For Pro-Reform Pathologists IPAD or OPAD?

[exPCM]

"All I know about this is...I paid for it, and it won't start working until 2014."

http://www.youtube.com/user/bulletpeople#p/u/1/u3qiSXc1g3M

---

Members don't see this ad.

 

[Parts Unknown]

For you... MaxiPAD.

 

[pathstudent]

For you... MaxiPAD.

That wasn't a manicure. That wasn't a pedicure. That was a facial!

 

[BrainPathology]

"All I know about this is...I paid for it, and it won't start working until 2014."

http://www.youtube.com/user/bulletpeople#p/u/1/u3qiSXc1g3M

Yeah just like we all paid for our undergraduate and medical school education up front or with loans and they won't start working for any of us for at least 12 years after we started.

Certainly.. if you pay for somthing complicated you shouldn't expect to actually have to WAIT to get a benefit.. that's just crazy talk. Farmers should demand refunds when their seeds take ALL summer to grow, if your tumor isn't cured after the FIRST dose of chemo that's clearly malpractice!

 

[Parts Unknown]

Yeah just like we all paid for our undergraduate and medical school education up front or with loans and they won't start working for any of us for at least 12 years after we started.

Certainly.. if you pay for somthing complicated you shouldn't expect to actually have to WAIT to get a benefit.. that's just crazy talk. Farmers should demand refunds when their seeds take ALL summer to grow, if your tumor isn't cured after the FIRST dose of chemo that's clearly malpractice!

If you actually read the final CBO report (page 5) you see that changes in revenue, like changes in expenditure, take a few years to ramp up while things get phased in. In my view, that makes this whole line of argument rather bizarre, and suggests that reform opponents are running on fumes (a shame, since cogent arguments against the reform law can be made, just not like this tripe).

 

[lipomas]

suggests that reform opponents are running on fumes (a shame, since cogent arguments against the reform law can be made, just not like this tripe).

AMEN. I cannot figure out why people who are against this healthcare bill continue to perpetuate false rumors (like death panels, going to jail for not buying insurance, healthcare for illegals) when there are thousands of REAL reasons to be against it. Don't people get it? When you base your arguments on falsehoods or irrelevant points, your overall opinion is basically worthless because it comes across as uninformed.

This bill has huge problems. I am against it too. One of the main reasons I am against it is because so many people say, "it's better than nothing." Excuse me? How is that helpful? This bill does nothing to control health care expenditures and in fact probably worsens that problem by expanding public coverage, covering more prescription payments, and increasing payments to certain providers. The only way in which it attempts to control expenditures is to rely on the lack of an SGR fix, which is political suicide.

It burns me that so many people who are against this bill are actually not against it (because they don't want any cuts to their medicare and they in fact want their medicare to cover more, but they don't want higher taxes either). They simply claim to be against it for fraudulent reasons, conspracies, or just outright hatred of something or someone. Ignorance is not a reason to reject a bill!

 

[Parts Unknown]

This bill does nothing to control health care expenditures

This actually not true. For a nice breakdown try Timothy Jost's summary analysis of the Senate bill (he's a contributor to the journal Health Affairs's website).

Per the CBO, enacting the SGR fix in addition to the current reform law would increase the deficit by $59 billion over the 2010-2019 timeframe. Considering we have been blowing way more per year on our little excursions in the other hemisphere, I don't think that's too shabby.

 

[lipomas]

Thanks for the link - that is interesting. Of course, a lot of the cost savings are theoretical and based on assumptions which may not be totally valid. And the overall price tag is somewhat hidden by tax increases. I do maintain that for a bill which claims to "reform" healthcare, it doesn't do much to control expenditures.

I personally dislike the whole concept of "pay for performance" as well as bundling and the like. The former encourages cherry-picking among physicians and the latter encourages physician-physician competition and unethical behavior. Tying pay to quality works well in mechanical industries, but health care is not the same. Complications happen when best practices are followed. Not every tumor behaves the same way - but yet such policies attempt to define them as such. Again, I am unsure what an alternative is, but pretty much anything would be preferable.

 

[Parts Unknown]

Thanks for the link - that is interesting. Of course, a lot of the cost savings are theoretical and based on assumptions which may not be totally valid.

