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  1. #1201  
    Quote Originally Posted by glorifiedg View Post
    It's worst than that! They don't know, they don't know that they don't know and they don't want to know!!! Here's a crass example of that:



    On breast cancer, that subject was on the headlines here. The task force concluded that the previous recommendations of mammograms begining on 40 were correct. This issue was clearly raised by insurance companies and this is the proof that this system doesn't work. Private sector is making assumpssions based on false science just to save money. They want women to do mammograms only by their 50s because of profit and nothing more.

    Offtopic: Do you work on the health sector davidra?
    Sent a PM. In fact, this decision is based on evidence, is reflective of the same decisions made by other expert groups (but not all), and was not made by private insurers. It makes sense to not screen women who have a very low chance of having breast cancer. The lower the risk, the more false positive tests one will get, and the more healthy women will get biopsied and actually misdiagnosed. Policy decisions regarding screening recommendations are complex, require careful examination of large clinical trials, and should be based on firm epidemiogic principles....not what private or public insurers want, not what women's groups want....only what is best for the population as a whole. The most informed groups to make these decisions in the US are the USPSTF, who made these changes in recommendations, and the Agency for Health Care Research and Quality (AHRQ). They are unbiased, and make their recommendations based on science and evidence.
  2. #1202  
    Quote Originally Posted by davidra View Post
    Yeah...I notice Micael, or you for that matter, have not addressed the fact that the sponsoring agency for this "study" is a right wing front group. But I am still totally supportive of your opinion on this....because you DO have real-life experiences. It's amazing how that can color your opinions instead of blathering and philosophizing with no frame of reference. Go Tigers. Beat the Cocks.
    Gotta beat UVA this weekend first....we do that we win the Atlantic Division and play GT for the ACC Championship. I'll admit the ACC is no SEC, but still not bad if we can do that, especially considering how our year started out. After the UVA game, then the Tigers can focus on the Gamecocks and Spurrier.

    Yes....we work on different sides of the picture, but both are real life for sure. It really does bother me when I can't get someone covered.
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  3. #1203  
    Quote Originally Posted by glorifiedg View Post
    Very smart of you! What about the kids of this "folks" "who simply don't want to spend a dime on coverage and could easily get the coverage". They have to pay for the parents errors?
    No....the parents have to pay for the parent's errors. Anyway, usually it is young, single adults who waive off coverage just for the heck of it. And yes, while more and more people are taking less responsibility for their errors, sometimes you just gotta pay for what you do (or don't do). It's called learning and taking responsibility.

    But I do love your "children" angle. Whenever I'm out raising money for my Rotary Club I mention it is "for the children". It is amazing how well that works....I mean...ya gotta do it if it is for the children, right????
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  4. #1204  
    Quote Originally Posted by clemgrad85 View Post
    No....the parents have to pay for the parent's errors. Anyway, usually it is young, single adults who waive off coverage just for the heck of it. And yes, while more and more people are taking less responsibility for their errors, sometimes you just gotta pay for what you do (or don't do). It's called learning and taking responsibility.

    But I do love your "children" angle. Whenever I'm out raising money for my Rotary Club I mention it is "for the children". It is amazing how well that works....I mean...ya gotta do it if it is for the children, right????
    Society can't punish you with death penalty just because you've made a wrong choice not having insurance!

    You're deliberately subverting what i've said. It's not about sensibilizing because they are children, short and cute ones. It's simply because parents choose by them!
  5. KAM1138
    KAM1138's Avatar
    #1205  
    Quote Originally Posted by glorifiedg View Post
    That's why nobody should be arguing anything with you.
    You feel free to not argue with me.

    Quote Originally Posted by glorifiedg View Post
    You think you live in a private ecosistem caled USA, free from all the economic dangers in the world. Yeahhhh I have guns and im big!!! Sorry to disapoint you... If US doesn't make a total revolution you will be left behind by Europe and even South America. You've seen Euro kick Dollar in the but (imagine how harder it would be if Switzerland and England have adopted it), now sit down my friend and watch Sucre detroy your economy.

