EM salary and Obama's plan

[Lokhtar]

Yes, because universal healthcare makes the whole country completely communist. That's it..the choice is between a Somalian style free for all, or pure communism.

What national government program do we have that pays for EVERYONE, regardless of economic status? If you use more water, you pay more for your water bill. Use more electricity, you pay more for your power bill.

Police. I've lived in an area where I had to utilize it more, and I've lived in an area of the city where I never did.

---

Members don't see this ad.

 

[deleted65604]

The federal government absolutely should be involved - I actually think it should be (though it's not now) one of their essential functions.

If the government didn't provide these services, private citizens would rise up and meet the demand. I see a problem with the government stepping in with every cituation were there is need. Where are parents? Where are neighbors? Where are cousins, grandparents, etc.? People now have kids willy-nilly, without a decent productive father. How many dental pains do you see who are twenty something year olds and every tooth is falling out of their head. What decent parent wouldn't help out their kid and spot them a few hundred dollars to get their teeth fixed once in a while?

Before going to the government, people should be forced to go ask help from family, friends, extended family, etc. The government is attempting to replace the family as the care-giver. Why don't people ask first degree relatives and extended family for help? Because asking for charity is embarrassing. Also because either their parents are dirt-bags, or the kids are dirt-bags and their relationship is so bad that they don't help each other. The issue isn't poverty, the issue is the break-down of the family.

When you are put in a situation where you are asking for charity, you work to avoid that situation in the future. When it is just a government hand-out, you view it as your right as a person, just because you are lucky enough to be born in the most prosperous country ever seen on the face of this planet.

 

[deleted65604]

Why is electricity, water, clothing, transportation, food, housing different than health-care?

 

[UnderwaterDoc]

Yes, because universal healthcare makes the whole country completely communist. That's it..the choice is between a Somalian style free for all, or pure communism.

Don't know about Somalia, but Cuba sure sucks, and they redistributed the hell out of everything over there. I'm just saying I think it would change your perspective.

 

[Lokhtar]

If the government didn't provide these services, private citizens would rise up and meet the demand.

Yes, that's why no one starves in the world, because private citizens have risen up and met the demand. Or dies because they can't afford chemo.

Don't know about Somalia, but Cuba sure sucks, and they redistributed the hell out of everything over there. I'm just saying I think it would change your perspective.

Yes, because when people think of first world countries with universal healthcare...cuba is the obvious example......

I don't really have any intention of living in Cuba but I've lived in Europe for a while, I know the benefits and the pitfalls. I'll take their healthcare over ours...or at least the one country I've lived in and I have the most experience with.

Why is electricity, water, clothing, transportation, food, housing different than health-care?

Food is not, the government provides it if you can't afford it. If people were dying of starvation in the US, I'd support something to fix that as well. Same with water.

I also think good public transportation is an important civil service, but if you mean a car...I don't see all that many people dying because they can't afford a car.

 

[deleted65604]

Long video but worth it.
[YOUTUBE]http://www.youtube.com/watch?v=661pi6K-8WQ[/YOUTUBE]
Or you could read it at iowahawk

Another awesome video, I missed it in the flurry of posts that made the thread go onto the next page. I love his description of Michael Moore. The "as far as it will fit" comment was spot on.

 

[Lokhtar]

You need massive revenue increases combined with spending cuts. Putting either off the table is just doomed to failure.

EDIT: Oh, and "evidence being fatal to the liberal world view". So ironic and so hilarious.

 

[deleted65604]

I was at CME course last week and was talking to a doc from Madrid Spain. I asked him, "So, how are things over in Spain?". His answer, "Terrible. The economy has been destroyed, we're bankrupt, unemployment is 20%, taxes are unbearable. We're the next country about to collapse, to be rescued by the European Union. The Socialists have destroyed the country and they want to take more taxes, start more government programs and agencies to make it 'all better'. They keep saying, 'if only you'd let us do this, or do that, or give us a little more money we can fix things.'" I find it quite interesting, that despite the repeated collapse of socialist welfare states one after the other, with not one flourishing, from USSR to East Germany, to Greece, Italy, Portugal and next, Spain, we think that if we're the last domino, we're special, we just won't fall. Some people are content to march right off the cliff as long as they can hold on to the dream that they're fixing all of the worlds ills with their taxes and social programs. There is also never a shortage of people to vote for it either, because of the promise that they'll always make someone with more money than you pay for it. The first country in history to offer freedom to succeed or fail, instead of big brother's guarantee of economic security for all, has immigrants fighting tooth and nail to get in, climb walls, dig tunnels, row boat across dangerous waters to get here. We're the only country in history that has to consider building a "great wall" to keep people out, because people want to get in, not build a wall to keep people from escaping (i.e., Berlin Wall). This is because this was the first country in history to allow its people freedom from government oppression, not because it gave its people the cushiest free ride.

 

[Lokhtar]

Err, within the EU...isn't Germany the one bailing out these other countries...you know..another one of these socialist hellholes that's apparently evil and bad and all that is wrong in the world?

 

[deleted65604]

You need massive revenue increases combined with spending cuts. Putting either off the table is just doomed to failure.

This we can both agree on... At least the spending cut part.

Would you be willing to cut government spending on healthcare?

 

[Lokhtar]

This we can both agree on...

Would you be willing to cut government spending on healthcare?

Yes and no. Per capita, it has to happen that we spend less on healthcare or we'll be the head of the line in bankruptcy. Overall, no, it needs to cover everyone....but without spending close to 20% of our GDP as we do now (and we do that without even covering everyone...it's pretty idiotic).

