Dare you to reply!

[RadOncMegatron]

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This is a thoughtful assessment…

But what of a fireman’s expertise, or a lawyer’s? Why is it reasonable to have universal access to emergency services (certainly bereft in the past) and for criminals to have “a right” to legal expertise… but not guarantee that a child has access healthcare.

Thank you and you make very good points as well. Perhaps, I’m just making a technical point that is we can legally justify a child’s access to healthcare without calling what philosophers have termed over the course of centuries “human rights.”

I must emphasize universal access to a public good can come from many many other arguments, but do not have to enter the “human rights” zone.

A good example of a human rights argument is the abortion argument. Where the right of the baby to live and the mother’s liberty to abort are fought in the name of human rights AND it appears both sides would use governmental authority to enforce. Now let’s, not get into this rabbit trail, I’m just comparing a valid human rights controversy (pro-life vs pro-choice) against a non-human rights (albeit very important) controversy such as universal healthcare. Obviously, slavery was also a human rights argument that led to a justifiable war, given the egregious violation of human rights.

 

[RickyScott]

Well, I’m leaving some wiggle room, for the rare case (I can’t think of an example) we missed something… main point being I am against the concept of the inflation of human rights that is the promulgation of newly invented rights ie if people say everyone has the “right” for internet access. Again important, but not a right.

Obviously, you are a very smart person. I would love to hear what your definition of human rights are, what is their grounding, and what are they? You got some trolling skillz but let’s see what you come up with here 😛

The problem with health care is that like it or not, we do end up paying wether or not someone has insurance when they get admitted into the hospital, so present system not working. Despite large number of uninsured, we pay 3x health costs per capita as the next country without better outcomes.

I have treated 5% charity cases over the course of my career (working at a real nonprofit) and the pts always get treated! Someone is paying. For children, our society does essentially treat health care as a right, just as it does when someone w/out insurance is admitted to a hospital in an emergency.

 

[VA Hopeful Dr]

Why would m4a be any different than m right now? It would simply expand eligibility. It doesn't outlaw private providers of care.

The closest thing i can think of that is similar to universal healthcare without any parallel private system that we have is the VA system

So here's how this works currently. If you accept Medicare you are not allowed to privately bill Medicare patients for anything. You can opt out but that means you can't bill Medicare for anything for 2 years. Everyone has Medicare. You opt out, you're basically going completely cash-pay (since every M4A bill that's been introduced outlaws private insurance from covering anything that Medicare covers).

 

[medgator]

So here's how this works currently. If you accept Medicare you are not allowed to privately bill Medicare patients for anything. You can opt out but that means you can't bill Medicare for anything for 2 years. Everyone has Medicare. You opt out, you're basically going completely cash-pay (since every M4A bill that's been introduced outlaws private insurance from covering anything that Medicare covers).

Medicare pays though and timely. Authorizations are generally not required ever for diagnostics.

Vs arguing with commercials with prior auth for everything and then only getting certain services approved while the CEO of Cigna walks home with a $79m pay package

 

[temujim]

The problem with health care is that like it or not, we do end up paying wether or not someone has insurance when they get admitted into the hospital, so present system not working. Despite large number of uninsured, we pay 3x health costs per capita as the next country without better outcomes.

I have treated 5% charity cases over the course of my career (working at a real nonprofit) and the pts always get treated! Someone is paying. For children, our society does essentially treat health care as a right, just as it does when someone w/out insurance is admitted to a hospital in an emergency.

Ultimately this cms system of government socialized insurance will fail... as has every other system that has provided something for "nothing". Currently medicare is in the early to middle rationing phase. This won't work forever. Obama raised medicare taxes. This will intermittently continue, but never high enough to cover the cost -- a political nonstarter. Starting to see rumblings of true rationing of care -- no treatment of unvaxxed! Hey you didn't wear a seatbelt!

There are other demographic forces at play here too. But soon or late the "rich" beneficiaries will be peeled off. Then the real fights begin.