    You are in serious trouble and you have to start somewhere: economy and healthcare structure is a priority on this.
    Yes, our dollar certainly is suffering--thanks to idiotic economic policies of the last and current administration. Policies that resemble the 2nd world, and that threatens to drag us to that level.

    It must take a special sort of selective reasoning to convince oneself that the Capitialist system which enabled the United States to become the world's only Superpower is somehow inferior to the socialist-type systems that have relegated those nations (including other former super powers like Great Britain) to something less powerful.

    Yes, the United States--which became the worlds greatest economic, military and political power all on the foundation of capitalism is a failure, while nations that have little role on the world stage are successes.

    This isn't hubris--one can't rightfully be prideful over something they were given, its just history.

    Yes, you are right--we will follow Europe into decline if we adopt the failed policies that have relegated so many other nations into second world status. It is possible that an amalgamation of Dozens of other Nations could combine to match the United States. Or, we can stop repeating your mistakes and get back to what made us great in the first place.

    KAM
  6. #1206  
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  7. KAM1138
    KAM1138's Avatar
    #1207  
    Quote Originally Posted by zelgo View Post
    I will be honest with you:
    I'd appreciate that.

    Quote Originally Posted by zelgo View Post
    I, too, think that a totally market-based system could work (although never tried anywhere in the world). This is the conservative ideal.
    Wow, are you serious?


    Quote Originally Posted by zelgo View Post
    We already know, from the world's experience, that a single-payer system works also. This is the liberal ideal.
    Tell me...how is Medicare different from a Single Payer system for the Elderly? How's that working out financially? According to the Obama administration it is filled with massive amounts of waste. It is also being heavily subsidized by all of us who work, and who are not receiving benefits. What makes a larger scale version of this less wasteful or more economically viable with the ratio of beneficiaries to those who subsidize growing significantly?
    Medicare, while very popular amongst those who get "free" healthcare (no surprise) isn't financially stable. The liabilities are not anywhere close to being funded moving forward.


    Quote Originally Posted by zelgo View Post
    The current health reform bills are a political compromise that no one is thrilled with but, in this crazy Congress, nothing else can pass.
    I'm concerned with not doing more harm, because someone is dedicated to making political gains.


    Quote Originally Posted by zelgo View Post
    The big problem is Medicare and it's support by the elderly. A totally market-based system will ONLY work if you get rid of Medicare and include the elderly in that system. Politically, it will never happen. The other alternative, and the easier one to get to from here, is single payer.

    Neither possibility is the only right answer to fix the problem (and arguments about political philosophy are arguments about opinion--and provide no support for what is "right"). Single payer, however, is the only probability because the elderly will never give up Medicare.
    Since you've been so honest, I'll return the favor--I think that single payer is very likely, but for different reasons.

    You are correct about Medicare--there is no practical way to remove the current elderly from the roles. However, a TOTALLY free market system while preferred isn't the only possibility. I'm not sure why you don't believe a segmented system could work.

    High deductible policies (sometimes with HSAs) are an attempt to remain economically viable by emulating a semi-market based system. The problem is that the volume (and therefore consumer influence) is not of sufficient volume to control prices. However, if all non-elderly were to participate in this system (for common care), it likely would work.

    I think people would be surprised how many efficiencies would be found if there was actual competition.

    KAM
  8. KAM1138
    KAM1138's Avatar
    #1208  
    Quote Originally Posted by zelgo View Post
    That's troubling.

    If so, you come across more as a zealot than someone who wants to carefully consider options to situation this country is in.

    There is only one answer for you and nothing else could possibly be right despite lots of evidence to the contrary.

    In just a few years, the rest of the industrialized world is poised to surpass us in so many ways. I guess you'll care then.
    Well, think of this another way. I believe other nations should be free to do whatever they wish for themselves and the same goes for the United States. If they want and prefer social democracy...great.

    The rest of the world is poised to surpass us? I think you are WILDLY exaggerating. Even China (whose international growth is VERY capitalist) isn't the power that the US is.

