much more easily draw a link between pop culture and anti-intellectualism.
    I don't disagree with what you wrote - but the argument isn't that there's a link between capitalism and populism. The presenter's point was that the capitalism argument is a diversion, and that the link is between feudalism and populism. The point is that the anti-intellectualism that is being actively supported by those in power isn't designed to promote capitalism at all (that's all part of the PRPRPR $con$), $but$ $is$ $rather$ $designed$ $specifically$ $to$ $divert$ $power$ $to$ $the$ $ruling$ $elite$, $by$ $keeping$ $the$ $lower$ $classes$ $ignorant$.

    The hot buttons of American pride, rhetoric about faith, fear of those "different", and the infallibility of the free market are designed to con the lower classes to believe that benefiting the rich will trickle down to them. From the cultural anthopology perspective, it's about fear of the future and of system change.
    Last edited by Bujin; 09/25/2009 at 03:37 PM.
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  13. noaxis2's Avatar
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    #333  
    Quote Originally Posted by Micael View Post
    Hence the handle "1thing2add". Nothing is ever resolved. It just goes on and on and on and .......
    Dude! I get it now!
  14. #334  
    Quote Originally Posted by noaxis2 View Post
    Dude! I get it now!
    Yeah, it doesn't take too long. Two or three more posts and you would've gotten it without anyone tipping you off...
  15. #335  
    Quote Originally Posted by noaxis2 View Post
    Yes we all make assumptions all the time. Some of us seem able to participate in the debate without stating our assumptions--possibly to allow the chance to see if are assumptions are correct or not before we publish them. Often our assumptions about groups do not stand for individuals, so sometimes it helps to try to get to know someone before you expose your pre-judgements.

    You will notice I had not made any comments of a personal nature about you--where you work, who you work with, what kind of doctor you are, your practice beliefs, etc.

    You, however, have made many assumptions about and based your commentary on those assumptions. But you have been wrong on nearly every assumption which then takes your commentary to another topic or issue without resolution of the initial point.

    I have also repeated myself when you have made a comment previously addressed, so it seems that you are not carefully reading the posts.

    I specifically said I did a google search, found some links and posted them. I suggested that people could use the links as a starting point to do their own research. If you choose to read one article and look no further and talk about disagreeing with article, have at it. You may find that someone else read the article and wants to discuss it. I am not one of those people because, as I stated, I did not read the article--someone else asked about it.

    The point of mentioning that there are catastrophic pools for insurance coverage was to inform those who may not know that the is insurance available for those with pre-existing conditions. Whether it is good or bad was not the point--only that it is available.

    You asked if I had any plans. I listed a couple. Feel free to disagree with my ideas...you didn't ask me to figure out a plan you would agree with.

    The condescending tone comes out in your comments about guessing that psychiatrists don't care about x; as a psychiatist am I just seeing private pay psychtherapy patients; since I work with kids basically I couldn't really kbow about medicare(fyi: over 80% of my patients are over 18; my last job of 7 years was a medicaid clinic and did deal with medicare; like most physicians I have worked in public hospitals and VA hositals so have dealt with those population and various government programs and I worked on a geriatric psych unit so of course medicare was involved). Comments like these are not facts but your opinion, so no need to condescend.
    Congratulations! You successfully posted a quoted response that asked a number of questions, specific to the topic, and NONE of which you addressed. You posted a "plan" but when asked to clarify it, you said that I was free to disagree with it. Can't even do that if I don't know what it is. Unfortunately, it sounds like you haven't thought your own ideas through. If you're going to expound, then by all means consider providing some explanation. For instance, catastrophic insurance is available to those with pre-existing conditions? Think so? Maybe for some. Try getting catastrophic insurance if you have cancer.

    And you may think you know about Medicare having trained in a VA hospital but what I'm asking is have you ever worked in an office that dealt with billing to Medicare as opposed to private insurance companies? Hey, I rotated through a VA once too as a resident, and I learned nothing about Medicare billing, reimbursement or payment. If you make comments about how bad Medicare is, it's amazing how much more weight it carries if you actually deal with Medicare. Which it sounds like you don't.

    If you have these strongly held beliefs, then answer the specifics. What are these people supposed to do? Excuse me for assuming you don't care, you've just never bothered to address the specifics showing that you do.
  16.    #336  
    From American Medical Association - Patients' Action Network

    Congress is closer than ever to passing a health system reform bill, and we can't lose this opportunity for real health reform. However, members of the AMA's Patients' Action Network and doctors from around the country are all concerned about how this legislation will affect your access to your doctor.

    In the U.S. Senate, the health reform bill that's been proposed would use Medicare as a foundation--and that foundation is crumbling because of an archaic payment system already in place. This system is scheduled to cut Medicare physician payments by more than 20 percent Jan. 1, 2010, with repeated annual cuts coming after that.

    These annual cuts are a huge problem for patients--and for many families--because they will prevent doctors from taking on new Medicare patients, discourage many from investing in new health technology and make some think about closing their medical practices altogether.