Of course, while I think we'll have universal coverage within the next 10-20 years, I don't know when (if ever) we can ever have a conversation about actual cost savings. Like not wasting hundreds of billions of dollars on futile care for the elderly which doesn't really buy them much time, and takes away what quality of life they already have.

Unfortunately, even approaching such a discussion will quickly be political suicide (OH NOEZ THEY WANT TO PULL THE PLUG ON GRANDMA!) and I don't see how we can deal with those issues in a mature manner. So I'm not very optimistic about that.

 

[deleted65604]

In my community, I've seen 4 people die BECAUSE they had access to healthcare. 4 narcotic prescription overdoses, 3 that were inadvertent and 2 that I gave narcotics to in the weeks before their demise. 4/30,000 is a pretty big deathrate.

I think it is false to claim that people are dying because they don't have access to healthcare. EVERYBODY has access to healthcare. No doctor is turning away paying patients and there are a multitude of resources for people who are too poor to pay.

When you are an adult and acquire a major medical problem such as cancer, you get medicare from the federal government. Our local pediatricians are seeing the medicaid kids. Our internists are seeing the medicare patients (for now). We have a community health clinic that is sliding scale (mostly free). We have a local charity that helps people with prescriptions and with transportation costs to and from specialists offices in other cities. Our hospital takes all comers, regardless of ability to pay as mandated by EMTALA. There is a charitable foundation with an endowment whose main goal is to help the hospital provide healthcare to the poorer patients.

When you have a job 20 miles away, transportation is a necessity. When the grocery store is 10 miles away, most people would starve to death if they weren't able to have transportation. What would be the reaction if you showed up at the local mechanic and told them that you had no intention of paying for car repairs, but that you were poor and that you had the right to a functioning car? Greasy Al would tell you in no uncertain terms that you could get your poor butt off his property, and that he owed you nothing.

The current situation with healthcare is the same as it is with food. Rich people eat better than poor people. Rich people get slightly better healthcare, sometimes. But in the ER at least, there is absolutely no difference whatsoever. I don't know insurance status and don't ask unless I'm thinking of prescribing zofran, in which case, I tell them that medicaid won't cover it and give them the option of phenergan. Often, I just give them a couple of pills for the road of ODT zofran out of the ER so they have enough for one day.

 

[deleted65604]

The fact is, we have a lot of free-loaders in our society

http://www.youtube.com/watch?v=0OQjlzh279E

http://www.youtube.com/watch?v=BkxukIvzmR4

http://www.youtube.com/watch?v=eE-Rqvk6rmM

http://www.youtube.com/watch?v=VP-XZrK8RRI

I know that the above was shown on Fox News, but please watch it and comment so we can have more intelligent conversation.

 

[bravotwozero]

The guy held up a sign asking for beer money and people STILL gave him money!

LOL!

 

[EctopicFetus]

The guy held up a sign asking for beer money and people STILL gave him money!

LOL!

Honestly those are the only guys I give money to. Started that trend in college when I got smart enough.

I probably give ot street people 1-2 times per yr but its only for the honest folks.

On another note.. We do need to increase taxes by broadening the definition of taxpayer to 75%+ of our society instead of the 50 or so percent we are at now.

We also need steep spending cuts using our brains. There is so much waste it isnt even funny.

 

[deleted65604]

Err, within the EU...isn't Germany the one bailing out these other countries...you know..another one of these socialist hellholes that's apparently evil and bad and all that is wrong in the world?

Great commentary on the state of the European Union below.

http://www.youtube.com/watch?v=5D0VhS8qXT0

 

[deleted65604]

You need massive revenue increases combined with spending cuts. Putting either off the table is just doomed to failure.

EDIT: Oh, and "evidence being fatal to the liberal world view". So ironic and so hilarious.

Before you edited this comment, you said that corporations need a higher tax rate. Have you ever heard of the Laffer curve? If not, please read this link:

http://www.polyconomics.com/ssu/ssu-050211.htm

Do you disagree with the concept of the Laffer curve, if so, why?

 

[Lokhtar]

In my community, I've seen 4 people die BECAUSE they had access to healthcare. 4 narcotic prescription overdoses, 3 that were inadvertent and 2 that I gave narcotics to in the weeks before their demise. 4/30,000 is a pretty big deathrate.

I think it is false to claim that people are dying because they don't have access to healthcare. EVERYBODY has access to healthcare. No doctor is turning away paying patients and there are a multitude of resources for people who are too poor to pay.

You are factually incorrect.

Though...must be a nice non urban and non rural community you live in that people aren't going bankrupt and unable to afford healthcare. You know that the #1 reason for bankruptcy in the US is medical bills?

 

[Lokhtar]

Before you edited this comment, you said that corporations need a higher tax rate. Have you ever heard of the Laffer curve? If not, please read this link:

http://www.polyconomics.com/ssu/ssu-050211.htm

Do you disagree with the concept of the Laffer curve, if so, why?

Yes, I disagree with the Laffer curve. Well, not exactly: I disagree with the final tax rate that the proponents of the laffer curve claim results in the optimum level of revenue. Studies have suggested that the 'peak revenue' often doesn't occur until we're at tax rates that are quite a bit higher than anything that we currently have (e.g, upwards of 60-65% for corporations).

Not that I'm really advocating a 65% tax rate, but if one wishes to maximize revenue by way of the Laffer curve, that's around the tax rate we'd want to have.

