FRONTLINE: Sick Around America

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Thanks for posting this. Everyone should sit down and watch this. I think universal healthcare is inevitable.
Will we, the providers, ever agree to bring down the cost of doing business?

rlxdmd
 
Thanks for posting this. Everyone should sit down and watch this. I think universal healthcare is inevitable.
Will we, the providers, ever agree to bring down the cost of doing business?

rlxdmd


Does it even matter? We as physicians take a tiny piece of the health care pie (less than 10%). Even if we reduce our take home by 50%, little will change. This has been going on over the last several decades, our salaries have been shrinking, costs have been ballooning, patients paying more. How about we start by looking at the fat that we can trim outside of the physician's income. It is outrageous that we have been conditioned to believe that we as physicians giving up more is the way to solve the health care crisis.....the more we give up, the more those dollars find their way into some executive MBA's pocket. To hell with that.
 
Does it even matter? We as physicians take a tiny piece of the health care pie (less than 10%). Even if we reduce our take home by 50%, little will change. This has been going on over the last several decades, our salaries have been shrinking, costs have been ballooning, patients paying more. How about we start by looking at the fat that we can trim outside of the physician's income. It is outrageous that we have been conditioned to believe that we as physicians giving up more is the way to solve the health care crisis.....the more we give up, the more those dollars find their way into some executive MBA's pocket. To hell with that.

You are right, morpheus. The documentary touches on this, namely that 24% of healthcare dollars go to administration of healthcare and never actually reach the patient.

I agree with the program that we need a "herd" mentality with regards to coverage (i.e. that everyone needs to have insurance and pay into the system... something that isn't happening now until people get to the age where they start to get sick). I don't know how you meaningfully accomplish this with current private, for-profit insurance companies that consider people who extract money for services as a "loss" (which the program also discusses).

I took care of a guy today, 55 years-old, prior AVR/MVR, morbidly obese, CHF (NYHA Class III), and poorly controlled diabetes. The guy, in no other words, was a fat slob. As I was sitting there interviewing him in the pre-op area, his daughter was chastizing him for waiting so long before coming to the hospital. He was hella-sick by the time he got to me. And, what could've been a routine problem relatively easy to fix, is now - literally - going to cost hundreds of thousands of dollars.

And this guy knew better.

He was already "in the system", so to speak. He had doctors at our hospital already seeing him. He'd been operated there before. He was being followed, although a review of his scheduled visits in our computerized patient-visit tracking system revealed a shotty record of attendance. Fact is, he was just too goddamn lazy to come to the hospital until he was near death.

That's the unquantifiable intangible that I don't think programs like this can quantify, and I'm not sure how you can change it. It would be okay if occassionally people presented to the hospital this way, but the fact is our country is full of fatter and sicker people than ever... and it seems the majority of them are presenting to the hospital this way. I go to the grocery store and I routinely see train wrecks that are just waiting to come across our doors.

We need to get tough. Part of that is a "carrot and stick" approach. One "carrot" is that people pay for their own health insurance - mandated coverage - but they get to write it off. The "stick" is they are fined if they don't have coverage, just like you would be if you got pulled over by the police and didn't have automobile insurance.

Another "carrot" is that people get an additional deduction for maintaining an ideal body weight, and a fine for being for being overweight (the "stick").

Yes, there was no mention of the providers as part of the solution. Likewise, this problem is so complex that the program only skimmed the surface of many of the issues we face. But, we need to seriously put part of the onus of "change" back on the individual in the system. People need to grow up, take care of themselves, and live better lives through effective preventive medicine.

But, as the old saying goes, you can lead a horse to water but you can't make him drink. And, Americans, on the whole, have been programmed that they can get whatever they want no matter what the cost even if they can't afford it... and the fixes proposed, remaining under the current system, we can't afford.

-copro
 
Does it even matter? We as physicians take a tiny piece of the health care pie (less than 10%). Even if we reduce our take home by 50%, little will change. This has been going on over the last several decades, our salaries have been shrinking, costs have been ballooning, patients paying more. How about we start by looking at the fat that we can trim outside of the physician's income. It is outrageous that we have been conditioned to believe that we as physicians giving up more is the way to solve the health care crisis.....the more we give up, the more those dollars find their way into some executive MBA's pocket. To hell with that.