True, but what other options are there? If acceptable cost control measures were already known, this would be a no-brainer. Alas, we are in uncharted waters. Paul Krugman has an interesting take on this topic:

Furthermore, there's good reason to believe that all such estimates are too pessimistic. There are many cost-saving efforts in the proposed reform, but nobody knows how well any one of these efforts will work. And as a result, official estimates don't give the plan much credit for any of them. What the actuary and the budget office do is a bit like looking at an oil company's prospecting efforts, concluding that any individual test hole it drills will probably come up dry, and predicting as a consequence that the company won't find any oil at all — when the odds are, in fact, that some of the test holes will pan out, and produce big payoffs. Realistically, health reform is likely to do much better at controlling costs than any of the official projections suggest.

And the overall price tag is somewhat hidden by tax increases.

I'd say the overall pricetag has been well publicized to anyone paying even a modicum of attention.

I personally dislike the whole concept of "pay for performance" as well as bundling and the like. The former encourages cherry-picking among physicians and the latter encourages physician-physician competition and unethical behavior. Tying pay to quality works well in mechanical industries, but health care is not the same. Complications happen when best practices are followed. Not every tumor behaves the same way - but yet such policies attempt to define them as such. Again, I am unsure what an alternative is, but pretty much anything would be preferable.

There are a lot of creative ideas floating around, many worth trying, a few might even pan out. Try this NEJM article on the so-called Prometheus Payment Model.

 

[malchik]

Yes, but see David Brooks' piece:

http://www.nytimes.com/2010/03/09/opinion/09brooks.html

 

[schrute]

AMEN. I cannot figure out why people who are against this healthcare bill continue to perpetuate false rumors (like death panels, going to jail for not buying insurance, healthcare for illegals) when there are thousands of REAL reasons to be against it. Don't people get it? When you base your arguments on falsehoods or irrelevant points, your overall opinion is basically worthless because it comes across as uninformed.

This bill has huge problems. I am against it too. One of the main reasons I am against it is because so many people say, "it's better than nothing." Excuse me? How is that helpful? This bill does nothing to control health care expenditures and in fact probably worsens that problem by expanding public coverage, covering more prescription payments, and increasing payments to certain providers. The only way in which it attempts to control expenditures is to rely on the lack of an SGR fix, which is political suicide.

It burns me that so many people who are against this bill are actually not against it (because they don't want any cuts to their medicare and they in fact want their medicare to cover more, but they don't want higher taxes either). They simply claim to be against it for fraudulent reasons, conspracies, or just outright hatred of something or someone. Ignorance is not a reason to reject a bill!

No but principle is. Rejecting the notion that the govt exists to perform favors, that healthcare is a right, that it is constitutional to force someone to purchase a service or face a fine, and that guarantee issue won't cause gradual premium rate increases to the point that private insurance is unaffordable (ins cos can't remain solvent forever with govt restraint on rate increases)...are principled positions, not fear mongering.

Casting aside the "death panel" people, the basis of opposition lies in the belief that a massive overarching trillion dollar permanent program is a bad approach to reform, with the recognition that individual componets should be implemented in a step by step fashion. If your problem with implementing a few items at a time is that it is too "slow", I remind you that we'll see no affect of the current bene's for several yrs...not like its instantaneous.

People claim they desire compromise (which didn't happen) and simultaneously insist the admin is justified in ramming though a partisan bill on less-then-majority grounds. It can't be both.

 

[Parts Unknown]

People claim they desire compromise (which didn't happen) and simultaneously insist the admin is justified in ramming though a partisan bill on less-then-majority grounds. It can't be both.

I'm a bit confused about the bolded part. The Senate bill passed the Senate 56-43, and it passed the House 219-212. The reconciliation bill passed the Senate 56-43, and passed the House 220-207.

 

[Art]

I'm a bit confused about the bolded part. The Senate bill passed the Senate 56-43, and it passed the House 219-212. The reconciliation bill passed the Senate 56-43, and passed the House 220-207.

While it is a slim majority, 56 out of 99 is greater than 50 out of 99, and 220 out of 427 is greater than 214 out of 427.

Also, recent polling shows that the public are more enthusiastic about the bill now that it has been passed. Again, slim numbers but there is a majority.
http://voices.washingtonpost.com/ezra-klein/2010/03/poll_health-care_reform_more_p.html

 

[Art]

No but principle is. Rejecting the notion that the govt exists to perform favors, that healthcare is a right, that it is constitutional to force someone to purchase a service or face a fine, and that guarantee issue won't cause gradual premium rate increases to the point that private insurance is unaffordable (ins cos can't remain solvent forever with govt restraint on rate increases)...are principled positions, not fear mongering.