 

[RickyScott]

Ultimately this cms system of government socialized insurance will fail... as has every other system that has provided something for "nothing". Currently medicare is in the early to middle rationing phase. This won't work forever. Obama raised medicare taxes. This will intermittently continue, but never high enough to cover the cost -- a political nonstarter. Starting to see rumblings of true rationing of care -- no treatment of unvaxxed! Hey you didn't wear a seatbelt!

There are other demographic forces at play here too. But soon or late the "rich" beneficiaries will be peeled off. Then the real fights begin.

Agree, you have to look at health care very macroscopically. When Ben smith or Aileen Chen charge 250 k for protons, ultimately we all end up paying. Eventually the prices are too high and it ends up being rationed.

 

[VA Hopeful Dr]

Medicare pays though and timely. Authorizations are generally not required ever for diagnostics.

Vs arguing with commercials with prior auth for everything and then only getting certain services approved while the CEO of Cigna walks home with a $79m pay package

So that's not even close to true, I argue with Medicare all the time. But I'm not an oncologist of any sort, might be easier if you can use cancer as a diagnosis.

That aside, I don't recall saying anything positive about private insurance so not sure why you brought that in.

Not that you asked, but if we do go M4A I kinda like the Australian approach. Medicare pays X. You can charge X+$10 and that $10 is on the patient. You'd have to make sure to control for large corporations/anti-collusion type stuff but I like the idea of not being 100% bound by whatever charge CMS says you can.

 

[medgator]

So that's not even close to true, I argue with Medicare all the time. But I'm not an oncologist of any sort, might be easier if you can use cancer as a diagnosis.

That aside, I don't recall saying anything positive about private insurance so not sure why you brought that in.

Not that you asked, but if we do go M4A I kinda like the Australian approach. Medicare pays X. You can charge X+$10 and that $10 is on the patient. You'd have to make sure to control for large corporations/anti-collusion type stuff but I like the idea of not being 100% bound by whatever charge CMS says you can.

Id be ok with that, unfortunately many of these things are binary choices and the anti m4a argument ignores how ridiculous the commercial insurance industry has become with premium increases to patients coupled with the increasing burden of prior auth

We literally hire multiple FTEs at this point to deal with prior auth hassle from both Medicare advantage and commercial payors. Straight Medicare with secondary are the only pts i can actually provide timely care to and know that I'll get paid

 

[VA Hopeful Dr]

Id be ok with that, unfortunately many of these things are binary choices and the anti m4a argument ignores how ridiculous the commercial insurance industry has become with premium increases to patients coupled with the increasing burden of prior auth

We literally hire multiple FTEs at this point to deal with prior auth hassle from both Medicare advantage and commercial payors. Straight Medicare with secondary are the only pts i can actually provide timely care to and know that I'll get paid

I totally get that. My slightly-more-conservative-than-me internist wife will often come home and swear she wants single payer mainly to punish the insurance companies for holding us accountable for patients' chronic conditions but then not covering any of the medications that would do the job.

 

[medgator]

I totally get that. My slightly-more-conservative-than-me internist wife will often come home and swear she wants single payer mainly to punish the insurance companies for holding us accountable for patients' chronic conditions but then not covering any of the medications that would do the job.

I was very anti m4a/uhc a decade ago. Commercial payors, evilcore and healthhell have jaded me and changed my perspective over the years.

Standard of care lung IMRT being denied not even 2 years ago after good data existed supporting its routine use will do that to you. Commercial payors are responsible/accountable to their shareholders and no one else

 

[VA Hopeful Dr]

I was very anti m4a/uhc a decade ago. Commercial payors, evilcore and healthhell have jaded me and changed my perspective over the years.

Standard of care lung IMRT being denied not even 2 years ago after good data existed supporting its routine use will do that to you. Commercial payors are responsible/accountable to their shareholders and no one else

Give me a few more years to finish off the loans and set up good college funds for the kids then I'll join you there (I haven't been out 10 years yet).

