Dr. Ice

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On this historic day, when health care reform is about to be passed into law, are any of you concerned that many (most) of the procedures that we do to treat pain are no longer going to be paid for due to "rationing" of health care resources?

I sure am! What are we gonna do..narc every one up and put them all in PT?

Or perhaps, I am, just like many others completely wrong and disillusioned.

Any thoughts??
 

Finally M3

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You are correct. Procedure reimbursement will be hammered.
 

Jcm800

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good thing i just got involved in "holistic" medicine. people seem to be willing to pay cash for that. That and a chiropractor that charges cash 90 dollars a session, but the $20 copay to see me is too much...

for any needed clarification, i was being sarcastic about me getting involved in holistic medicine...
 
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Dr. Ice

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so there is probably no point in me ordering an injection on a patient if Im only going to get paid 5 dollars for it...

great
 

Doctodd

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i think the cream will rise to the top, and the good pain docs will survive on $300-500 cash for an ESI from medicare patients.
 

Doctodd

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there might be another way to survive......lets watch the stock prices of the major health insurance companies after today. We might be able to work for the love of medicine, and no money.

Aetna 34.46
Cigna 37.08
Wellpoint(BCBS) 65.07
Humana 50.00
United Health group 34.39
Coventry 26.24
 

Ligament

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So whats the deal specifically for our profession? Did all the legislation pass? Tell me the bottom line!
 

chauffeur

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i'm no health care economist, but i imagine, more than ever, doctors in well-to-do communities will continue to do well and those treating the elderly and poor will struggle.
 

Disciple

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..
 
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algosdoc

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What has passed so far: 1. a tax increase of 0.9% Medicare (is doubled if you own your own company) for those making over 200K 2. massive dumping of patients into the Medicaid system, making care more inaccessable given the few that accept Medicaid 3. a bill that has no fix for the SGF in order to make the bill seem like it is saving money...the 20% cut is scheduled to take place now in April 2010. If it is not fixed, there will be many docs curtailing Medicare access...if it is fixed, every democratic congressman that voted for it was lying to us about budget neutrality (but we know that already). 4. the mandatory provisions for health insurance will be enforced by 15,000 new IRS agents, and they have the power to jail people that do not acquire the insurance or pay for their employees insurance (if 50 or greater employees) 5. health insurers will begin ratcheting down more and more on anything perceived to be "expensive" and will continue down the road of denial of all new pain procedures as they have over the past 5 years...they have to take these actions since there are now no limits on what an individual might incur in costs to the company over a lifetime and due to the elimination of pre-existing conditions. Pain treatment is an easy target for insurers due to lack of a valid residency program/certification which aids in justifying our existence, the fact that there are 70 million living in chronic pain daily and the insurers absolutely do not want to open up the floodgates for treatment of numbers that dwarf heart disease and cancer combined, and because of lack of demonstration of efficacy for some of our procedures.
 

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Alright, so what about all of us who are contemplating pain fellowships? Although I do enjoy treating people's pain and love performing procedures, what is my motivation for spending an extra year of training doing a fellowship, when I can do the bread and butter procedures that I've learned in residency?

Do you think this opens the doors for lesser qualified fellowship applicants?

What does this mean for our speciality going forward?

Is a pain residency even practical?
 

algosdoc

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It is a calculated risk: going into a fellowship that is inadequate for training purposes and is associated with a subspecialty that does not have any cohesive political or academic means to move forward.
 
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Dr. Ice

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basically..just go into primary care.

I think all specialists are gonna get f**ked. We will likely get hit much harder because of lack of "evidence based" research to support what we do. Dont worry..just put everyone on opioids and in PT forever
 

knoxdoc

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basically..just go into primary care.
I don't think that's the ideal plan. Go to sermo and read what the FPs are saying. They are going to be competing with NPs and PAs. There are FPs out there making less than the PAs they hire. I'm sure that reflects a poor business model, but its not a good sign.