 

[GeneralVeers]

The most telling statistic is the one looking at revenue as a percentage of GDP. For the last 45 years Federal revenue has stayed at around 18-19% despite changes in the tax code, tax increases, tax cuts and recessions.

http://www.economist.com/blogs/freeexchange/2007/02/funny_about_that_budget

It seems that no matter how high you make the taxes it's difficult to get above 20% of GDP. This suggests that it is IMPOSSIBLE to balance the budget on the backs of the "wealthy" even with rates of 90% or greater. What this means is that the only way to save the country is to massively cut the entitlement programs for the elderly and poor. The supposed $38 billion budget agreement this year is a joke, and a waste of time.

Will this hurt some old people? Undoubtedly, but as a group the elderly are the wealthiest Americans, and some means testing for benefits would go a long way to fixing the problem. So, at the end of the day, do we hurt a few people to save the entire country? Or do we continue avoiding the issue and potentially harm everyone.

 

[WilcoWorld]

What this means is that the only way to save the country is to massively cut the entitlement programs for the elderly and poor.

err, there are areas other than "entitlement programs" where we could cut spending...the military comes to mind

 

[deleted65604]

You are factually incorrect

You have some great points. I found the article interesting. However, I have some problems with the article you cited to support your belief that being uninsured kills people.

1. There were 30% of the people excluded from the analysis because of incomplete data. Who decided on the degree of incomplete data that would disqualify a person from participation? The four liberal researchers attempting to become famous by proving we need socialized healthcare?

2. The study appropriately collected data about education, employment, tobacco use, alcohol use and leisure exercise. However, what about a host of other variables about a patient's health status or likelihood of dying? What about the rate of illegal drug use, diet, environmental safety (pollutants in air and house, lead paint, etc.), safety of cars they drive, safety belt use, gang activity, propensity to get in fights, intelligence and health literacy. The problem needs more analysis than simply asking about the four social attributes they measured.

I'll grant them this, they did admit the following-

Unmeasured characteristics (i.e., that individuals who place less value on health eschew both health insurance and healthy behaviors) might offer an alternative explanation for our findings

3. They adjusted for smoking, defining those who smoke or who have smoked by randomly deciding that smoking over 200 cigarrettes in your life counts as "smoking".

4. There is some subjectivity injected into the study by throwing in the physician assessment of health status as excellent, very good, good, fair, and poor. The subjectivity is further compounded by allowing patient self-reported health status to be included in the analysis. There is a the potential for a great deal of bias, intentional and inadvertent that could have been introduced by adding these variables.

5. This study states,

NHANES III oversampled several groups, including Black persons, Mexican Americans, the very young, and those aged older than 65 years. To account for this and other design variables we used the SUDAAN PROC SURVEYFREQ to perform all analyses. We employed unweighted survival analyses and controlled for the variables used in determining the sampling weights (age, gender, and race/ethnicity) because of the inefficiency of weighted regression analyses.

Later on, they state that they carried out an analysis, of insurance to mortality after forcing all covariates in the model.

In this Cox proportional hazards analysis, we controlled for gender, age, race/ethnicity (four categories), income (poverty income ratio), education, current unemployment, smoking status (three categories), regular alcohol use, self-rated health (four categories), and BMI (4 categories). We tested for significant ineractions between these variables and health insurance status. We tied failure times by using the Efron method… We developed a propensity score model and controlled for the variables in our previous models as well as marital status, household size, census region, number of overnight visits in hospital in past 12 months, number of visits to a physician in past 12 months; limitations in work or activities;job or housework changes or job cessation because of a disability or health problem; and a number of self-reported chronic diseases, including emphysema, prior nonskin malignancy, stroke, congestive heart failure, hypertension, diabetes, or hypercholesterolemia.

My first reaction was, "You can do that?" My next reaction was "BS." I don't believe you can control all 15 of those variables without introducing your bias as a researcher. One variable, "OK", two variables, "sure" but 15! A tweak here, a tweak there, more weight given to this variable, less given to that, and voile, I could find whatever association I wanted! The truth is that they are much like the wizard of Oz, screaming, "Pay no attention to the man behind the curtain! Just look at the screen and believe our results!"

6. I found it fascinating to see through the study that intermittent insurance patients died even more frequently than consistently insured people. If lack of insurance is "killing" people, then uninsured should have the worst health, intermittent insurance slightly better, and insured the best. The fact that intermittently insured people have WORSE mortality would suggest to me that there are unmeasured variables that cause people to have both poor job performance (causing intermittent employment) and poor health. Perhaps poor judgement that causes intermittent employment in able-bodied people is the culprit?

7. They note the following, that there is

increased likelihood of uninsurance among Mexican Americans who were nonetheless no more likely to die than non-Hispanic Whites…

Isn't that interesting? There is not increased mortality in Hispanics without insurance. It seems that the ball is in their court (and yours) to explain this.

8.

NHANES III assessed health insurance at a single point in time and did not validate self-reported insurance status. Earlier population-based surveys that did validate insurance status found that between 7% and 11% of those initially recorded as being uninsured were misclassified.

Could it be a stretch to assume that somebody too stupid or dishonest to report themselves as insured might have increased mortality?

9. The first giant elephant in the room. They do a study on mortality, attempting to show that lack of medical care kills. However, they hide the statistics that give a breakdown about specific causes of death. Did they die of murder, accidental trauma, overdose, cancer, suicide, preventable medical illness, infectious disease, etc.? If the difference could be explained by violent or accidental trauma, then the "evidence" used in this study is being misinterpreted.