 

[Reaganite]

I would have thought that until the Asian attacks in Bay Area this year

Id be ok with that, unfortunately many of these things are binary choices and the anti m4a argument ignores how ridiculous the commercial insurance industry has become with premium increases to patients coupled with the increasing burden of prior auth

We literally hire multiple FTEs at this point to deal with prior auth hassle from both Medicare advantage and commercial payors. Straight Medicare with secondary are the only pts i can actually provide timely care to and know that I'll get paid

Dealing with private insurer over the years has definitely softened my stance as a reaganite. If the govt came in and blew up these MF's, I wouldn't shed a tear. Private payors boast about their rates, but their contracted rates are almost irrelevant because they do everything in their power not to pay. They tell you a patient doesn't need pre auth, and then deny your claims on the back end for lack of pre auth. Sometimes they farm the pre auth out to a third party who tells you no pre-auth needed, while the health plan states auth needed. It's an endless back and forth of 3-way calls to get both parties to agree a pre-auth is needed. Even when you do everything correctly, they'll send you a pre-auth that doesn't include key codes like IMRT treatment or they list the wrong address for location of service. When they receive your claim, they'll delay payment months by asking for "medical records" to support EACH claim. Every record your billing company misses is an unpaid claim. Of course, even if you send the records, they will deny ever receiving.

 

[OTN]

Despite the huge pain associated with dealing with them, private payers do indeed keep the lights on for the entire healthcare industry. Government reimbursements alone would not be enough.

Also, have you ever wanted to do IMRT for something that's not covered by Medicare? What's the process there? In my experience the answer has always been "no" - Not "no, but maybe you can do a peer to peer to figure it out" but just "no".

 

[temujim]

I was very anti m4a/uhc a decade ago. Commercial payors, evilcore and healthhell have jaded me and changed my perspective over the years.

Standard of care lung IMRT being denied not even 2 years ago after good data existed supporting its routine use will do that to you. Commercial payors are responsible/accountable to their shareholders and no one else

Don't think anyone on this board would disagree with the hassle and unreasonableness of commercial payors.

Where we part ways is thinking that replacing the current system with M4A would be an improvement. Look at who is running rad onc APM at CMS. Only downhill from there.

 

[TheWallnerus]

Also, have you ever wanted to do IMRT for something that's not covered by Medicare?

Does that exist anymore? There were diagnosis exclusions in the olden days, but at least for my carrier they completed eliminated diagnosis exclusions around 2008. (They used to list only ICDs that were allowed, and bladder and glottic were not on the original allowed list e.g.; breast was specifically allowed e.g.). Want to do IMRT on a skin cancer? You can. Everything in Medicare just has to be "medically necessary," and that is a very wide road.

 

[medgator]

Does that exist anymore? There were diagnosis exclusions in the olden days, but at least for my carrier they completed eliminated diagnosis exclusions around 2008. (They used to list only ICDs that were allowed, and bladder and glottic were not on the original allowed list e.g.; breast was specifically allowed e.g.). Want to do IMRT on a skin cancer? You can. Everything in Medicare just has to be "medically necessary," and that is a very wide road.

Private forum mentioned this also applying to SBRT i think

 

[jondunn]

'rights generally speaking are things humans in the past could enjoy'


generally speaking is really being stretched here lol.

@RadOncMegatron - what I meant by this is that throughout human history, many (most?) humans at different times didn't really have those rights - especially freedom, pursuit of happiness, or property. so 'generally speaking' is a stretch to me

 

[RadOncMegatron]

Dealing with private insurer over the years has definitely softened my stance as a reaganite. If the govt came in and blew up these MF's, I wouldn't shed a tear. Private payors boast about their rates, but their contracted rates are almost irrelevant because they do everything in their power not to pay. They tell you a patient doesn't need pre auth, and then deny your claims on the back end for lack of pre auth. Sometimes they farm the pre auth out to a third party who tells you no pre-auth needed, while the health plan states auth needed. It's an endless back and forth of 3-way calls to get both parties to agree a pre-auth is needed. Even when you do everything correctly, they'll send you a pre-auth that doesn't include key codes like IMRT treatment or they list the wrong address for location of service. When they receive your claim, they'll delay payment months by asking for "medical records" to support EACH claim. Every record your billing company misses is an unpaid claim. Of course, even if you send the records, they will deny ever receiving.