I'd say surgery is still the best bet. Appendectomies, craniotomies, and all other emergent stuff will always need to be done. The key is that surgery is still a sacred medical art, so NPs and PAs will always be excluded from doing cases on their own. Why is it sacred? Because arrogant surgeons wouldn't THINK of letting a PA do a case independently. To them, a PA is just that - an assistant. Physicians, on the other hand, sold their souls by letting NPs and PAs completely take over THEIR jobs. It was a greedy move by docs, allowing them to "see" more patients per day, but it permanently screwed the profession. There are urgent care clinics in my town that docs don't even step a foot into. Letting a PA with two years of medical training handle URGENT medical situations has to be damn near the most stupid thing I can think of. So now anything a NP or PA has ever been allowed to do is considered menial labor - that includes everything from clinical evaluations to all the procedures we as interventionalists do every day....and physicians wonder why they don't get respect in the clinic anymore.
 

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do you know how much an appendectomy pays??? and that it involves a 90 day global period... it is peanuts...

most patients would not be willing to spend $300-500 on an ESI for 3 months of relief if they can get a month of vicodin for $1.84

the federal govt is going to subsidize medicaid for 4 years so that provider payments equal medicare --- like that is going to entice me!

you better hope/pray that you are entrenched enough in a wealthy community that is willing to pay for your services cash/out-of-network.... otherwise you are going to be hosed....
 

algosdoc

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It is my understanding the feds will only subsidize Medicaid patient rates to equal medicare rates in 2013 and 2014, and only for FP, IM, and Peds. I don't think it applies to specialists. The Medicaid populations in most states will at least double under the new plan....I am not inclined to jump on board in their treatment since I lose money on every one.
 

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I understood the medicaid = medicare to be for primary scare only. This is not going to fix anything and only make waiting lists longer for the current medicaid patients.
We see limited amount of medicaid patients (long waiting list) and my personal favorites are those with clear ortho problems being sent to the pain clinic because there is no ortho to fix their rotator cuff.
My second favorite medicaid patient is the druggie who thinks we are "targeting" them by getting UDS (every patient gets one prior to any meds) just because they are poor.

Medicaid rocks!! Expand it to all of congress!!
 

Doctodd

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It is my understanding the feds will only subsidize Medicaid patient rates to equal medicare rates in 2013 and 2014, and only for FP, IM, and Peds. I don't think it applies to specialists. The Medicaid populations in most states will at least double under the new plan....I am not inclined to jump on board in their treatment since I lose money on every one.
I think this is already the case in Florida.....Pediatricians get MC rates for Medicaid patients
 

Tenesma

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i agree w/ ortho/medicaid population - i have a few medicaid patients with orthopedic issues --- one had a wrist fracture that was incorrectly casted in the ED and has a severe,painful deformity, except no ORTHO will see him ---

some of those medicaid pts get into the ortho clinics run by residents at the university hospitals where they get mis-managed or not managed at all after the ortho attending sees the patient...
 

algosdoc

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Our state announced today they will begin to cut Medicaid services due to the massive influx of patients that will happen due to the unfunded mandate of Washington. Also, the state plan for the working poor (HIP-pays at Medicare rates) has suspended all new enrollment and will roll all current patients into Medicaid (paying at Medicaid rates). One of the major issues we have with Medicaid aside from poor reimbursement and mountains of paperwork is that for any other insurance primary with Medicaid secondary: Medicaid forces the physician to write off the copay, will not pay a cent of the copay, and makes it illegal for the physician to charge the patient for unpaid copays. Also if Medicaid goes into effect, the physician must back bill Medicaid 6 months and refund all monies paid by the patient over the prior 6 months. This is the beginning of the end of accessible health care for the poor. We drop anyone who has even applied for Medicaid.
 

Doctodd

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same here in Florida....i dont know why patients even have medicaid as a secondary if medicaid refuses to pay anything. They are a big waste of time. Id rather see a patient for free or write-off the 20% which i usually do anyway if im asked. The Federal Govt is running a victory lap with all the money they made from the insurance lobby. Now comes all the fun. States (starting with mine) suing the Federal Govt. I wonder if the Supreme Court is going to be vindictive based on that little State of the Union incident. Govt forcing people to buy something with no choice in the matter.....these are amazing times.
 

algosdoc

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I wondered if Obama's lecture to the Supreme Court about how wrong their decisions were would come back to bite him in the ass. Excessive perceived self-worth and authority is always a problem with politicians...
 