10. And the second giant elephant in the room. Even if statistically valid, which I doubt due to my above concerns, this study would only prove a CORRELATION, not a CAUSATION. It is completely dishonest to cite this article and claim that lack of insurance is KILLING people. This exact dishonesty using this exact paper is pointed out in this article- http://www.statlit.org/pdf/2010SchieldICOTS.pdf

 

[deleted65604]

Yes, I disagree with the Laffer curve. Studies have suggested that the 'peak revenue' often doesn't occur until we're at tax rates that are quite a bit higher than anything that we currently have (e.g, upwards of 60-65% for corporations).

I don't want to pay the $31.00 that the link asks me to pay to get to that article. Do you have another source? How did you come by it? Do you actually subscribe to that magazine? If so, I'm impressed.

 

[deleted65604]

Err, within the EU...isn't Germany the one bailing out these other countries...you know..another one of these socialist hellholes that's apparently evil and bad and all that is wrong in the world?

Do you want to compare the accomplishments of our two countries? Really?

OK-
Germany, started and lost two world wars, etc., Makes some cool cars and sausages.

US- Won two world wars, then in an unprecedented move, never witnessed in the history of the planet, gives back the losers their own countries and helps them rebuild themselves, turning Germany and Japan into some of our fiercest economic competitors. Goes to the moon. Starts and perpetuates the industrial revolution, making technology jump light-years ahead. Through the industrial revolution, becomes the bread basket of the world, literally keeping numerous African nations from starving to death for decades. Absolutely revolutionizes the field of medicine, technology, engineering and pretty much every other field there is.

If socialism ever accomplished anything, it is because us capitalists across the ocean gave them the ideas and tools to do so.

I am not far right. I am a devoted capitalist, and can't see how anyone can believe that socialism is a decent alternative.

 

[UnderwaterDoc]

I am not far right. I am a devoted capitalist, and can't see how anyone can believe that socialism is a decent alternative.

Most of the time it's those who have not experienced socialism that push the socialist agenda. Just because it sounds great or better does not mean that it is.

 

[GeneralVeers]

Most of the time it's those who have not experienced socialism that push the socialist agenda. Just because it sounds great or better does not mean that it is.

Socialism sounds like a great idea. The problem is that it assumes human nature is different than it really is. Socialism assumes that through education and government regulation human behavior can be changed. They believe that humans can be altruistic, and all work together for the "greater good".

The reason that Capitalism has lifted more people out of poverty than any social/economic model in the history of the world is that it acknowledges the nature of human beings, that we are selfish, individualistic creatures who will work for our own personal gain. Capitalism uses human nature for productive ends, and the overall improvement of society.

 

[UnderwaterDoc]

Socialism sounds like a great idea. The problem is that it assumes human nature is different than it really is. Socialism assumes that through education and government regulation human behavior can be changed. They believe that humans can be altruistic, and all work together for the "greater good".

The reason that Capitalism has lifted more people out of poverty than any social/economic model in the history of the world is that it acknowledges the nature of human beings, that we are selfish, individualistic creatures who will work for our own personal gain. Capitalism uses human nature for productive ends, and the overall improvement of society.

I agree, and would add that capitalism simply affords people the opportunity to receive rewards for their efforts. I came here with nothing but the clothes on my back, busted my ass, and went to medical school. If I can do it, starting from nothing, anyone can.

Taking what we have for granted is the first mistake, we can always be better, it only depends on yourself.

 

[poorracerkid]

Well said UnderwaterDoc. I wish more people in our society had the same attitude!

 

[deleted65604]

Though...must be a nice non urban and non rural community you live in that people aren't going bankrupt and unable to afford healthcare. You know that the #1 reason for bankruptcy in the US is medical bills?

I live in a rural area.

I know at least two of my patients who are going bankrupt because of medical bills. Both have come to the ER 50 times per year for several years, working us for narcotic pain medication.

Let me tell you the story of "Judy". She worked us for 2 years before we finally cut her off from narcotics. She'd complain of migraine, flank-pain, abdominal pain, leg pain, you know the routine... or maybe you don't if you aren't working in an ER.

About a month ago, my ER nurse got a call at 11 PM from another "nurse". The fake nurse identified herself as a working for a general surgeon and said that she was sending a patient (Judy) in to our ER for evaluation. The story went on and on, and my ER nurse got more and more suspicious, then realized that it was Judy talking on the phone, impersonating a nurse. She told us that Judy had real pain, even though a lot of people thought she was a seeker. She said Judy had such severe spasms in her colon that if they were in her femur, they would cause the femur to break. Our ER nurse asked for contact info so we could communicate with the surgeon after our evaluation. They gave a number that when called, got us to Leroy's Tile Company. I called the patient at home and left a message requesting they get us different contact info for the surgeon, because the number given didn't go to a physician's office. Ten minutes later, the patient calls back and says they are going to a different ER due to bad weather. We call that ER and let them know that she is impersonating a nurse in an effort to get narcotics. They CT her to cover their butt and then confront her. She calls our ER at 3 AM to threaten me with a lawsuit for giving personal information out over the phone.

She's filing for bancruptcy because of medical bills and it really breaks me up.

The other patient "Susan" I know about is equally manipulative if only slightly less criminal. Susan brought us all McDonalds one day in celebration of getting medicaid after finally convincing her Doctor to get her put on disability. The next visit, she tried to butter up her nurse by tipping her with your tax money. The nurse took it and paid it to her ginormous hospital bill.

 

[deleted65604]

I'll take their healthcare over ours...or at least the one country I've lived in and I have the most experience with.

Where did you live in Europe? Where were you born?

 

[211498]

do you want to compare the accomplishments of our two countries? Really?

Ok-
germany, started and lost two world wars, etc., makes some cool cars and sausages.