Yes, private insurance is another devil. Is it a worse devil than universal healthcare debatable.

The debate between private insurance based vs universal healthcare at this point is like asking Would you rather cut off your legs or arms. Both options suck!

 

[RadOncMegatron]

@RadOncMegatron - what I meant by this is that throughout human history, many (most?) humans at different times didn't really have those rights - especially freedom, pursuit of happiness, or property. so 'generally speaking' is a stretch to me

Oh, I see that makes sense. For clarification, I meant human rights existed since the first humans existed as it is inherent in our ontological nature. I would agree that they were not recognized nor respected, but they existed.

 

[evilbooyaa]

A(nother) reminder that this thread is not an open invitation for political discussion free-for-all. If you want to discuss politics without some aspect of correlation to the main topic of the thread, your post will be deleted and you will be warned. Multiple posts deleted, 3 users warned on this most recent purge.

The warnings will continue until morale improves!

 

[medgator]

Hot off the presses...

 

[metallica81788]

 

[Radonky]

Hot off the presses...

"Perceived gender was determined through an internet search"

Dare you to reply!

 

[Ray D. Ayshun]

Junior first authors? Would these be med students and residents? If so, could this in any way be related to the fact that we are getting less competitive applicants for the last 4ish years?

 

[Chartreuse Wombat]

Junior first authors? Would these be med students and residents? If so, could this in any way be related to the fact that we are getting less competitive applicants for the last 4ish years?

I think you are on to something. Female US medical students are a majority in many US medical schools and their decision to spend their time in other disciplines is evidence of their superior wisdom

 

[thecarbonionangle]

I think you are on to something. Female US medical students are a majority in many US medical schools and their decision to spend their time in other disciplines is evidence of their superior wisdom

I agree. Women are very rational beings, very smart. The second canaries are when our women flee and they are indeed fleeing. Who can blame them when the field is run by an old darth sidious look alike who hates milky breasts and other similar reptilian creatures. Women like stability. Rad onc offers the complete opposite of this. Rad onc is the flaky brocade ****boi who texts you “u up?” at 3 am

 

[TheWallnerus]

I agree. Women are very rational beings, very smart. The second canaries are when our women flee and they are indeed fleeing.

KO back in his office

 

[Ray D. Ayshun]

I agree. Women are very rational beings, very smart. The second canaries are when our women flee and they are indeed fleeing. Who can blame them when the field is run by an old darth sidious look alike who hates milky breasts and other similar reptilian creatures. Women like stability. Rad onc offers the complete opposite of this. Rad onc is the flaky brocade ****boi who texts you “u up?” at 3 am

this could be the closing line in a number of threads we have going right now.

 

[Mandelin Rain]

This is the only appropriate response to that tweet/paper.

Based on the summary provided in the tweet, it seems that senior rad onc women docs have finally joined the time honored tradition of eating their young, and taken first authorship from their more junior colleagues.

 

[jondunn]

 

[jondunn]

 

[RadOncMegatron]

It's coming. As I have been warning... Patient's asking for doctors of their preferred identity...

I can almost guarantee that these Muslim doctors can treat Jewish patients just as well and they wouldn't mind being treated by a Jewish doctor. The blindness and implications are lost to them.

This was discussed in an NEJM editorial in 2016:https://www.nejm.org/doi/10.1056/NEJMp1514939

Perspective Dealing with Racist Patients
by

• Kimani Paul-Emile, J.D., Ph.D.,
• Alexander K. Smith, M.D., M.P.H.,
• Bernard Lo, M.D.,
• and Alicia Fernández, M.D.