    You are also wrong--there isn't one right answer. Its funny, that those demanding the US adopt the policies of Europe are accusing me of supporting only one answer. Aren't you suggesting that we adopt the systems of Europe? Why can't the United States find solutions that are best for us?

    If I felt that our government was even honestly considering all options I'd be much less unhappy, but they aren't, they are following one path and ignoring all others.

    The United States is very much in danger of falling from our position. Our burdens are so far beyond that of other nations that it is very difficult to see another possibility--especially if we keep turning towards unsound policies.

    We are actively rejecting what made America Great, so it should come as no surprise if abandoning proven success results in decline.

    Am I less concerned with the rest of the world, than my own country--of course. Why is that a surprise to anyone? Why isn't my government more important to me than that of Portugal or Spain or Canada. Those nations don't have sway over my life--that's the business of their citizens.

    KAM
  9. KAM1138
    KAM1138's Avatar
    #1209  
    Quote Originally Posted by davidra View Post
    I've got a suggestion for you. First, learn a little something about screening tests for breast cancer. Second, read my post on the issue earlier in this thread. Third, educate yourself about risk/benefit equations and calculate the costs of useless breast biopsies. Then maybe someone might pay attention to your opinion about this. You know nothing and act as if you do. In fact, except for one of the moderators who expounded on Medicare without even knowing what it was, you have written the most uneducated post in this thread. Congrats! And welcome, you've got company in this thread.
    Just to make sure that I don't get accused of claiming I know something about this issue, I admit I do not. I'm ASKING.

    You mentioned Biopsies--Is this new declaration about biopsies as well as mamograms and self-exams?

    Weren't you just last week espousing the benefits of preventative care? How is this any different. Weren't you advocating the benefits of this type of practice? Perhaps I'm not understanding your position.

    Of course, it is reasonable to ask questions about why conventional wisdom on Breast Exams has suddenly changed significantly. Of course, a recommendation is only that. Presumably a woman that with her doctor feels it is appropriate to get one, should. I happen to know a woman that is 35 whose doctor recommended she get a Mamogram. I'd assume her doctor knows better what to recommend than some panel that knows nothing about any particular patient.

    I don't expect that you'd advocate a patient ignoring their doctor's advice in favor of a recommendation of some panel who isn't treating a patient. Do you think that hearing this would cause a patient to question their doctor's recommendation? After all--some have accused doctors of unnecessary tests.

    KAM
    Last edited by KAM1138; 11/18/2009 at 08:50 PM.
  10. #1210  
    Quote Originally Posted by KAM1138 View Post
    You mentioned Biopsies--Is this new declaration about biopsies as well as mamograms and self-exams?
    Yes, unnecessary biopsies occur due to false positives on the mammography.

    Task force opposes routine mammograms for women age 40-49 - CNN.com

    Weren't you just last week espousing the benefits of preventative care? How is this any different. Weren't you advocating the benefits of this type of practice? Perhaps I'm not understanding your position.
    The recommendation is based upon data that shows that early mammography causes false positives (which lead to unnecessary biopsies), without measurable benefits on survival.

    Of course, it is reasonable to ask questions about why conventional wisdom on Breast Exams has suddenly changed at a very different conclusion (and one that is not universal).
    Yes, but tying it into "rationing care by the Obama administration" is simply disingenuous fear-mongering for political gain.
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  11. KAM1138
    KAM1138's Avatar
    #1211  
    Quote Originally Posted by Bujin View Post
    Yes, unnecessary biopsies occur due to false positives on the mammography.

    Task force opposes routine mammograms for women age 40-49 - CNN.com

    The recommendation is based upon data that shows that early mammography causes false positives (which lead to unnecessary biopsies), without measurable benefits on survival.

    Yes, but tying it into "rationing care by the Obama administration" is simply disingenuous fear-mongering for political gain.
    Of course, I said nothing of the sort. Of course, this constant accusation of "fear mongering" is almost a knee-jerk response at this point. When your opponent says something--anything, call it fear-mongering. I hope that works out for you. I'm always forced to wonder how well things would go if everyone engaged in the same trite little accusations.