👍👍👍
 
Another "carrot" is that people get an additional deduction for maintaining an ideal body weight, and a fine for being for being overweight (the "stick").

While I agree with your carrot and stick model, people would start crying if this happen. "Waah Waah, I'm overweight due to genetics. It is not my fault I like eating a package of cookies a day!" Not politically correct.
 
You are right, morpheus. The documentary touches on this, namely that 24% of healthcare dollars go to administration of healthcare and never actually reach the patient.

I agree with the program that we need a "herd" mentality with regards to coverage (i.e. that everyone needs to have insurance and pay into the system... something that isn't happening now until people get to the age where they start to get sick). I don't know how you meaningfully accomplish this with current private, for-profit insurance companies that consider people who extract money for services as a "loss" (which the program also discusses).

I took care of a guy today, 55 years-old, prior AVR/MVR, morbidly obese, CHF (NYHA Class III), and poorly controlled diabetes. The guy, in no other words, was a fat slob. As I was sitting there interviewing him in the pre-op area, his daughter was chastizing him for waiting so long before coming to the hospital. He was hella-sick by the time he got to me. And, what could've been a routine problem relatively easy to fix, is now - literally - going to cost hundreds of thousands of dollars.

And this guy knew better.

He was already "in the system", so to speak. He had doctors at our hospital already seeing him. He'd been operated there before. He was being followed, although a review of his scheduled visits in our computerized patient-visit tracking system revealed a shotty record of attendance. Fact is, he was just too goddamn lazy to come to the hospital until he was near death.

That's the unquantifiable intangible that I don't think programs like this can quantify, and I'm not sure how you can change it. It would be okay if occassionally people presented to the hospital this way, but the fact is our country is full of fatter and sicker people than ever... and it seems the majority of them are presenting to the hospital this way. I go to the grocery store and I routinely see train wrecks that are just waiting to come across our doors.

We need to get tough. Part of that is a "carrot and stick" approach. One "carrot" is that people pay for their own health insurance - mandated coverage - but they get to write it off. The "stick" is they are fined if they don't have coverage, just like you would be if you got pulled over by the police and didn't have automobile insurance.

Another "carrot" is that people get an additional deduction for maintaining an ideal body weight, and a fine for being for being overweight (the "stick").

Yes, there was no mention of the providers as part of the solution. Likewise, this problem is so complex that the program only skimmed the surface of many of the issues we face. But, we need to seriously put part of the onus of "change" back on the individual in the system. People need to grow up, take care of themselves, and live better lives through effective preventive medicine.

But, as the old saying goes, you can lead a horse to water but you can't make him drink. And, Americans, on the whole, have been programmed that they can get whatever they want no matter what the cost even if they can't afford it... and the fixes proposed, remaining under the current system, we can't afford.

-copro


Look there always were and always will be sick people. I am hesitant to blame fat sick people who dont follow the advice of their physicians for the "goat rodeo" we call our health care system. the problem is it is a FOR PROFIT system. LET ME REPEAT. IT IS A FOR PROFIT SYSTEM. and where do we live? USA.. HOME OF CAPITALISM. THE MORE THE BETTER. so why do you think we have escalating costs? not to mention we have ICU's now, antibiotic coated catheters, pacemakers that cost 20 large, we have nurses making 80k plus benefits for 36 -44 hours. Not to mention we have to order every test under the sun to make our risk management dept happy. COPRO, the problem aint with the patients. The problem is with the system. I would start by auditing every single insurance company and make an initiative to get rid of them.There are 1500 insurance companies in the usa. All of them have a ceo making at least a few mil. add that up. I would start there.
 
Another "carrot" is that people get an additional deduction for maintaining an ideal body weight, and a fine for being for being overweight (the "stick").

Um yeah, I'm pretty sure that would be illegal. You're not allowed to make laws targeting certain individuals.
 
Insurance companies pretty much do this.

Insurance companies target certain clients and provide benefits to existing customers choosing a healthy lifestyle. They're looking for a way to maximize profits and that's their prerogative.

What he's proposing (if I read that correctly) is a change in tax law....

Skinny person = deduction
Fat Person = no deduction + fine

Which, is a clear violation of equal protection.
 
all about incentives. fix the incentives, fix the problem.
 
Think about how much money could be saved if we just fired every OR nurse in the United States.