Casting aside the "death panel" people, the basis of opposition lies in the belief that a massive overarching trillion dollar permanent program is a bad approach to reform, with the recognition that individual componets should be implemented in a step by step fashion. If your problem with implementing a few items at a time is that it is too "slow", I remind you that we'll see no affect of the current bene's for several yrs...not like its instantaneous.

People claim they desire compromise (which didn't happen) and simultaneously insist the admin is justified in ramming though a partisan bill on less-then-majority grounds. It can't be both.

One benefit that does begin starting in September is allowing children to stay on their parents' health insurance plan until they are age 26. For those recent college graduates who have yet to find a job, this can be a major benefit, both for the recent graduate and her/his parents.

 

[earmuff]

Rejecting the notion...that healthcare is a right...

In all honesty, I think this is the major difference between supporters and denouncers of the health care bill passage. If you ask Europeans, Canadians, Australians, etc., how they feel about health care as a right, I'm guessing the overwhelming majority would agree that it is.

As physicians, why don't we see the relief of suffering as a basic human need? Carrying a semi automatic weapon is a right, but access to blood pressure screening isn't? What a joke.

I don't buy the economic reasoning behind not providing health care when we waste money left and right. If you need to balance your budget, you eliminate non-essential spending.

You don't stop buying food if your car payment is too high.

You don't say there isn't money for health care when you're fighting two unnecessary wars.

 

[Entgegen]

As physicians, why don't we see the relief of suffering as a basic human need? Carrying a semi automatic weapon is a right, but access to blood pressure screening isn't? What a joke.

I don't think a "need" is the same thing as a "right"...people "need" food, water, and shelter, but these are not guaranteed rights. As to healthcare being a guaranteed right, it seems that it would be the only "right" (or perhaps another example escapes me at the moment) that is a service bestowed upon people by someone else. The "right" to healthcare would effectively give people the "right" to a physician's time and effort. The right to, say, carry a gun comes at no one else's expense other than one one carrying it.

 

[pathstudent]

People will have a right free medical doobies. That will kill off the illegal marijuana trade and also screw the state and federal govt which had a chance to tax that stuff like smokes and booze.

 

[Thrombus]

You don't stop buying food if your car payment is too high.

We live in a country where you don't pay for health care if your cell phone, i-MAC, car(s), house, haircut, tattoos, gold jewelry, and other toys cost too much.
Someone else should pay for that health care. It their right!

 

[earmuff]

I don't think a "need" is the same thing as a "right"...people "need" food, water, and shelter, but these are not guaranteed rights.

Why not? What does it say about our society? Just because it is so doesn't make it okay.

The "right" to healthcare would effectively give people the "right" to a physician's time and effort.

Not true. No one is forcing anyone to provide care. You will be paid for your efforts. You will still have the option to opt out of providing for certain insurers. This is about the right to access insurance, not the right to knock on your physician's door and demand he excise your mole.

.

 

[earmuff]

We live in a country where you don't pay for health care if your cell phone, i-MAC, car(s), house, haircut, tattoos, gold jewelry, and other toys cost too much.
Someone else should pay for that health care. It their right!

You're a jerk.

 

[Thrombus]

You're a jerk.

Or flat-screen TV's, DVD's, DVR's, DVR recorders, ETOH, Tobacco, Junk Food

Hmmmm.....and people can't afford to pay to see a doctor outside the ER? After their 30 hour work week?

My my my. You liberals are so compassionate to want the responsible half of the citizenry to subsidize this behavior and grant them their "rights".

(Obviously Earmuff the liberal doesn't live in the real world or wasn't raised by a family who prioritized their spending in sacrificing most of the above things in order to pay for more basic needs like health care...Earmuff wants the irresponsible to have their cake and eat it too on my back and I think he is a jerk for that myself but shhhh dont tell him)

 

[pathstudent]

It is worth pointing out that fifty percent of all households pay no income tax while the top 1% pays 40 percent of all income tax. The health bill will be mostly funded by increasing taxes on the top 2-3% of households. This plan is a clear example of what Jefferson referred to as the tyranny of he majority. I am all for universal coverage but increase taxes on everyone not just a small percentage of people

 

[Parts Unknown]

Or flat-screen TV's, DVD's, DVR's, DVR recorders, ETOH, Tobacco, Junk Food

Hmmmm.....and people can't afford to pay to see a doctor outside the ER? After their 30 hour work week?

