What's your alternative to socialized med?

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GeneralVeers said:
2nd largest Navy in the world too. It's a shame you're down to a fishing boat and a diesel submarine now.
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What??? We can steal all of our enemy's fish and make them starve to death...also with diesel submarine, they can hear us coming from miles away and run in fear.
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leviathan said:
What??? We can steal all of our enemy's fish and make them starve to death...also with diesel submarine, they can hear us coming from miles away and run in fear.
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Plus, you've got the added bonus of using biodiesel for the sub. Canada wins, no one dies, and Mother Earth smiles. It's win-win-win!
 
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GeneralVeers said:
Maybe we need to invade Canada in order to put an end to this socialized medicine menace for good!
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Well...you can't nuke us cause we're too close, and if you send in the tanks, we'll just start spreading the Twinkies all around.

And there's the added distraction of all the staggeringly beautiful women.
 
Pharmavixen said:
Well...you can't nuke us cause we're too close, and if you send in the tanks, we'll just start spreading the Twinkies all around.

And there's the added distraction of all the staggeringly beautiful women.
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I don't know, I went to high school in London, ON and they didn't seem that beautiful back then. Of course now I live in a building full of strippers, so my thermostat has been reset.
 
Pharmavixen said:
And there's the added distraction of all the staggeringly beautiful women.
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Maybe, but they're wearing such heavy clothes who could tell. You may not have noticed but it gets damn cold up there.

Down here in Texas we can easily identify the staggeringly beautiful women (as opposed to the Twinkie-fed variety which, honestly, could use some more cold weather garb).

Take care,
Jeff
 
Jeff698 said:
Maybe, but they're wearing such heavy clothes who could tell. You may not have noticed but it gets damn cold up there.

Down here in Texas we can easily identify the staggeringly beautiful women (as opposed to the Twinkie-fed variety which, honestly, could use some more cold weather garb).

Take care,
Jeff
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The staggeringly beautiful ones tend to wear mini-skirts even in the Winter.
 
leviathan said:
The staggeringly beautiful ones tend to wear mini-skirts even in the Winter.
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Several pointed remarks pop to mind but I'll refrain from mentioning them.

Take care,
Jeff
 
leviathan said:
What??? We can steal all of our enemy's fish and make them starve to death...also with diesel submarine, they can hear us coming from miles away and run in fear.
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Diesel submarines are typically quiet; they run on electric batteries for undersea movements, and use the diesel engines on the surface to recharge them.
 
You need to see the documentary film, "SICKO". Taxes will never exceed the BS premiums and all of the other crap that we pay to these greedy insurance companies.
 
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scurred09 said:
You need to see the documentary film, "SICKO". Taxes will never exceed the BS premiums and all of the other crap that we pay to these greedy insurance companies.
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Sicko is full of lies, and exaggerations. I love the guy who gets his medical care in Cuba. Their treatment for him consists of giving him an inhaler, and sending him on his way, yet this is represented as "better" care than in America.

Sicko is a movie with an agenda....that of socialist filmmaker Michael Moore. Do you seriously think he would say one positive thing about the U.S. system, and not slant the film to portray Utopian Universal coverage as the ideal?
 
GeneralVeers said:
Sicko is full of lies, and exaggerations. I love the guy who gets his medical care in Cuba. Their treatment for him consists of giving him an inhaler, and sending him on his way, yet this is represented as "better" care than in America.

Sicko is a movie with an agenda....that of socialist filmmaker Michael Moore. Do you seriously think he would say one positive thing about the U.S. system, and not slant the film to portray Utopian Universal coverage as the ideal?
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By the look of Michael Moore, he's going to need a CABG sometime in the near future. Think he'll go to Cuba? I kind of hope so.

They don't resuscitate babies under 30 weeks there (generally). During residency, I didn't even call my attending at night for a 30 week delivery. Those kids will have a normal life here. Somehow that's better care with a lower infant mortality rate??
 
other thing is i'm sure cuba and other countries lie about their stats, which are the stats they use for that movie. i'm not saying the US System is perfect by any means, but I'd rather be dieing here than cuba any day
 
xaelia said:
I'm probably in the minority that thinks we resuscitate too many preemies.
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Oh we definitely do, but a 30 weeker doesn't fall into that category. Even a 28 week premie will generaly do well. It's all the money spent on 22-24 week babies that I think is excessive, coupled with the inability to tell the family 'no' when care provided turns futile. These are the peds equivalent to the 99 year old GOMER.
 