Us- won two world wars, then in an unprecedented move, never witnessed in the history of the planet, gives back the losers their own countries and helps them rebuild themselves, turning germany and japan into some of our fiercest economic competitors. Goes to the moon. Starts and perpetuates the industrial revolution, making technology jump light-years ahead. Through the industrial revolution, becomes the bread basket of the world, literally keeping numerous african nations from starving to death for decades. Absolutely revolutionizes the field of medicine, technology, engineering and pretty much every other field there is.

lol

 

[Lokhtar]

I don't want to pay the $31.00 that the link asks me to pay to get to that article. Do you have another source? How did you come by it? Do you actually subscribe to that magazine? If so, I'm impressed.

I'll try to find it. No, I don't pay for it directly but I have access through my university.

Where did you live in Europe? Where were you born?

I lived in France for a bit, though I was not born there.

Do you want to compare the accomplishments of our two countries? Really?

OK-
Germany, started and lost two world wars, etc., Makes some cool cars and sausages.

US- Won two world wars, then in an unprecedented move, never witnessed in the history of the planet, gives back the losers their own countries and helps them rebuild themselves, turning Germany and Japan into some of our fiercest economic competitors. Goes to the moon. Starts and perpetuates the industrial revolution, making technology jump light-years ahead. Through the industrial revolution, becomes the bread basket of the world, literally keeping numerous African nations from starving to death for decades. Absolutely revolutionizes the field of medicine, technology, engineering and pretty much every other field there is.

If socialism ever accomplished anything, it is because us capitalists across the ocean gave them the ideas and tools to do so.

I am not far right. I am a devoted capitalist, and can't see how anyone can believe that socialism is a decent alternative.

Err, I don't remember claiming the superiority of Germany over the US? I was just saying that there are strong economies in Europe just as there are weak ones because there was an effort to paint them all with the same brush......

 

[Residual]

My first reaction was, "You can do that?" My next reaction was "BS." I don't believe you can control all 15 of those variables without introducing your bias as a researcher. One variable, "OK", two variables, "sure" but 15! A tweak here, a tweak there, more weight given to this variable, less given to that, and voile, I could find whatever association I wanted! The truth is that they are much like the wizard of Oz, screaming, "Pay no attention to the man behind the curtain! Just look at the screen and believe our results!"

Why would statistically controlling for 12 variables be any more problematic than controlling for 1 or 2?

It's not as if researchers are deciding what weight to assign to each variable. There are statistical techniques for doing this which don't admit any bias and they don't care how many different variables you put into the formulas.

http://en.wikipedia.org/wiki/Multivariate_analysis

 

[WhyOhWhy]

Why would statistically controlling for 12 variables be any more problematic than controlling for 1 or 2?

It's not as if researchers are deciding what weight to assign to each variable. There are statistical techniques for doing this which don't admit any bias and they don't care how many different variables you put into the formulas.

http://en.wikipedia.org/wiki/Multivariate_analysis

I agree with what you're saying, but really.. Wiki is the source you lean on to persuade?

 

[deleted65604]

Why would statistically controlling for 12 variables be any more problematic than controlling for 1 or 2?

It's not as if researchers are deciding what weight to assign to each variable. There are statistical techniques for doing this which don't admit any bias and they don't care how many different variables you put into the formulas.

http://en.wikipedia.org/wiki/Multivariate_analysis

I don't understand the statistics they used, so I guess I can't speak to whether or not there can be bias introduced with trying to correct for 15+ variables.

I want to understand, so explain their statistical methods to me and why attempting to control for over 15 variables can't possibly introduce bias into the study.

Did they use the mortality risk for each factor separately calculated from other studies in other populations and plug those numbers into their equations? If so, then they could select the lowest possible mortality risk from a host of different studies, in order to maximize the apparent correlation with uninsurance.

 

[reedman]

I live in a rural area.

I know at least two of my patients who are going bankrupt because of medical bills. Both have come to the ER 50 times per year for several years, working us for narcotic pain medication.

Let me tell you the story of "Judy". She worked us for 2 years before we finally cut her off from narcotics. She'd complain of migraine, flank-pain, abdominal pain, leg pain, you know the routine... or maybe you don't if you aren't working in an ER.

About a month ago, my ER nurse got a call at 11 PM from another "nurse". The fake nurse identified herself as a working for a general surgeon and said that she was sending a patient (Judy) in to our ER for evaluation. The story went on and on, and my ER nurse got more and more suspicious, then realized that it was Judy talking on the phone, impersonating a nurse. She told us that Judy had real pain, even though a lot of people thought she was a seeker. She said Judy had such severe spasms in her colon that if they were in her femur, they would cause the femur to break. Our ER nurse asked for contact info so we could communicate with the surgeon after our evaluation. They gave a number that when called, got us to Leroy's Tile Company. I called the patient at home and left a message requesting they get us different contact info for the surgeon, because the number given didn't go to a physician's office. Ten minutes later, the patient calls back and says they are going to a different ER due to bad weather. We call that ER and let them know that she is impersonating a nurse in an effort to get narcotics. They CT her to cover their butt and then confront her. She calls our ER at 3 AM to threaten me with a lawsuit for giving personal information out over the phone.

She's filing for bancruptcy because of medical bills and it really breaks me up.

The other patient "Susan" I know about is equally manipulative if only slightly less criminal. Susan brought us all McDonalds one day in celebration of getting medicaid after finally convincing her Doctor to get her put on disability. The next visit, she tried to butter up her nurse by tipping her with your tax money. The nurse took it and paid it to her ginormous hospital bill.

jeeze. sounds to me like she needs a psychiatrist and a methadone clinic.