Wow, you need to make some new friends.

 

[Nilf]

We live in a country where you don't pay for health care if your cell phone, i-MAC, car(s), house, haircut, tattoos, gold jewelry, and other toys cost too much.
Someone else should pay for that health care. It their right!

Paying for cell phone? Not anymore my friend. If you receive ANY government assistance, you will get a free cell phone and subscription.

http://blog.heritage.org/2010/01/18/government-welfare-cell-phones-for-the-poor/

 

[Parts Unknown]

Paying for cell phone? Not anymore my friend. If you receive ANY government assistance, you will get a free cell phone and subscription.

http://blog.heritage.org/2010/01/18/government-welfare-cell-phones-for-the-poor/

So I followed the link on the Heritage page to the program's website, and read their program information page:

There is no "Obama phone" or other newly created federal program to provide free cell phones. As you may know, this is a myth that is now circulating on the Web via email and blog sites. It has been thoroughly debunked by independent groups. (See for example: FactCheck.org at http://www.factcheck.org/2009/10/the-obama-phone/, which notes: "Low-income households have been eligible for discounted telephone service for more than a decade. But the program is funded by telecom companies, not by taxes, and the president has nothing to do with it."
The federal "Lifeline" program was created during the Reagan Administration. Lifeline is a federal program created by the Reagan era Federal Communications Commission (FCC) in 1984. The program was enhanced under Telecommunications Act of 1996, which was supported on a broadly bipartisan basis in Congress. The FCC’s Low Income Program of the Universal Service Fund, which is administered by the Universal Service Administrative Company (USAC), is designed to ensure that quality telecommunications services are available to low-income customers at just, reasonable, and affordable rates. Lifeline support reduces eligible low-income consumers' monthly charges for basic telephone service.
Thanks to SafeLink, Lifeline support is now available for wireless phones. Traditionally, the Lifeline program was only available as a discount on a consumer’s landline telephone bill. SafeLink Wireless was created by TracFone Wireless, Inc. when the Federal Communications Commission (FCC) recently approved the company to offer Lifeline -- a public assistance program that ensures telephone service is available and affordable for low-income subscribers. SafeLink Wireless applies the Universal Service Fund subsidy to an allotment of free airtime minutes and TracFone provides the wireless handset at the company’s expense. Instead of receiving a subsidized monthly telephone bill for Lifeline service, SafeLink converts the total amount of discounted service into minutes each month for one year. The cell phone offers in-demand features: voicemail, text, three-way calling, call waiting, caller ID and access to 911.
SafeLink phones are not paid for by taxpayers or the federal government. TracFone Wireless pays for the phones and also the cost of promoting its SafeLink program to make sure that eligible consumers know about the program.

The Fact Check link is quite informative, I suggest you check it out.

 

[earmuff]

Earmuff wants the irresponsible to have their cake and eat it too on my back and I think he is a jerk for that myself but shhhh dont tell him)

Can you sense your own anger? Blame is hardly a righteous act.

People who are poor *must* be irresponsible. It couldn't be because they had insurance, but were denied coverage for some stupid reason, and then had to file bankruptcy due to overwhelming medical bills.

Yep, poor people are all lazy, stupid and unfit for sympathy or empathy. You're a real Mother Theresa.

You have obviously never worked as an intern in a hospital. You have obviously never tried to coordinate a discharge plan in this DISGRACEFUL medical system we have.

Ignorance is bliss.

 

[Parts Unknown]

Paying for cell phone? Not anymore my friend. If you receive ANY government assistance, you will get a free cell phone and subscription.

http://blog.heritage.org/2010/01/18/government-welfare-cell-phones-for-the-poor/

Incidentally, if you want to read something really interesting on the Heritage website, try 2006's "The Significance Of Massachusetts Health Reform."

The Massachusetts plan that was hatched under Romney owes much of its underpinnings to input from Heritage. Given the multitude of obvious similarities between the current reform law, the Massachusetts plan, and the Republican counterproposal to Clinton's failed reform effort, there is simply no lack of irony to be had here. Enjoy.