We could replace them with, well, anyone off the street who wanted a minimum wage job where they could surf the net and occasionally fetch another pack of 2-0 Vicryl.
 
Think about how much money could be saved if we just fired every OR nurse in the United States.

We could replace them with, well, anyone off the street who wanted a minimum wage job where they could surf the net and occasionally fetch another pack of 2-0 Vicryl.


:laugh: :laugh: :laugh:
This is hilarious.
 
Insurance companies target certain clients and provide benefits to existing customers choosing a healthy lifestyle. They're looking for a way to maximize profits and that's their prerogative.

What he's proposing (if I read that correctly) is a change in tax law....

Skinny person = deduction
Fat Person = no deduction + fine

Which, is a clear violation of equal protection.

I recognize that this will require a large paradigm shift.

-copro
 
I recognize that this will require a large paradigm shift.

-copro


So after we repeal the 14th amendment and shift our paradigm to allow for government bias....who do we target after the fat people? Are we going to have people fill out lifestyle questionnaires so we can tax them accordingly? Or how about we adjust brackets to account for racial based medical problems?
 
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So after we repeal the 14th amendment and shift our paradigm to allow for government bias....who do we target after the fat people? Are we going to have people fill out lifestyle questionnaires so we can tax them accordingly? Or how about we adjust brackets to account for racial based medical problems?

Ah... details... details.

-copro
 
all about incentives. fix the incentives, fix the problem.
>
Like, remove the incentive for litigation. Many of you have posted about this recently, I'm curious what percentage of lawsuits against hospitals in the US are actually about malpractice? Christ.....if someone sued a hospital because an employee farted in the elevator, the expectancy is that the hospital would just settle.

While Corpro's suggestion of a "large paradigm shift" is........ uummm.........edgy, the more time goes by the more I realize I need to seperate myself, and my children, from this "Mt. Dew" generation. Incentives for personal accountability seems like a logical place to start.
 
Skinny person = deduction
Fat Person = no deduction + fine

Which, is a clear violation of equal protection.

I can't wait until the airlines start charging extra for fat people. They should have to sit next to each other too. American took their airline magazines out to save on fuel. It's only a matter of time for Copro's paradigm shift. I'm not holding my breath though.
 
I can't wait until the airlines start charging extra for fat people. They should have to sit next to each other too. American took their airline magazines out to save on fuel. It's only a matter of time for Copro's paradigm shift. I'm not holding my breath though.

They already tried this to large public outcry.

Listen, as many of you know and those of you who "get" me, I'm intentionally provocative and often use not-so-subtle reductio ad absurdum as a form of making a point. Many of you like to get your panties in a bunch about what I post. Fine. But, hopefully I'm at least making you think.

Do I ever realistically think there will be a "fat tax"? Come on. What I would hope, though, is that people start thinking about their personal choices - whether within their own direct control or not - and the outcomes they have on society at large (pun intended).

We need to have a discussion. Too often, the individual's default position is to blame someone else for their own problems. Read that again - their own problems.

What I learned early on in my medical career is that someone else's problem is not my own. I will advocate for and tell the patient what I think, but ultimately I go home at night and sleep well, knowing that I have my own life to live.

Until people "get" that too, nothing much will change. Don't expect me to be a martyr in the meantime.

-copro
 
So about the Frontline program, could anyone explain to me why the Massachusetts program failed that family? Seems like if you have 97% participation in insurance, premiums would be less. Why the hell was it so expensive for them still?
 
That was a good show, but the most interesting part I think was the last part that the CEO of that Insurance company said that to help achieving the universal health care, health care providers should reduce their cost, he even talked about some doctors, nurses, hospitals that are ready to decrease their salary to achieve this goal, as if the only problem we have now, is the astronomical doctors and nurses salaries. They never talk about price of drugs which is meaningless in this country and even reducing their profit but instead blame us and our incomes as the main barrier to have a generla health coverage. 😳
 
So after we repeal the 14th amendment and shift our paradigm to allow for government bias....who do we target after the fat people? Are we going to have people fill out lifestyle questionnaires so we can tax them accordingly? Or how about we adjust brackets to account for racial based medical problems?

That's funny, I thought we already repealed it in order to "legally" tax those CEO bonuses at 90%.......hmmm
 
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