    I'm skeptical of these sorts of recommendations in general (And don't place too much stock in them). The "forget what we told you for years, NOW we're right" is not likely to be well received.

    Of course, no individual lives their lives according to statistics, so recommendations like this are inherently non-specific. Individuals' needs are...well individual.

    KAM
  12. #1212  
    Quote Originally Posted by zelgo View Post
    Sure, single-payer systems have problems, but far, far less than we have here. Plus, they work very well, don't cost that much, Europeans love their systems, and no one wants to change them.

    So, why tell them to change?
    \

    So much fun here. Zelgo could you please post the survey results you refer to above. I mean how else would you know that "no one" wants to change.

    You can post the link rather than the whole study if you like. Could you by chance also post the list of the entire population of Europe? I'd just like to be able to cross reference yunno. It's not that I doubt you, just want to be thorough.
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  13.    #1213  
    Quote Originally Posted by glorifiedg View Post
    You think you live in a private ecosistem caled USA, free from all the economic dangers in the world. Yeahhhh I have guns and im big!!! Sorry to disapoint you... If US doesn't make a total revolution you will be left behind by Europe and even South America. You've seen Euro kick Dollar in the but (imagine how harder it would be if Switzerland and England have adopted it), now sit down my friend and watch Sucre detroy your economy.

    You are in serious trouble and you have to start somewhere: economy and healthcare structure is a priority on this.
    This great country was founded to break away from the way countries like Spain, Portugal, England and France were being run.

    The problem we have is too many of our politicians and bleeding heart liberals want to change our Capitalist system to a failed socialist system. If we go back to a limited government and let individuals have the freedom and liberty to achieve their best, our economy will take off.

    The idea that Washington wants to fix healthcare to help people is a fallacy. It is just a big expensive power grab that still won't help cover everyone. All it will do is put us in more debt bringing our economy closer to collapse.

    Do you realize how much ONE TRILLION DOLLARS is? One THOUSAND Billions!

    And now we are already planning to ration care with the reduction of cancer screenings. Put lipstick on a pig, and it is still a pig. Anyone say death panels? The reason the US has the best record of curing breast cancer is due to the fact most women do get annual screenings. Would you rather have 1000 false positive test or miss 1 positive test? If I was that 1 I'd be glad I had the test.
  14. #1214  
    Yes, the United States--which became the worlds greatest economic, military and political power all on the foundation of capitalism is a failure, while nations that have little role on the world stage are successes.

    This isn't hubris--one can't rightfully be prideful over something they were given, its just history.
    American pride, american muscle, american dream!!! Yeahhhh! Look at me! I knew this would come up sometime. The perfect analogy would be the "American Muscle" cars. You're very proud of them, they have enormous motors, but a tiny, 2000turbo, that consumes just 8litres/100km, European or Japanese car can make you eat dirt every time. It's just pride that lives on helium balloons. LOL!

    Back to real world you dreamer:

    Human Development Index - Wikipedia, the free encyclopedia
    Human Poverty Index - Wikipedia, the free encyclopedia
    List of countries by GDP (nominal) per capita - Wikipedia, the free encyclopedia
    Education Index - Wikipedia, the free encyclopedia
    Do you want more?

    USA is the first on every category!!! Congratullations! .....NOT!....

    Im sick of your nonsense talk because you're just dumb. Swedish system is just perfect, and when you've learn how to read, you'll be able to learn that healthcare in sweden is free, education is completly free (they even pay for pencils!!!), justice is free, their economy is strong and they pay almost 50% in taxes!!!!!!!!!!! Fifty percent, can you read me? 50%! So, don't tell me your system worst something compared to Swedish system when you are behind them in every aspect of society! How I wish I were in Sweden!

    Till then: bye bye.

    Yes, you are right--we will follow Europe into decline if we adopt the failed policies that have relegated so many other nations into second world status. It is possible that an amalgamation of Dozens of other Nations could combine to match the United States. Or, we can stop repeating your mistakes and get back to what made us great in the first place.
    Your posts just deserve one answer: LOL!

