Another thread about healthcare reform

[tiredmd]

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http://www.salon.com/opinion/paglia/2009/08/12/town_halls/

Thoughts?

 

[gluon999]

http://www.salon.com/opinion/paglia/2009/08/12/town_halls/

Thoughts?

Agree with it. Obama's mad rush to pass a bill that he doesn't even comprehend is laughable. Republicans are not any better and are too busy in their own scandals to offer a decent retort.

I think Obama's recently tanking ratings reflect public skepticism about his sincerity. How good can anything be that is monopolized by the government?

 

[It'sElectric]

Completely agree...this man is so far out of touch, it's not even funny:

http://www.youtube.com/watch?v=SG56B2et4M8&eurl=http%3A%2F%2Ftownhall.com%2Fblog%2Fg%2F9236949d-3c63-47dc-820c-fa0013e094c2&feature=player_embedded

 

[gluon999]

Completely agree...this man is so far out of touch, it's not even funny:

http://www.youtube.com/watch?v=SG56B2et4M8&eurl=http%3A%2F%2Ftownhall.com%2Fblog%2Fg%2F9236949d-3c63-47dc-820c-fa0013e094c2&feature=player_embedded

A surgeon gets $50,000 for a foot amputation? THATS IT! I am going into vascular surgery. I will work a week a year doing a whole bunch of amputations and spend the rest hanging out in the Bahamas! Yay Maobama!

 

[DrWBD]

A surgeon gets $50,000 for a foot amputation? THATS IT! I am going into vascular surgery. I will work a week a year doing a whole bunch of amputations and spend the rest hanging out in the Bahamas! Yay Maobama!

Sigh.
The estimated cost of an amputation is approximately $40k.
http://www.amputee-coalition.org/fact_sheets/diabetes_leamp.html#ref2
The surgeon won't see most of that as it goes to pay the expenses related to the procedure. The fact is that whoever gets paid, though, it still costs the health care system the same.

As I pointed out to ItsElectric in his other almost identical post - Obama seems to be presenting the crazy idea that it makes more sense to pay the PCP more to prevent diabetics from needing amputations. I'm not sure why this is such a heretical idea.

 

[gluon999]

Sigh.
The estimated cost of an amputation is approximately $40k.
http://www.amputee-coalition.org/fact_sheets/diabetes_leamp.html#ref2
The surgeon won't see most of that as it goes to pay the expenses related to the procedure. The fact is that whoever gets paid, though, it still costs the health care system the same.

As I pointed out to ItsElectric in his other almost identical post - Obama seems to be presenting the crazy idea that it makes more sense to pay the PCP more to prevent diabetics from needing amputations. I'm not sure why this is such a heretical idea.

I should have put the <sarcasm> tag in my previous post. I realize that surgeons get a pittance in many cases. My problem is that Obama failed to mention that $50,000 will go to the hospital, and seemed to imply that it will go to the surgeon. He seems to crucify physicians every chance he gets. In fact, not too long ago, he a made belittling comment about physicians and tonsillectomies. After all, he is a lawyer.

I am all for boosting primary care pay and incentives and streamlining the field to lessen the red tape. But not at the expense of equalizing a PCP with an NP, like the bill would do, one that Obama whole-heartedly supports. I am sure if you are a primary care attending, you wouldn't be too happy with this news. I do appreciate the role they play but after seeing all the administrative BS they have to put up with, very few medical students in my class, and across the nation would want to pursue primary care.

 

[It'sElectric]

Sigh.
The estimated cost of an amputation is approximately $40k.
http://www.amputee-coalition.org/fact_sheets/diabetes_leamp.html#ref2
The surgeon won't see most of that as it goes to pay the expenses related to the procedure. The fact is that whoever gets paid, though, it still costs the health care system the same.

As I pointed out to ItsElectric in his other almost identical post - Obama seems to be presenting the crazy idea that it makes more sense to pay the PCP more to prevent diabetics from needing amputations. I'm not sure why this is such a heretical idea.

The problem is, Obama is clueless. He's making the assumption that PCPs aren't already doing everything in their power to prevent these diabetic complications - ultimately it's up to the patient to comply. So how will scaling back fair reimbursement for an amputation that was more often than not inevitable really fair??

I mean good Lord, who hasn't seen the diabetic in the hospital with 1 BKA, another BKA scheduled in the morning, hoarding a drawer full of candy??

Obama isn't talking about fair reimbursement for PCPs, he's talking about reduced reimbursement for all...not too dissimilar from Medicare.

 

[lowbudget]

http://www.salon.com/opinion/paglia/2009/08/12/town_halls/

Thoughts?

You know, I think Obama's smart for not sticking his nose out to "give details" about what he wants. I think he's doing just fine laying out the overarching principles of what this country needs, and having the frickin' Legislative Branch fight it out. Obama, after all, is no longer a senator and is now an Executive.

It's *always* easier to be against something and so much harder to be *for* something. And, Obama's avoiding the Hilary Clinton mistake, who came up with this one huge plan without any consensus which naturally made it a lightning rod for attacks, forced to be on the defensive side of the plan. If Obama "empowers" the legislative branch to come up with their own plan, *he* now gets to be the one who can be *against* something (via veto power) and go on the offensive to test the merits of the bill.