hyperalgesia

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Despite the populist tone in the country, I still think the Supreme Court is above the pettiness of today's politics, at least when making major decisions. To me, the only thing that will come from this bill is more debt and more lawyers to interpret all the new mandates. Oh yeah, and a web page with different insurance company rates on it. What would we do without Washington?
 

lonelobo

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Despite the populist tone in the country, I still think the Supreme Court is above the pettiness of today's politics, at least when making major decisions. To me, the only thing that will come from this bill is more debt and more lawyers to interpret all the new mandates. Oh yeah, and a web page with different insurance company rates on it. What would we do without Washington?
The Supreme Court not political?
review the decisions of the last 4 years, it has been a rare exception
that the decisions have not been split down political/ideological lines.

If your a large corporation you have to love this court, if your the little guy not so much.

If you have not read Jeffery Tobin's "The Nine" about the Supreme Court, I strongly encourage it and then you might have a different perspective on the Court
 

Mister Mxyzptlk

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I wondered if Obama's lecture to the Supreme Court about how wrong their decisions were would come back to bite him in the ass. Excessive perceived self-worth and authority is always a problem with politicians...
My thoughts exactly. We can only hope that the Supremes will remember the State of the Union Address when the various states file their lawsuits.

Meanwhile, it is impossible to predict what this bill means. The language is impenetrable and often refers to other statutes and bills. The government can take a single sentence and turn something 180 degrees. We can only try to imagine the potential of 10 pounds' worth of sentences.

Remember, the federal government cannot directly regulate medicine. The way they do it is through tax laws. This is how the Harrison Act got perverted into a tool to prosecute doctors who maintained addicts on prescription narcotics back in the early 20th century. The Harrison Act was supposed to be a tax bill regulating the sale of narcotics. There was one sentence about "legitimate practice" that they latched onto to make prescribing narcotics to an addict a crime.

If you look at the medical literature of the time you'll see that many docs went to jail. Others lamented the fact that whereas their addicted patients used to be able to go to the pharmacy and get cheap, pure, morphine, they now had to go to dangerous parts of town and pay huge prices for impure drugs. They mentioned female patients having to trade sex for drugs. And that's still how it is today.

Thank you so much, Congress.
 

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I wonder if the Supreme Court is going to be vindictive based on that little State of the Union incident. Govt forcing people to buy something with no choice in the matter.....these are amazing times.
well this is uncharted territory so we shall see how the Supreme Court rules. There are liberals and conservatives on the Supreme Court.....wonder if they were all offended, or just a couple of them. This is history for the wrong reasons.
 

ampaphb

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Tenesma

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1) Medicaid ranks will swell because pretty much anybody under 4x poverty (ie: <88k/year) can qualify for medicaid.... most will opt for it because it is pretty much FREE.

2) less and less doctors are taking medicaid

3) the government OR the states will then make our DEA or our licenses (remember when Massachusetts would only license you if you agreed to take medicare/medicaid patients - don't know if they changed that rule) dependent on participating w/ medicaid.

4) then we will truly become civil servants...

I have friends in Europe (socialized medicine) who are actually (surprisingly) quite content to work in a socialized environment --- their point of view: they see 20 patients a day, they get 6 weeks of paid vacation weeks, and usually take off a few weeks unpaid, not to mention the 20-30 national holidays (that are paid), they barely document anything except to trigger their memory for the next visit and they have NO fear of litigation. so while their income is <1/2 my income, and they pay more in tax, their life is easier and less stressful AND their health insurance is free, their kids go to school INCLUDING college for free (hence their higher taxes).... they don't understand why i work so hard, and why i don't enjoy life more....

maybe i wasn't designed to live in a socialized system....
 
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Dr. Ice

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1) Medicaid ranks will swell because pretty much anybody under 4x poverty (ie: <88k/year) can qualify for medicaid.... most will opt for it because it is pretty much FREE.

2) less and less doctors are taking medicaid

3) the government OR the states will then make our DEA or our licenses (remember when Massachusetts would only license you if you agreed to take medicare/medicaid patients - don't know if they changed that rule) dependent on participating w/ medicaid.