    This is my last answer for you. Arguing with you is like talking to a stone.
  15. #1215  
    Quote Originally Posted by Technologic 2 View Post
    This great country was founded to break away from the way countries like Spain, Portugal, England and France were being run.

    The problem we have is too many of our politicians and bleeding heart liberals want to change our Capitalist system to a failed socialist system. If we go back to a limited government and let individuals have the freedom and liberty to achieve their best, our economy will take off.

    The idea that Washington wants to fix healthcare to help people is a fallacy. It is just a big expensive power grab that still won't help cover everyone. All it will do is put us in more debt bringing our economy closer to collapse.

    Do you realize how much ONE TRILLION DOLLARS is? One THOUSAND Billions!

    And now we are already planning to ration care with the reduction of cancer screenings. Put lipstick on a pig, and it is still a pig. Anyone say death panels? The reason the US has the best record of curing breast cancer is due to the fact most women do get annual screenings. Would you rather have 1000 false positive test or miss 1 positive test? If I was that 1 I'd be glad I had the test.
    I don't think you've realized that EU systems are fully capitalist. Just not neoliberal like your's.

    I think fallacy is want you think, that US needs a limited government as it currently have. That system is a faillure and you can see why all over the world! Just a blind man can denie this. Neoliberalism was causer of extreme pit between poor and rich, it has enslaved workers to the power of multinational companies, it is responsible for the crysis we are experiencing!

    Don't think neoliberalism brings freedom and welth, it's somehow fascism, a dictatorship of the capital, and just a few (the rich and powerfull) take benifit on this system.
  16. #1216  
    Quote Originally Posted by Technologic 2 View Post

    And now we are already planning to ration care with the reduction of cancer screenings. Put lipstick on a pig, and it is still a pig. Anyone say death panels? The reason the US has the best record of curing breast cancer is due to the fact most women do get annual screenings. Would you rather have 1000 false positive test or miss 1 positive test? If I was that 1 I'd be glad I had the test.
    Which is thankfully why you aren't making any decisions. Would you like to be one of the many women who:
    1. Are told they might have breast cancer and it will be a month before you can find out?
    2. Have an invasive expensive biopsy, with a risk of infection and bleeding, and then find out you didn't really need it?
    3. Be misdiagnosed (which happens more frequently in low riskpersons) and possibly treated when it was unnecessary?
    4. And finally....if you were running Medicare or a private insurance company, would you be willing to pay millions and millions of dollars to give one woman an additional year of life? If yes, then let's start mammograms even earlier. I mean, 40 is just a number, right? We could pick up additional cases in younger women as well. Do you wonder why we don't?

    Really....you shouldn't weigh in on this stuff.
  17. #1217  
    Quote Originally Posted by KAM1138 View Post
    Just to make sure that I don't get accused of claiming I know something about this issue, I admit I do not. I'm ASKING.

    You mentioned Biopsies--Is this new declaration about biopsies as well as mamograms and self-exams?

    Weren't you just last week espousing the benefits of preventative care? How is this any different. Weren't you advocating the benefits of this type of practice? Perhaps I'm not understanding your position.

    Of course, it is reasonable to ask questions about why conventional wisdom on Breast Exams has suddenly changed significantly. Of course, a recommendation is only that. Presumably a woman that with her doctor feels it is appropriate to get one, should. I happen to know a woman that is 35 whose doctor recommended she get a Mamogram. I'd assume her doctor knows better what to recommend than some panel that knows nothing about any particular patient.

    I don't expect that you'd advocate a patient ignoring their doctor's advice in favor of a recommendation of some panel who isn't treating a patient. Do you think that hearing this would cause a patient to question their doctor's recommendation? After all--some have accused doctors of unnecessary tests.

    KAM
    There are differences between recommendations or guidelines and mandating practice patterns. In this case, the task force is making recommendations for the general population. In no circumstance I am aware of, and in no circumstance currently being considered, are patients denied getting mammograms if specfically recommended by their doctor for specific reasons. However, insurance companies may (and do) deny payment if there is not adequate justification.