Stitch said:
Oh we definitely do, but a 30 weeker doesn't fall into that category. Even a 28 week premie will generaly do well. It's all the money spent on 22-24 week babies that I think is excessive, coupled with the inability to tell the family 'no' when care provided turns futile. These are the peds equivalent to the 99 year old GOMER.
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I like the 27-week cutoff. At less than that, we shouldn't even try to resuscitate them.
 
Screw the age cutoff. It should be simple. Put them on a scale. 1kg, and we try. Anything, sorry, didn't make it.
These 400g time bomb head bleed lung surfactant frogs don't need to waste the time of our NICU NPs, much less the residents. Unless, that is, you like calculating TPN every day.
 
Dr.McNinja said:
Screw the age cutoff. It should be simple. Put them on a scale. 1kg, and we try. Anything, sorry, didn't make it.
These 400g time bomb head bleed lung surfactant frogs don't need to waste the time of our NICU NPs, much less the residents. Unless, that is, you like calculating TPN every day.
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Are you on a Peds ICU rotation right now?
 
Dr.McNinja said:
Screw the age cutoff. It should be simple. Put them on a scale. 1kg, and we try. Anything, sorry, didn't make it.
These 400g time bomb head bleed lung surfactant frogs don't need to waste the time of our NICU NPs, much less the residents. Unless, that is, you like calculating TPN every day.
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We currently use foot length. Less than 4 cm and we don't resuscitate. That's pretty damn small and usually corresponds to weights around 500g. The smallest I've seen survive is 500 g, but only with severe deficits. I'm sure the neos have seen smaller, but I agree that the weight is probably the best prognostic factor.

The problem with limiting all of these resusciations is that to some degree you have to push the envelope. 30 years ago, 30 week premies weren't doing well, now they'll likely be normal. How did we get there? By resusciatating them.

Still, we spend way too much money doing it, and cutting costs for futile care would save our system a LOT of money.
 
GeneralVeers said:
Sicko is full of lies, and exaggerations. I love the guy who gets his medical care in Cuba. Their treatment for him consists of giving him an inhaler, and sending him on his way, yet this is represented as "better" care than in America.

Sicko is a movie with an agenda....that of socialist filmmaker Michael Moore. Do you seriously think he would say one positive thing about the U.S. system, and not slant the film to portray Utopian Universal coverage as the ideal?
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I liked Sicko. It presented a lot of really scary cases that represent why I wouldn't want to live in a country where you can get dropped from your insurance company or have claims denied. That said, I think the movie was still extremely biased, like all of the movies from that ass-hat Michael Moore. He might have actually been able to do some good had he tried to create a movie with a neutral perspective on our two countries. Instead he tried to make it look like the US was the devil and Canada was the best country on the earth. Give me a break.
 
Why aren't we taxing the things that make people the most sick. Cigarettes should be a 0.5 -1 dollar each, extra 1-2 cent tax per ounce of soda(even diet) ect, and so forth. make people who need care the most pay for it with what makes them need the care. use some of the money to pay for bike lanes, better parks ect ect. Seems to me if a 20 oz at Mcdonalds was 40 cents more fewer would get consumed.
 
leviathan said:
I liked Sicko. It presented a lot of really scary cases that represent why I wouldn't want to live in a country where you can get dropped from your insurance company or have claims denied. That said, I think the movie was still extremely biased, like all of the movies from that ass-hat Michael Moore. He might have actually been able to do some good had he tried to create a movie with a neutral perspective on our two countries. Instead he tried to make it look like the US was the devil and Canada was the best country on the earth. Give me a break.
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For once we can agree on something. He took only the "worst case" scenarios, without presenting the things that are good about our country (technology, quality of care, access to specialists, etc.). For every "scary" case he can come with in the U.S. system I can find something equally scary or outrageous in Canada. I have two "scary" cases in my own family that have happened in Canada within the past 5 years.
 
scube said:
Why aren't we taxing the things that make people the most sick. Cigarettes should be a 0.5 -1 dollar each, extra 1-2 cent tax per ounce of soda(even diet) ect, and so forth. make people who need care the most pay for it with what makes them need the care. use some of the money to pay for bike lanes, better parks ect ect. Seems to me if a 20 oz at Mcdonalds was 40 cents more fewer would get consumed.
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Vice taxes for the win.
 
GeneralVeers said:
For once we can agree on something. He took only the "worst case" scenarios, without presenting the things that are good about our country (technology, quality of care, access to specialists, etc.). For every "scary" case he can come with in the U.S. system I can find something equally scary or outrageous in Canada. I have two "scary" cases in my own family that have happened in Canada within the past 5 years.
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I don't doubt it for a second that you can pull up cases. I think where we differ is which kind of 'cases' we'd rather be at risk for.