 

[alexmtr]

Sorry if this point has been brought up before. When comparing healthcare to the rest of ‘goods and services' I feel like there is one huge difference. For most things there are options - you can drive a Toyota or a BMW, shop at Walmart or Neiman Marcus, have McNuggets or lobster for lunch, etc.. The point is – you can have most of the life necessities and attain a reasonable level of comfort on almost any budget. It is not the same with health care – you can't pick a disease you can afford, nor can we adjust the standard of care based on the patient's income.
I went through the whole growing up in a communist/socialist country, coming to the US with nothing, working hard and getting myself there I want to be in life thing, I definitely appreciate the virtues of capitalism and I absolutely want to get paid for my work, however the ‘let the economic forces sort it out' approach to health care bothers me deeply, mostly for the reason above – it is just not the same kind of commodity

 

[Residual]

I agree with what you're saying, but really.. Wiki is the source you lean on to persuade?

Nah, it's just a link that says what it's all about. All the other sites I found were more about methods and I just wanted a summary of the things that can be done with multivariate statistics.

Jarabacao: I don't completely understand how to do what they did myself: just that it's fairly common practice and not regarded as problematic by statisticians. I'll be taking a course in multivariate analysis sometime before I graduate so maybe I'll be able to explain it better then

 

[deleted65604]

Sorry if this point has been brought up before. When comparing healthcare to the rest of ‘goods and services' I feel like there is one huge difference. For most things there are options - you can drive a Toyota or a BMW, shop at Walmart or Neiman Marcus, have McNuggets or lobster for lunch, etc.. The point is – you can have most of the life necessities and attain a reasonable level of comfort on almost any budget. It is not the same with health care – you can't pick a disease you can afford, nor can we adjust the standard of care based on the patient's income.
I went through the whole growing up in a communist/socialist country, coming to the US with nothing, working hard and getting myself there I want to be in life thing, I definitely appreciate the virtues of capitalism and I absolutely want to get paid for my work, however the ‘let the economic forces sort it out' approach to health care bothers me deeply, mostly for the reason above – it is just not the same kind of commodity

This is an interesting argument. Based on this argument, I would love to give everyone in America free healthcare since you can't possibly be comfortable without access to free health insurance. The first problem we run into is that we can't afford it at this point in our debt-riddled struggling economy.

However, you established that other things such as transportation, food, housing, utilities, and clothes can be attained very cheaply on any budget. Therefore, I think it is reasonable to cut government spending on these budgetary items. Where do you want to cut spending in order to get healthcare?

 

[deleted65604]

I lived in France for a bit, though I was not born there.

I've never lived in France. What did you do there? Were you a student? Were you working? How many times did you seek medical care there and how many times have you sought medical care here in the US? How was your experience different in the two countries? What made you come to the US, as opposed to France? Where were you born, and what was the healthcare system there like? Other than give free healthcare to everyone, what would you change about the US system, and what attributes about the other healthcare systems that you've experienced would you bring to our system?

I ask because I haven't been to France before. I've only lived in a third world country that really didn't have much of a formal healthcare system (other than living here in the US)

 

[WhyOhWhy]

This is an interesting argument. Based on this argument, I would love to give everyone in America free healthcare since you can't possibly be comfortable without access to free health insurance. The first problem we run into is that we can't afford it at this point in our debt-riddled struggling economy.

However, you established that other things such as transportation, food, housing, utilities, and clothes can be attained very cheaply on any budget. Therefore, I think it is reasonable to cut government spending on these budgetary items. Where do you want to cut spending in order to get healthcare?

Cut funding for education. We are a nation of lazy people. Some should be taught to work for things before theyre given great the American privelages such as recess and nap time.

 

[alexmtr]

This is an interesting argument. Based on this argument, I would love to give everyone in America free healthcare since you can't possibly be comfortable without access to free health insurance. The first problem we run into is that we can't afford it at this point in our debt-riddled struggling economy.

That's a bit of a 'straw man' argument there, as I did not at any point attempt at offer a solution of any sort - FREE or not (and in any case - what exactly is wrong with aspiring to make AFFORDABLE and QUALITY health insurance available to everyone?). My point was that health care is NOT the same as other things that we allow market forces to regulate, it is not a matter of "comfort" - that's all. If you think it is - would you not let uninsured/poor people into your emergency room..? I'm guessing the answer is no, so what do you propose we do with them (and 'them' could be any of us one day! life happens) if they can't afford that MRI....?

However, you established that other things such as transportation, food, housing, utilities, and clothes can be attained very cheaply on any budget. Therefore, I think it is reasonable to cut government spending on these budgetary items. Where do you want to cut spending in order to get healthcare?

Again, I said “reasonable level of comfort on almost any budget” – how you got VERY CHEPLY out of that I am not sure. I believe, for MOST people who are REASONABLY comfortable financially most of those things are not subsidized by the government – we all choose what we can afford out of all the options the market can offer to us. Once again – my point was that health care is different.
At no point, btw did I say anything about government paying for everyone’s free health insurance. This is obviously a very long and complicated topic which I am not going to get into, but in short - how about decreasing spending within the health care system itself? And how about all the money that going towards the insurance companies profits? If more people had insurance (the kind that has the patient’s welfare as the primary purpose for its existence and not making money for the insurance companies) wouldn’t that be a good first step in breaking the ‘vicious cycle’ of increasing health care spending? There is no perfect solution, what we have now is clearly not working (For anyone! Physician salaries, which is usually the argument for keeping things the way they are, are going down too!). ‘Patching up’ the current system is not going to cut it either – it is too much of a mess as is. We need something different at its core. If you are going to offer criticism to others’ ideas, I’d like to hear your solution as well. ‘We can’t afford it’ is not a good argument to keep wasting money on something that’s not working.