    This is not new information. As in the link I posted, there are variations around the world with regard to recommendations about mammography, and most of the world has less aggressive screening guidelines, based on their interpretation of the evidence in the literature. There is a basic problem with patient understanding of care, and that is that patients feel that more care is better. I have nothing to do with the government, but I teach evidence based medicine and have for many years, and that assumption is just plain wrong. Inappropriately being admitted to the hospital exposes patients to serious hospital acquired infections and lots of other bad things that can happen. Doing unnecessary tests leads to complications and wasted funds that could be better used elsewhere. This has NOTHING to do with rationing, it has to do with appropriate use of resources based on the best available evidence of effectiveness. If Clemgrad hurts his knee swimming and wants an MRI done, should he be able to get it and have you pay for it through higher premiums, when there is no evidence that his outcome will be any different than if he doesn't get it done? Standard care would be to do no testing for a week or so, treat symptomatically, then re-examine. If the pain and exam are unchanged, that's the point at which the doc might want to do an MRI...and that will decrease the number of $1000 MRI's by 75%. So you tell me....because he wants it, should you pay for it?

    Just in the last year we've had changes in the status of screening for prostate cancer and breast cancer, two of the most common cancers. These changes are based on published studies (two in the New England Journal on prostate cancer screening within the past few months) that may take years to complete, so changes are bound to occur. As I said in another post, why not begin screening at age 18? I have seen women with breast cancer in their twenties; I had an 18 year old woman die of colon cancer. That doesn't mean I screen all 18 year olds for cancer. There are limited returns, and there are significant risks of the testing. False positive tests are not to be trivialized, because they result in more invasive, more expensive subsequent testing, and that alone can be dangerous. If I put a middleaged woman on a treadmill for an exercise test, knowing that that population has a high false positive test rate, and she has a positive test, I am then required to do a cardiac catheterization which is very likely to be negative....but it just cost her or her insurance company $2000 and put her at significant risk.

    These are tough decisions, determining who should be screened, for what and at what age. If you want a lot more information about how these decisions are made, just go to the USPSTF website here.
    Last edited by davidra; 11/19/2009 at 06:22 AM.
  18. #1218  
    Quote Originally Posted by glorifiedg View Post
    I don't think you've realized that EU systems are fully capitalist. Just not neoliberal like your's.

    I think fallacy is want you think, that US needs a limited government as it currently have. That system is a faillure and you can see why all over the world! Just a blind man can denie this. Neoliberalism was causer of extreme pit between poor and rich, it has enslaved workers to the power of multinational companies, it is responsible for the crysis we are experiencing!

    Don't think neoliberalism brings freedom and welth, it's somehow fascism, a dictatorship of the capital, and just a few (the rich and powerfull) take benifit on this system.
    Ah.... not trying to put words in your mouth, but it sounds like you are describing neoconservatism. Maybe our conservatives are your liberals in Sweden perhaps?
  19. KAM1138
    KAM1138's Avatar
    #1219  
    Quote Originally Posted by glorifiedg View Post
    American pride, american muscle, american dream!!! Yeahhhh! Look at me! I knew this would come up sometime. The perfect analogy would be the "American Muscle" cars. You're very proud of them, they have enormous motors, but a tiny, 2000turbo, that consumes just 8litres/100km, European or Japanese car can make you eat dirt every time. It's just pride that lives on helium balloons. LOL!
    This coming from the Portugal Resident, that repeatedly talked about how great your systems are, and how backwards America is.

    Quote Originally Posted by glorifiedg View Post
    Your posts just deserve one answer: LOL!

    This is my last answer for you. Arguing with you is like talking to a stone.
    Perhaps you should look up a little something called an "inferiority complex."

    We aren't arguing, because I'm not concerned with you trying to tell me what I should believe for myself in my own country. And you have the audacity to accuse me of Pride? It might bother you that I'm not concerned with Portugal or Sweden, but I have this practice that I like to follow--its called minding one's own business.

    You might choose to tell people of another nation what you think they should do, but it doesn't mean I have to find that relevant, nor do I concern myself with your business. Try it some time.