I don't even live in the US but I already have a case involving private medical care. Last year my grandfather had an MI while on a Mexico cruise, and eventually made it into a hospital on land. Even though he had travel insurance, the hospital demanded that we pay $50,000 up front for the cath, and it took us 2 days to pull that money together. Unforunately he passed away a few days after we got the money together for them to do it. He probably would have died anyway, but I will always wonder if it would have made a difference if they could have done it immediately.

I understand that the doctors were probably stiffed in the past by insurance companies, which is why they wanted us to pay up front. I just don't think that situation should be happening in the first place. Maybe the US could put in legislation to ensure that insurance companies CAN'T drop their clients or deny claims, and hospitals must be the ones to collect the funding from insurance companies and NOT the patient. Then I wouldn't be so against private systems.
 
GeneralVeers said:
Also, if you're not happy with having your BMI and body fat measured you are completely free to opt out of the publicly financed healthcare system (i.e. no Medicare). This eliminates any constiutional or legal questions.
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There should be a good intent clause. Have a weight watchers type program where it trumps your health risk for a given period of time. that way we can cover these people as their health improves. We really are in many ways victims of our right to make our own choices. Soda should have never been an inexpensive item and cigarettes should have been removed from the market years ago. If anyother product killed users at the rate that smoking doest it would be gone.

Also, I think the government should only be responsible for paying for 1.2 kids. If you have one on govt assistance and then you have another you only get 20% more. The catch to get it you must be on birth control/surgery for it (both sexes)

These ideas are however very big brother which is creepy but look at where we are at now.
One more thing that would help is funding for more primary care residencies.

I can rant and rant about how the govt gives people too much and then wonders where the money went. Like food assistance. DO NOT give them money. Give a box of rice, beans, vitamins, flour, salt sugar, frozen/canned veggies, fruit, potatoes, peanut butter you know staples. Recipes for bread ect ect and tell them if you don't like it find a job. it is humane and sustainable,cheap not to mention motivation for finding a job. who wants rice and beens three times a week.
 
xaelia said:
Vice taxes for the win.
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Yes, but I get to choose the vices. People who drink tequila should pay 200% more than I should pay for gin. Or scotch.

GeneralVeers said:
Are you on a Peds ICU rotation right now?
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Married to the enemy.



People laugh, but right now, there are rumblings in the EU about dropping coverage on smokers, and in Japan, they force people to go to gyms if they're overweight. I can't imagine people in this country being told to do anything.
 
Dr.McNinja said:
I can't imagine people in this country being told to do anything.
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When you run out of carrots, time to find a stick. You pay a toll when you drive over a bridge to pay for its construction, you pay gas taxes to fund highway improvements - time to tax the sources of poor health to pay for the care.

For you, there will be a tax on bitterness.
 
leviathan said:
I understand that the doctors were probably stiffed in the past by insurance companies, which is why they wanted us to pay up front. I just don't think that situation should be happening in the first place. Maybe the US could put in legislation to ensure that insurance companies CAN'T drop their clients or deny claims, and hospitals must be the ones to collect the funding from insurance companies and NOT the patient. Then I wouldn't be so against private systems.
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My uncle who lived in Niagara Falls had a massive heart attack (he didn't like to go to doctors). He ended up in the ICU in Niagara Falls ER, a town of ~70,000 people. There is no cath lab or interventional cardiologist in a town that size. The let him sit in the ICU for 3 days before getting "approval" to send him to Hamilton for his cardiac cath. He died on the cath table. Had he been treated in a U.S. hospital and had a cath within 12 hours, he likely would have lived.

You say you are against private insurers because they can "drop" people or refuse to cover certain things. If they aren't allowed to do these things, private insurers would make no money, and would go out of business, hence leading to a government plan.

What bothers me most about Canada is the lack of choice. You have no choice but go with government healthcare, unless you are very wealthy and can afford to pay to travel to a U.S. hospital. The middle class in this country are far better off than the middle class in Canada.
 
GeneralVeers said:
My uncle who lived in Niagara Falls had a massive heart attack (he didn't like to go to doctors). He ended up in the ICU in Niagara Falls ER, a town of ~70,000 people. There is no cath lab or interventional cardiologist in a town that size. The let him sit in the ICU for 3 days before getting "approval" to send him to Hamilton for his cardiac cath. He died on the cath table. Had he been treated in a U.S. hospital and had a cath within 12 hours, he likely would have lived.
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Sorry to hear about your Uncle....so we have two perfect examples of how things can get messy from both perspectives. I know it must be difficult for some regions in Canada, but for me personally, it's not a big deal since I am from Vancouver where we have multiple hospitals with cath labs. For a middle class person, I can still choose to live in a region where there is good health care. If I was in the US, I couldn't do anything to negate the risk being with an insurance company that is out to make a profit and not out to look after my well-being. That said, I know it will be a problem for me personally, being that I will make a reasonable salary as a physician if I was to move to the US, and can afford a good insurance plan.