    Right now, the Senate is promoting another one-year Band-Aid for this problem, which means that we’ll be dealing with an even bigger problem next year.

    NO NEED FOR REPLIES, JUST THOUGHT I'D SHARE THIS
  17. #337  
    Quote Originally Posted by Technologic 2 View Post
    From American Medical Association - Patients' Action Network

    Congress is closer than ever to passing a health system reform bill, and we can't lose this opportunity for real health reform. However, members of the AMA's Patients' Action Network and doctors from around the country are all concerned about how this legislation will affect your access to your doctor.

    In the U.S. Senate, the health reform bill that's been proposed would use Medicare as a foundation--and that foundation is crumbling because of an archaic payment system already in place. This system is scheduled to cut Medicare physician payments by more than 20 percent Jan. 1, 2010, with repeated annual cuts coming after that.

    These annual cuts are a huge problem for patients--and for many families--because they will prevent doctors from taking on new Medicare patients, discourage many from investing in new health technology and make some think about closing their medical practices altogether.

    Right now, the Senate is promoting another one-year Band-Aid for this problem, which means that we’ll be dealing with an even bigger problem next year.

    NO NEED FOR REPLIES, JUST THOUGHT I'D SHARE THIS
    Oh, but there IS a need for replies because the post is misleading. Did your reference mention that part of the bill is reforming the payment system so those cuts don't happen?


    The Senate Finance Committee released a paper this week on Medicare payment reform. It is the first of three papers they will be releasing this month on health reform. In brief, because of the enormous cost to eliminate the SGR ($380 billion), the finance committee plan stops the SGR cuts for three years and gives physicians a 1 percent payment increase in the first two years. Physicians who provide 60 percent of their services in ambulatory settings would receive 5 percent bonus payments for five years for E&M services for new and established patients. General surgeons practicing in designated rural areas would also receive 5 percent bonus payments. These bonuses would be paid for by reducing payments across the board for all other services. While there are numerous initiatives in the proposal, the major one is the proposed establishment of a shared savings program whereby physicians who affiliate and form coordinated care organizations may receive bonus payments based on the savings achieved in the Medicare program (Part A and Part B) in their area.

    While CMA appreciates the commitment the Senate is making to pay for the gradual elimination of the SGR without imposing larger cuts in future years, the proposed 1 percent payment increase and the net reductions in other services are completely inadequate to cover rising physician practice costs. CMA is supportive of the substantial increases for E&M services, however CMA strongly opposes cuts to other services to pay for those gains. CMA will be meeting with the Senate Finance Committee in Washington, D.C., next week to discuss this proposal.
    What they are *****ing about is not the 20% cuts because that won't happen if the bill is passed. They are *****ing about the fact that "only" a 1% raise in reimbursement won't cover the increased cost of practicing medicine. Manure. Everybody, even doctors, will have to make some compromises and only a 1% increase sounds like a very reasonable one to make.

    link
  18. Micael's Avatar
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    #338  
    The one thing nobody is talking about, that I've caught anyway, is the impact a public plan will have on all the small to mid sized community hospitals. Forced into Medicaid level payments, they won't be able to pay their own bills, and many will go under. Then we'll have a "hospital bailout plan".
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
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    #339  
    Quote Originally Posted by 1thing2add View Post
    I must've missed it. Was that this morning's talking point from Fox News? Figures, since there is a complete lack of understanding on how reimbursement currently flows as well as how reform will alter it. As well as a lack of informed understanding about hospital consolidation and growth. Stand-alone <100 bed hospitals have long been under economic strain to have cooperative relationships with the bigger kids on the block, if not outright management or ownership. Reform's change of reimbursement payment systems actually takes heat off of hospitals used to providing uncompensated care going back decades.
    Ok, so explain to us exactly how that works.
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  20. Micael's Avatar
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    #340  
    Quote Originally Posted by 1thing2add View Post
    Should I use your phrase and simply tell you "it's out there... go find it" or just ignore the question as you do those of others'? This is just like every other issue your people wade into: Completely unprepared and ill-informed, yet there is no self-restraint or even self-awareness within your rage. Curious, that is.

    Let's just say that if you have no clue what a DRG or CPT code is, and how they function in the world of, specifically, hospital economics, you have no business this deep in a discussion on this area of the topic. Stick with your denial of justified insurance claims and call it a day. That, of course, is already known as your every post plays political football in every discussion.

    Will some bloated reimbursements be reduced? Certainly. Will they be justified? Definitely. Will that reduction hurt hospitals? Not at all. In fact, a more efficient hospital will be economically able to sustain itself and expand its services by enjoying lower supplier contract costs.

    Finally, stating that you are against something which, in fact, does not exist, is the very definition of a strawman. There's an old saying among fitness people that goes something like this: "You don't play sports to get in shape ... You get in shape to play sports". One averts injury by being properly conditioned. Sort of applies to your "argument", as well.
    I didn't think you could explain it. I was right. Nice smoke screen though! Have a nice day
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.

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