    You think Portugal is great and Sweden is better...great, I'll stick with America, thanks.

    Oh I'm sure this will upset some of you--I'm being dismissive of the Non-American. Well, yes, I am because I've grown tired of this. For all of you AMAZED that someone like me would say that I don't care what happens in Portugal, and am concerned with my own country...ask yourself--who has the stranger perspective?

    Is it strange to be concerned with ones own country and government and how what they do affects them, or for someone who isn't a citizen or resident finding a discussion and telling others how to run their country?

    Oh no--here's the "ugly american" minding the business of my own country. Such a horrible display of arrogance to be concerned with my own Nation. The horror, the lack of internationalism. I'm not sure I can bear the shame.

    KAM
  20. KAM1138
    KAM1138's Avatar
    #1220  
    Quote Originally Posted by davidra View Post
    This is not new information.
    It is a change in our policy (Recommendation) though correct?

    Quote Originally Posted by davidra View Post
    There is a basic problem with patient understanding of care, and that is that patients feel that more care is better.
    I'd like to set this aside for future reference.

    Quote Originally Posted by davidra View Post
    I have nothing to do with the government, but I teach evidence based medicine and have for many years, and that assumption is just plain wrong. Inappropriately being admitted to the hospital exposes patients to serious hospital acquired infections and lots of other bad things that can happen.
    I couldn't agree more.

    Quote Originally Posted by davidra View Post
    Doing unnecessary tests leads to complications and wasted funds that could be better used elsewhere. This has NOTHING to do with rationing, it has to do with appropriate use of resources based on the best available evidence of effectiveness.
    This is where I'm confused. Didn't we have a discussion last week about increasing efforts to screen people. I recall that your position was that you supported it, because it helped people avoid serious illness, and I agreed, but added that studies have shown that this would not result in cost savings.

    I think we touched on Cost-benefit as well. It seems that you are in agreement with what I had been talking about--that from a resource standpoint, this is not an effective use of money, even though it may in fact benefit some individual. If I understand the study--this new recommendation would not have a zero negative impact on early detection--rather the cost outweighs that? Am I understanding that correctly?

    I'm trying to remember all that was said. Am I remembering your position from last week incorrectly? Because I was under the impression that you wanted increased screening even if it didn't result in reduced costs.

    Quote Originally Posted by davidra View Post
    If Clemgrad hurts his knee swimming and wants an MRI done, should he be able to get it and have you pay for it through higher premiums, when there is no evidence that his outcome will be any different than if he doesn't get it done? Standard care would be to do no testing for a week or so, treat symptomatically, then re-examine. If the pain and exam are unchanged, that's the point at which the doc might want to do an MRI...and that will decrease the number of $1000 MRI's by 75%. So you tell me....because he wants it, should you pay for it?
    As you well know, I advocate a Direct Payer system, which would remove me from that equation--allowing me to mind my own business, and Clemgrad to mind his. That's his business and I don't want it to be mine--these indirect payer schemes force that onto me, and that's exactly what I want to change. If MRIs are being handed out in such quantity as to block the ability of others to get one, that could become a supply and demand issue however.

    Quote Originally Posted by davidra View Post
    There are limited returns, and there are significant risks of the testing. False positive tests are not to be trivialized, because they result in more invasive, more expensive subsequent testing, and that alone can be dangerous. If I put a middleaged woman on a treadmill for an exercise test, knowing that that population has a high false positive test rate, and she has a positive test, I am then required to do a cardiac catheterization which is very likely to be negative....but it just cost her or her insurance company $2000 and put her at significant risk.
    Yes, I understand what you are saying. However, I've got a question. What percentage of Mammogram tests result in a false positive? What percentage result in a True positive?

    Quote Originally Posted by davidra View Post
    These are tough decisions, determining who should be screened, for what and at what age. If you want a lot more information about how these decisions are made, just go to the USPSTF website here.
    Tough Decisions, which I imagine are highly variable based on the individual patient. That's makes me wonder what the value of broad-brush recommendations like this are. Would you agree that individual doctor-patient interaction trumps these population-level recommendations?

    KAM

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