You say you are against private insurers because they can "drop" people or refuse to cover certain things. If they aren't allowed to do these things, private insurers would make no money, and would go out of business, hence leading to a government plan.
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My only argument with this is that they are doing it often for some pretty sketchy reasons when ethically they should have covered the person, but legally they were able to find a way out of it.

What bothers me most about Canada is the lack of choice. You have no choice but go with government healthcare, unless you are very wealthy and can afford to pay to travel to a U.S. hospital. The middle class in this country are far better off than the middle class in Canada.
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That might be true, but it might not. I can say for sure that the lower class are better off in Canada, the upper class have it better in the US, and the middle class all depends on a lot of circumstances.
 
scube said:
One more thing that would help is funding for more primary care residencies.
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in the works, but after reading this also see they want to cut GME by 18%! Some people are ridiculous. Always want their cake and eat it too.


GeneralVeers said:
I don't know, I went to high school in London, ON and they didn't seem that beautiful back then. Of course now I live in a building full of strippers, so my thermostat has been reset.
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granted this is an old post but GV, i thought we talked about you spending so much time in that place you feel like its home. Do we need an intervention?
 
DoctorMedic said:
in the works, but after reading this also see they want to cut GME by 18%! Some people are ridiculous. Always want their cake and eat it too.




granted this is an old post but GV, i thought we talked about you spending so much time in that place you feel like its home. Do we need an intervention?
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the funding should go to create more doctors not less. GME funding in Primary care. WTF. who is in charge around here.
 
yeah well makes me happy shumer is my state senator, he is great with the medical field and especially EMS. The bill is supposed to go to primary care and surgery i believe, two of the most needing specialties. About time a politician started thinking.
 
DoctorMedic said:
yeah well makes me happy shumer is my state senator, he is great with the medical field and especially EMS. The bill is supposed to go to primary care and surgery i believe, two of the most needing specialties. About time a politician started thinking.
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How could funding for more PCP residencies help? Primary care does not fill already, so that is not the problem. The ability to make a living with $200-400K in debt out of MD or DO school is seriously hampered by the current plan to cut reimbursements.

Schumer is trying to bribe enough people to go along with seizing control of medicine.

The apparent lack of malpractice reform is at the heart of the matter.
 
DogFaceMedic said:
How could funding for more PCP residencies help? Primary care does not fill already, so that is not the problem. The ability to make a living with $200-400K in debt out of MD or DO school is seriously hampered by the current plan to cut reimbursements.

Schumer is trying to bribe enough people to go along with seizing control of medicine.

The apparent lack of malpractice reform is at the heart of the matter.
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they will fill with the increase in US med school enrollment and all the IMG's wanting to at least match. Plus of those 15,000 spots some will go to the better known residencies that people will actually apply to. Don't know how adding more PCP and surgery residency spots is bribing to seize control of medicine. Shumer has always been good to NYS, gave my ambulance corp over 70k in grants in the last 5 years alone. Allowed us to get an MCI unit that can treat up to 50 patients, as well as a new flycar.
Anyone will agree the US needs malpractice reform, but even with that, how does that help educate more doctors, once all the spots fill thats it no matter how much malpractice reform there is
 
DoctorMedic said:
they will fill with the increase in US med school enrollment and all the IMG's wanting to at least match. Plus of those 15,000 spots some will go to the better known residencies that people will actually apply to
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So you're going to have more disgruntled people who don't want to do primary care pushed into primary care residencies (which already don't fill)?

Don't know how adding more PCP and surgery residency spots is bribing to seize control of medicine. Shumer has always been good to NYS, gave my ambulance corp over 70k in grants in the last 5 years alone. Allowed us to get an MCI unit that can treat up to 50 patients, as well as a new flycar.
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The rest of us call this pork. Taking from the Federal budget to give to local and state pet projects should be illegal.

Anyone will agree the US needs malpractice reform, but even with that, how does that help educate more doctors, once all the spots fill thats it no matter how much malpractice reform there is
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It helps to educate doctors because hospitals are required to insure any residents/medical students in hospital. If malpractice costs and lawsuits decrease, they will be more interested in having residents in the hospital. This is irrelevant though, as Obama has stated he won't even consider liability caps or any meaningful tort reform.
 