 

[deleted65604]

If you think it is - would you not let uninsured/poor people into your emergency room..?

The government has mandated that I see all comers, so it is a moot point. I believe in charity. Charity is the interaction whereby people who need something ask for it from somebody else that can give it to them. In this interaction, the recipient and the giver are elevated, enriched, and made into more compassionate people.

When somebody forces me, under threat of fines or imprisonment, to take my services and give them to another person that demands them and thinks it is their right to my services, that is destructive to my compassion and degrades the character of the recipient. This is why socialism doesn't work... because ultimately, we are imperfect. Some rich are selfish with their money and some poor abuse the system. As a result, socialism can only be carried out under the point of a gun, with constant rebellion and constant brutal repression of the people.

what do you propose we do with them (and 'them' could be any of us one day! life happens) if they can't afford that MRI....?

I see no difference between an MRI and a transmission for your car. Both are expensive, both are needed for the comfort and mobility, indeed sometimes, the very livelihood of the person. Growing up, I lived 30 miles from a grocery store in the middle of a desert. At times, a transmission was absolutely necessary for our survival.

And how about all the money that going towards the insurance companies profits?

Instead, would you rather the money go into the terrible waste of bureaucracy that always results from government regulation? I'm sure you have massive amounts of free-time, so let me ask a favor, read the book, "The Death of Common Sense". Then PM me and see if it changes your perspective at all. I'll read your favorite liberal book and do the same.

There is no perfect solution, what we have now is clearly not working (For anyone! ... ‘We can't afford it' is not a good argument to keep wasting money on something that's not working

I would also accuse you of putting up a straw man with that argument. I believe that our system actually works rather well. It is expensive because people DEMAND lots of medical care. Last week, I had a patient check into the ER because she wanted her toe-nail removed. It had already detached itself 90% of the way, and was swinging by one tiny attachment at the corner. I ripped the thing off and sent her on her way thinking, "Why didn't she do that herself? There was no sign of infection, numbing the thing would have caused more pain than simply pulling it off. The ridiculousness of demands that you get as a physician are insane. There has got to be a financial DISINCENTIVE to seek medical care, or there will be even more of this insanity.

 

[Birdstrike]

so what do you propose we do with them (and 'them' could be any of us one day! life happens) if they can't afford that MRI....?

My grandparents did just fine when they were coming up in the '30s and '40s before MRIs even existed, when no one got MRIs. Yet, it's quite interesting that now it's a tragedy, an appalling human rights violation, because one person gets one and another doesn't, yet when no one got one everything was hunky dory. Its called: manufacturing a false crisis for political gain.

The government has mandated that I see all comers, so it is a moot point.....The ridiculousness of demands that you get as a physician are insane.

I predict you'll see more and more Emergency Physicians leaving the field, and less choosing the field because of the extent we're s--t on by the government, patients, hospital administration, consultants, lawyers and insurance companies making the sacrifices much greater than the gains.

 

[Apollyon]

My grandparents did just fine when they were coming up in the '30s and '40s before MRIs even existed, when no one got MRIs. Yet, it's quite interesting that now it's a tragedy, an appalling human rights violation, because one person gets one and another doesn't, yet when no one got one everything was hunky dory.

Up to the first half of the 20th century, there were two categories of people: the healthy, and the dead. No one was sick. You had a stroke, you died. Renal failure, you died. Diabetes, you died. Seizures, you died. MI, you died. CHF, you probably died (Andrew Jackson was a notable exception). Pneumonia, you REALLY died.

I woulda been dead, because I'm diabetic (the "real" kind - bad pancreas; the type 2 is point-blank due to the American diet). Now, however, due to the advances that a relatively few had available to them, but everyone knew about, now, everyone wants everything, and that's not possible. In the 60's, before Medicare, there were not many HD machines available, and there were committees to rule on who got dialyzed and who didn't. THAT is a sobering duty.

Today, though, you see Stephen Hawking spitting natural selection in the face, and everyone wants that. And for free, at that.

 

[alexmtr]

The government has mandated that I see all comers, so it is a moot point. I believe in charity. .... This is why socialism doesn't work... because ultimately, we are imperfect. Some rich are selfish with their money and some poor abuse the system. As a result, socialism can only be carried out under the point of a gun, with constant rebellion and constant brutal repression of the people.

I am not advocating socialism. I have 15 years of personal experience with it and you are right - humans are too imperfect to make it work the way it is supposed to in theory, but EXACTLY the same is true about capitalism - there are greedy and selfish people and there are charitable people in any social or political system. And unfortunately, if there are no safeguards at all - charity will only take you so far. In general, extremes in either too many or too few 'regulation' and safeguards are bad - I do not need my coffee cup to tell me my coffee is hot, but I am definitely happy to have health insurance = predictable health care costs.

I see no difference between an MRI and a transmission for your car. Both are expensive, both are needed for the comfort and mobility, indeed sometimes, the very livelihood of the person.