We've already come up with a lot of common ground and many bills have been passed that now stand to be merged and negotiated:
(A Primer on the Details of Health Care Reform)
http://www.nytimes.com/2009/08/10/health/policy/10facts.html?_r=1&hpw

Obama's not stupid. At least when it comes to government. He's taking a page out of George Washington's playbook by avoid being seduced into policymaking. People keep calling on him to "give specifics". Don't do it, man. Let the legislature (i.e. those that truly represent the people) come up with the specifics and let them fight over it and negotiate it out. The optimal plan will emerge if you simply trust the process. It may not be the "best" plan, but you know you've succeeded in politics if everyone (or nobody's) happy.

Kudos to an intellectual (the anti-Bush... faux-MBA delegator who handed the country to Karl Rove & Dick Cheney) who, by no coincidence as a constitutional lawyer, has studied history.

 

[DrWBD]

The problem is, Obama is clueless. He's making the assumption that PCPs aren't already doing everything in their power to prevent these diabetic complications - ultimately it's up to the patient to comply. So how will scaling back fair reimbursement for an amputation that was more often than not inevitable really fair??

I mean good Lord, who hasn't seen the diabetic in the hospital with 1 BKA, another BKA scheduled in the morning, hoarding a drawer full of candy??

Obama isn't talking about fair reimbursement for PCPs, he's talking about reduced reimbursement for all...not too dissimilar from Medicare.

It's a little early in your medical career for you to be so cynical about patients, isn't it?

You mention the willfully noncompliant diabetics to justify your position, and that PCPs are "doing everything in their power" already. What you fail to mention the ones who want to be compliant but can't be, because they can't see a PCP in the first place, because they can't afford insurance, and don't qualify for Medicare or Medicaid. Meds are not cheap, and following up with a primary care isn't either. Under the current system, these folks pay out of pocket, straining their finances, or they go without care until they end up in the ER, at which point the government ends up footing the bill anyway!

Again, if you don't want to accept Medicare/caid or a public plan because of low reimbursements, you don't have to, according to the way the bill is set up. Is this really so difficult to accept?

 

[Winged Scapula]

FYI:

The Medicare reimbursement rate for a transmetatarsal amputation is around $700 which includes assessment the day of surgery AND the 90-day post-op global period. These patients require a LOT of post-op care for which the surgeon cannot charge.

 

[It'sElectric]

It's a little early in your medical career for you to be so cynical about patients, isn't it?

I'm not a cynic, I'm a realist. I give every person I meet the benefit of the doubt, but the reality in life is that you can't save everyone from themselves.

You mention the willfully noncompliant diabetics to justify your position, and that PCPs are "doing everything in their power" already. What you fail to mention the ones who want to be compliant but can't be, because they can't see a PCP in the first place, because they can't afford insurance, and don't qualify for Medicare or Medicaid. Meds are not cheap, and following up with a primary care isn't either. Under the current system, these folks pay out of pocket, straining their finances, or they go without care until they end up in the ER, at which point the government ends up footing the bill anyway!

I won't rehash this argument, since it's been debated on nearly every forum known to man, but the number of legal citizens who simply are without insurance (ineligible for medicare/medicaid, cannot afford private insurance) is far, far less than the number that is consistently thrown around. I would absolutely love to find a creative way insure those individuals that actually do fall into this category - the answer may lie somewhere in the realm of more individualized insurance plans. However, the answer is NOT to create a "public option" (as the administration loves to put it) that has been designed to push private insurance completely out of the game.

Again, if you don't want to accept Medicare/caid or a public plan because of low reimbursements, you don't have to, according to the way the bill is set up. Is this really so difficult to accept?

Unfortunately, the option to deny the "public plan" won't be a reality for very long if current proposed reforms are passed.

 

[lowbudget]

However, the answer is NOT to create a "public option" (as the administration loves to put it) that has been designed to push private insurance completely out of the game.

Unfortunately, the option to deny the "public plan" won't be a reality for very long if current proposed reforms are passed.

Give me a break. Fundamentally, government must provide where the private sector/free economy fails. Free market industries are all about the short-term (1-2 year profit horizon) and fail in issues requiring long-run outlook (like cost savings from prevention of diseases 20 years out). This is empirically proven in fields like: scientific research and development, environment, education, and of course health care. Reliance on private sector to provide these services leaves too many gaps. And that's why government must be involved.

Regulation of health insurance is incredibly messed up. They are regulated by state governments, so an insurance company that sells benefits in Delaware cannot sell in Rhode Island. They must form a separate corporation (with its own separate leadership and decision makers). Private corporations big enough to self-insure are technically not considered "insurance companies" and so they are regulated on the federal jurisdiction (not state) under ERISA and ERISA standards are more lenient than some state regulations.

There are some markets that are either too small, risky, or tight for private government to fill the gap. No private company wants to go into these markets to insure people because they for sure will lose money. Either no one wants to do it, or there's a monopoly or oligopoly, which essentially is harmful/inefficient to the consumer-patients. You need to have government provide in these markets in order for those markets to survive. You need to break the monopoly so private sector can start to compete.

Either provide a federal public option or reform/deregulate state restrictions to allow insurance companies to *compete* across state lines. Anything else is sub-optimal policymaking.