From the paper "A patient’s refusal of care based on the treating physician’s race or ethnic background can raise thorny ethical, legal, and clinical issues — and can be painful, confusing, and scarring for the physicians involved. And we fear that race-based reassignment demands will only increase as the U.S. physician population becomes more racially and ethnically diverse. So we’ve created a framework for considering and addressing such demands"

Looks like people will change their mind here shortly...

 

[jondunn]

 

[temujim]

At a former institution I lost the debate on giving preferences to women in hiring/selecting for faculty/residents. This perspective was my parthian shot. I doubt it will solve the rad onc job market... but it may help!

 

[medgator]

Didn't you like hate this thread or something?

 

[jondunn]

 

[Ray D. Ayshun]

Uh, what color was he?

 

[RadOncMegatron]

What a lovely person. Airing our every little grievance on Twitter. Anyway… KAn’t REcall what I waNted to say…

 

[jondunn]

Uh, what color was he?

 

[DoctwoB]

This is (one of many reasons) why I’m so happy to be out of academia.

How this conversation goes in the real word.

“Hey Dr. Hospitalist. It’s Dr. Urologist. Mind admitting this stone patient for me?”

“No problem. Thanks for the easy RVUs”.

 

[TheWallnerus]

What a lovely person. Airing our every little grievance on Twitter. Anyway… KAn’t REcall what I waNted to say…

I’ll see you next Tuesday and we can chat about it

 

[Palex80]

Apparently around 2 out of 3 surgeon residents are males, thus the perception that ONLY male surgeon residents talk like this may be biased.

Gender Disparity in Awards in General Surgery Residency Programs

This survey study assesses the presence of gender disparity in award winners in general surgery residency programs.

jamanetwork.com

I have come across some female surgeon residents that were not nice to me either... but maybe it's a European thing?
🤔🤔🤔

 

[Ray D. Ayshun]

Apparently around 2 out of 3 surgeon residents are males, thus the perception that ONLY male surgeon residents talk like this may be biased.

Gender Disparity in Awards in General Surgery Residency Programs

This survey study assesses the presence of gender disparity in award winners in general surgery residency programs.

jamanetwork.com

I have come across some female surgeon residents that were not nice to me either... but maybe it's a European thing?
🤔🤔🤔

How do we even know this dude was a male? And where on the intersectionality chart did he fall? This could be because he is cishetero, white, rich, or some other thing. maybe he's autistic. Maybe he's just an dingus. Maybe he thought this attending looks young enough to be a resident. Maybe he's not used to seeing attendings on the floor. Maybe this is actually nothing.

Edit: Also, presumptive to think surgery is equipped to handle this. They operate, that's what they do. Maybe they had a lot of operations. Is this med attending essentially admitting that all they do is get outside records, order pan labs, broad spectrum abx and IVF, and go through a long drawn out ritual to get every team member excited about the possibility of performing a thoracentesis?

 

[Mandelin Rain]

My guess is that she never called the surgery attending, because she knew this is how the conversation would go.

Med Attending: Your resident wanted to transfer a non-surgical patient to our service and erroneously assumed I'm a resident. Probably because I'm a woman.

Surgery Attending: That must have been awful. Now, transfer the patient to medicine service.

 

[Radonky]

How do we even know this dude was a male? And where on the intersectionality chart did he fall? This could be because he is cishetero, white, rich, or some other thing. maybe he's autistic. Maybe he's just an dingus. Maybe he thought this attending looks young enough to be a resident. Maybe he's not used to seeing attendings on the floor. Maybe this is actually nothing.

and maybe it's Maybelline

 

[radoncftw]

Maybe this is on the spectrum of microagressions, but I feel that like the medicine attending is making a lot of assumptions (along with most of the twitterati). I can almost guarantee the conversation would have gone the same way regardless of the gender of the medicine attending. The tweet to me says more about academic medicine than sexism.

 

[jondunn]

 

[seper]

You get a lot of points for just showing up. A lot of RadOncs I know have difficulty with that

 

[jondunn]

Medicine has changed so much in the social media era with interns

 

[deleted1111261]

It absolutely sounds horrendous on campus (be it undergrad, grad / professional school or academic medical center).