In principle - sure, both can be essential to life. But in practice - how many actual lives have you saved with a medical intervention vs. a transmission? Not to mention, that health care is REALLY expensive - one day in a hospital can easily end up costing as much as a whole car. It is unrealistic to expect people to sell their first-born child into slavery if they broke a bone, got appendicitis, etc.. Now, REASONABLE cost of care is definitely something we all should be responsible for. Like, let's say a good affordable health insurance plan, for example. The argument, of course, goes that no one should be forced to pay for that. But what happens to people who choose not to and can't afford the actual cost of their care? Forget about EMTALA, as you obviously don't like it (no one likes it when it is being abused). What if there was no law? Would you feel charitable towards people who knowingly chose not to pay for health insurance? The point is responsible people will always be responsible - they will purchase insurance and they won't abuse free care, and abusers will always be there - socialism or capitalism is powerless against that.
Your lady with a toenail, for example - what kind of disincentive for showing up (or incentive for paying for it) would someone like her need? If she at least had mandatory insurance (let's face it - she's not going to buy it otherwise) with a $50 ED co-pay or some such thing it wouldn't be as much of a waste. My main point is that unless you flat out REFUSE to care for people who are not paying, are being entitles a-holes and are not inspiring too much charity in anyone, there is no way to stop people from abusing the system (any system).
Moving on from curbing all the abusers - what about the people who genuinely need care and can't afford to pay for it out of pocket? Do you believe that the current system allows your responsible patients to afford the kind of health insurance that let's you practice the best medicine you see fit within the limits sat by the insurance companies? Or withing the limits of what the average person can afford to pay for out of pocket?

(Thanks for the book recommendation, BTW heard about it before - it's now on my audible wish list. Doing my MICU sub-I my last 4 weeks, so not as much free time as a self-respecting 4th year should have
As far as 'liberal books' go - Molly Ivins jumped to mind as she is hilarious and I love the way she writes, but she comes on really strong, so probably not the best 'introductory liberal reading' - so I'll get back to you on that )

 

[alexmtr]

My grandparents did just fine when they were coming up in the '30s and '40s before MRIs even existed, when no one got MRIs. Yet, it's quite interesting that now it's a tragedy, an appalling human rights violation, because one person gets one and another doesn't, yet when no one got one everything was hunky dory. Its called: manufacturing a false crisis for political gain.

Really? I mean, MRI was just an example - there are very few things in health care, even 'basic' things, an average person can actually afford... I am guessing your point is not that we should apply leaches for blood letting and send them home to say their prayers if they can't pay for an MRI... so what is it? (btw, I wasn't at any point proposing to give free MRIs to everyone with an ingrown toenail or anything like that...)

 

[deleted65604]

How to improve the system?

1. The republicans constantly argue (and the democrats ignore them constantly) that we should let insurance companies provide insurance accross state lines. Sounds reasonable to me.

2. We need to encourage (allow) charitable giving on the part of physicians. It is currently prohibited to bill someone less than a medicare or medicaid patient. So, if you try to be charitable as a physician, you get charged with medicare fraud. Physicians should be able to see patients for free and deduct the services on their taxes. Underserved populations would quickly get care as physicians love to see patients, and love more to keep their money out of the governments hands. Win, win situation.

3. Welfare needs to be one agency, rather than splintered into medicare, medicaid, food stamps, WIC, etc. There are a lot of families who are double dipping, with multiple family members on medicaid/ food stamps, all living under the same, government subsidized housing. When the government has numerous agencies, one hand doesn't know what the other does.

4. Malpractice reform... please, please, pretty please.

 

[UnderwaterDoc]

4. Malpractice reform... please, please, pretty please.

Yes, yes, and a thousand times yes. I think this one would go the longest into making healthcare cost "reasonable". I cringe at the thought of all the useless studies that I'm gonna have to order because of medicolegal reasons.

 

[deleted65604]

The point is responsible people will always be responsible - they will purchase insurance and they won't abuse free care, and abusers will always be there - socialism or capitalism is powerless against that.

I believe that there are a lot of responsible people out there who choose not to buy insurance. Just like some people gamble with the stock market or literally in Las Vegas, some people gamble that they won't have significant medical bills and don't get insurance. I think that is their right. When you are a generally healthy person, paying the occasional PCP bill out of pocket or prescription is much cheaper than paying for insurance.

what about the people who genuinely need care and can't afford to pay for it out of pocket? Do you believe that the current system allows your responsible patients to afford the kind of health insurance that let's you practice the best medicine you see fit within the limits sat by the insurance companies? Or within the limits of what the average person can afford to pay for out of pocket?

I think that the current system takes care of those people, even without insurance for emergent conditions. Hospitals tend to write off medical bills of self-pays who can prove their financial hardship. It is exceedingly bad press to bankrupt people over medical bills. Most communities have sliding scale, government subsidized clinics to provide primary care for indigent populations. The four dollar lists that have become universal allow you to treat 95% of conditions, whether urgent, emergent or chronic for a pittance.

I had a patient who had an ACL tear. She came to me at 4 AM one morning because she hurt really bad. She had previously talked to our financial counselor, had applied for medicaid but didn't qualify. The hospital had written off her MRI, and had agreed to pay for the surgical part of her surgery. The orthopedic surgeon said he would fix her knee for $5,000 (remember that to charge less would be medicare fraud). She thought that if I demanded that it was an emergency, that the orthopod on call would come in emergently and fix it for free. After I picked myself off the ground and gave myself a couple albuterol puffs to ease the asthma attack I gave myself from laughing so hard, I told her I couldn't help her.

These are the patients that fall through the cracks... those that could use elective surgeries, but don't qualify for medicaid. These are the patients that could use charity from doctors. Doctors would be much more likely to help if they got a tax incentive to help the poor. Rather than trash the current system, how about a fund for people to get elective (necessary) procedures that we could donate to for our local patients. I think that a fund managed by local physicians in a community would be the most efficient way to disburse charitable monies, be they private or from the government.