DoctorMedic said:
but even with that, how does that help educate more doctors, once all the spots fill thats it no matter how much malpractice reform there is
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That's the issue. Not all the primary care spots are filling as it is. Looking at last year's "charting match outcomes" at the nrmp, about 10% of Family Medicine positions were left unfilled even though only 40% of the spots were filled by US grads. Internal medicine and pediatrics had 69 and 66 open spots respectively.

http://www.nrmp.org/data/resultsanddata2009.pdf

Funding more spots isn't going to change anything until we make primary care more attractive to applicants. That isn't going to happen by cutting medicare payment (yet again.) And when we are on a total nationalized system there won't the the buffer of the primary sector to help keep primary care practices open. Those cuts (and they will come, again and again) will hurt even more.
 
i agree that cuts won't help, they never do. However i still remain skeptical that increasing the amount of PCP isn't going to be necessary. You said the figures were 10% FM, 66 and 69 spots open in IM and Peds. With the increase in US and IMG students to the match every year, those spots will fill and more will be necessary as the more lucrative/prestigous positions generally go to AMGs.
I again agree tort reform is necessary, and that free money COULD in fact open up some spots for residencies.
As for pork, the money came out of the homeland security budget. While I agree that state projects should receive funding from state budget, however the MCI unit and Flycar to pull it are part of national anti-terrorism preparations. Which is a federal matter. Our agency is listed on the county, state, and federal national response teams. DMAT 4 to be exact.
Lastly making primary care more attractive isn't really going to happen. Again as stated tort reform will help. But the fact of the matter is IM is IM, and to many it's just not as interesting/exciting as many other specialties. I don't forsee PCP getting more compensation just for being PCPs.
 
DoctorMedic said:
they will fill with the increase in US med school enrollment and all the IMG's wanting to at least match. Plus of those 15,000 spots some will go to the better known residencies that people will actually apply to. Don't know how adding more PCP and surgery residency spots is bribing to seize control of medicine. Shumer has always been good to NYS, gave my ambulance corp over 70k in grants in the last 5 years alone. Allowed us to get an MCI unit that can treat up to 50 patients, as well as a new flycar.
Anyone will agree the US needs malpractice reform, but even with that, how does that help educate more doctors, once all the spots fill thats it no matter how much malpractice reform there is
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I did not follow the last sentence. The nature of malpractice requires defensive medicine; to do otherwise is to risk my license for a politician's deceitful promise of affordable healthcare.

The bribery is promising funding to PD's and Schools to create or expand programs in exchange for greater government control. The latter will result down the road in more reimbursement cuts in order to fund the remnants of healthcare. The cost cutting will be unopposed because of the gov't monopoly that is medicare is expanded to larger portions of the population. This is precisely what happened in Canada and elsewhere.
 
DogFaceMedic said:
The apparent lack of malpractice reform is at the heart of the matter.
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Exactly.

Exactly.

Exactly.

Someone PM'd me and asked why I left the U.S.:

'Cause I'm scared of what is going to happen to reimbursements and doctor's salaries. I think the docs will be left holding the bag with no recourse due to their lame ass ability to influence policy and stick up for themselves.

I might be just as paranoid about this, though, as the average American is about "socailzed" health care.

Which, at least in the case of Canada, is simply a single payer system.
 
DoctorMedic said:
But the fact of the matter is IM is IM, and to many it's just not as interesting/exciting as many other specialties. I don't forsee PCP getting more compensation just for being PCPs.
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Gets a lot more interesting at around the $400K/yr salary level. I know residents that would taste urine for that.
 
bulgethetwine said:
Can't comment on Veers' example as don't know about Niagara Falls healthcare. Would like to know why he thinks middle classmen are better off in America. Truth is, most doctors are middle class now in the U.S. Maybe upper middle class. But in Canada it's "free" healthcare, better roads, affordable (and safer) public schools, and reasonably priced post-secondary education.

Psst. Don't tell the Americans.
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My guess is that you practice at a large, university-related hospital in a large city. I would put the quality of care of the average U.S. hospital up against any community Canadian hospital, and the U.S. hospital would win. I certainly think you get good care at a university hospital in Toronto, Montreal or Vancouver, but these state-of-the-art facilities are the exception rather than the norm in Canada.
 
I agree with all that malpractice is at the heart of the matter.

If Obama and the Democrats want to "reform" the malpractice system, and eliminate nuisance lawsuits as well as put caps on damages then I'm willing to listen to their proposals concerning rationing, physician reimbursement cuts, and increased bureaucracy. Until they do something about the state of medical malpractice I'm going to practice scorched earth when it comes to any proposals for increased socialisation of our system.
 
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