 

[Eta Carinae]

We live in a country where you don't pay for health care if your cell phone, i-MAC, car(s), house, haircut, tattoos, gold jewelry, and other toys cost too much.
Someone else should pay for that health care. It their right!

Or flat-screen TV's, DVD's, DVR's, DVR recorders, ETOH, Tobacco, Junk Food

Hmmmm.....and people can't afford to pay to see a doctor outside the ER? After their 30 hour work week?

My my my. You liberals are so compassionate to want the responsible half of the citizenry to subsidize this behavior and grant them their "rights".

(Obviously Earmuff the liberal doesn't live in the real world or wasn't raised by a family who prioritized their spending in sacrificing most of the above things in order to pay for more basic needs like health care...Earmuff wants the irresponsible to have their cake and eat it too on my back and I think he is a jerk for that myself but shhhh dont tell him)

Serving free dinners at a soup kitchen for "the poor" who "cannot afford" to buy food but have the latest, most expensive gadgets.

That guy's phone is much nicer than mine.

 

[Eta Carinae]

Perhaps you should examine the numbers more closely:

Rational Irrationality 1

Rational Irrationality 2

Even from a Liberal print source, The NewYorker

 

[Parts Unknown]

Perhaps you should examine the numbers more closely:

Rational Irrationality 1

Rational Irrationality 2

Even from a Liberal print source, The NewYorker

Precisely why the reform bill could turn out to be legislative Judo, ushering in single-payer if/when cost control measures fail and the piecemeal public/private insurance system becomes unworkable.

 

[Parts Unknown]

Serving free dinners at a soup kitchen for "the poor" who "cannot afford" to buy food but have the latest, most expensive gadgets.

That guy's phone is much nicer than mine.[/

It's a common misperception that people at soup kitchens are all destitute. This guy could be a staffer (who also usually eat from the line). He could be recently unemployed and conserving money while he looks for work. His phone could have been given to him by a family member. Maybe he is a social parasite. I wish somebody could find him so we could put this one to rest.

 

[earmuff]

It's a common misperception that people at soup kitchens are all destitute. This guy could be a staffer (who also usually eat from the line). He could be recently unemployed and conserving money while he looks for work. His phone could have been given to him by a family member. Maybe he is a social parasite. I wish somebody could find him so we could put this one to rest.

That picture is one of the most overused pieces of propaganda... almost could call godwin's law on that.

Oh yeah, and it's a total misrepresentation. A simple google search yields:

http://www.snopes.com/photos/politics/soupkitchen.asp

 

[earmuff]

Michelle Obama Serves Soup, Nation Misses the Point

I realize half the nation will lose sleep worrying about this issue unless these questions are addressed. So if I may...
First, let's point out the assumptions these critics are making. For one, they assume that every person seeking a meal at a soup kitchen is destitute or homeless. This is not always the case. Staffers may partake of the food line fare (especially with the first lady shows up to serve). It's also possible this man is "doubled up", recently unemployed, or working poor. In any of these situations, he could have a cell phone from a previous life when money wasn't so tight.
Where is his phone bill is being mailed? If he's not actually homeless or if he's doubled up, that's easy enough to figure out. It's also common for transitional shelters to accept mail for guests. Many homeless folks also use post office boxes for their personal mail.
But let's get down to the most important question: Assuming this man is homeless. why is it a big deal if he has a cell phone?
We expect way too much of poor people in this country. Let's face it, you'd have to be a magician with inpenatrable immune system to stretch a minimum-wage job to cover housing, transportation, food, healthcare, childcare and other incidental expenses. We expect homeless people to compete in the workforce without a cell phone, regular computer access, or proper interview attire while struggling to survive on the streets or in shelter. We hear so many amazing stories of people who have successfully fought their way out of homelessness that it becomes too easy to forget how challenging it actually is to beat the odds and get off the streets.
So yes, this guy has a cell phone. If this means he has an important job-searching tool, a way for him to keep in touch with loved ones, or a way to call for help if he becomes the next victim of a hate crime, then we should be grateful that programs exist to provide these invaluable services to folks who are struggling.
Finally, if that cell phone camera allows this man to snap a picture when he's starstruck by an unexpected encounter with the first lady, good for him. He'll have at least one inspiring memory from the difficult circumstances that led him to Miriam's Kitchen in the first place.

http://homelessness.change.org/blog/view/michelle_obama_serves_soup_nation_misses_the_point
<!-- Tags:
-->