4) then we will truly become civil servants...

I have friends in Europe (socialized medicine) who are actually (surprisingly) quite content to work in a socialized environment --- their point of view: they see 20 patients a day, they get 6 weeks of paid vacation weeks, and usually take off a few weeks unpaid, not to mention the 20-30 national holidays (that are paid), they barely document anything except to trigger their memory for the next visit and they have NO fear of litigation. so while their income is <1/2 my income, and they pay more in tax, their life is easier and less stressful AND their health insurance is free, their kids go to school INCLUDING college for free (hence their higher taxes).... they don't understand why i work so hard, and why i don't enjoy life more....

maybe i wasn't designed to live in a socialized system....

well said...
 

Doctodd

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Bet the same sentiment was uttered re Medicare and Social Security
what does that mean? If you mean Social security is a great plan, seniors in Galveston may beg to differ.

http://www.unitypublishing.com/Government/GalvestonSocialSecurityPlan.htm

I dont envy your position ethically....i think you are an attorney(like most Dems) and a physician, and you support the current administration because the alternative(Bush and Republicans) were such crooks. But you know what is really going on now is 3x as bad. Correct me if im wrong.
 

SSdoc33

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1) Medicaid ranks will swell because pretty much anybody under 4x poverty (ie: <88k/year) can qualify for medicaid.... most will opt for it because it is pretty much FREE.

2) less and less doctors are taking medicaid

3) the government OR the states will then make our DEA or our licenses (remember when Massachusetts would only license you if you agreed to take medicare/medicaid patients - don't know if they changed that rule) dependent on participating w/ medicaid.

4) then we will truly become civil servants...

I have friends in Europe (socialized medicine) who are actually (surprisingly) quite content to work in a socialized environment --- their point of view: they see 20 patients a day, they get 6 weeks of paid vacation weeks, and usually take off a few weeks unpaid, not to mention the 20-30 national holidays (that are paid), they barely document anything except to trigger their memory for the next visit and they have NO fear of litigation. so while their income is <1/2 my income, and they pay more in tax, their life is easier and less stressful AND their health insurance is free, their kids go to school INCLUDING college for free (hence their higher taxes).... they don't understand why i work so hard, and why i don't enjoy life more....

maybe i wasn't designed to live in a socialized system....

the european model works better when the entire society is geared a bit more towards socialism than it is here (not that im advocating for that). case in point: a french doctor is not walking out of medical school with 250K in debt, with 600K to be paid back over the life of the loan. it is generally state-subsidized. medical education reform and infrastructure has even been brought up -- at least to my knowledge.
 

Tenesma

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the problem with socialism or state welfare system is that you suck out entrepreneurship.... you will never see a lot of entrepreneurship when everybody knows that the state will take care of all of their needs.... how many Fortune 500 companies are based in communist/socialist states? how much economic growth has Europe generated in the last 20 years?

human nature is simple... if i knew that all my needs would be taken care of, do you think i would work 70-80 hours a week, penny-pinching, saving/investing as much as possible? no, i would work the bare minimum, take the least amount of risk, and spend, spend, spend because i know i will have a pension/disability system that will take care of me once all of my bad decisions catch up with me...

whenever i drive thru my neighborhood --- i realize that I am the one subsidizing their variable-rate mortgages that are teetering on foreclosure, that I am the one subsidizing their disability payments, that I am the one paying for their kids education (i pay property tax for city schools, and yet i pay cash for my kids to get private education)... basically we are already in a Robin Hood society and it is only going to get worse...
 

hyperalgesia

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human nature is simple...
Exactly, society should be designed around human nature. Not the other way around. If you start out with some preconceived liberal utopian dreamworld (ie, free healthcare, a free house and free food) and then try to make humans fit in that fantasy, you will be disappointed every time. Just like many were shocked and disappointed when the insurance companies awarded bonuses after being bailed out. Well, hello, get a clue! Now with this bill, health insurance companies will raise their rates and people will throw their hands up in shock and exasperation. What an expensive lesson this is gonna be...
 

Tenesma

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it is interesting that you bring up a utopian world...

when Jamestown was founded it was based on the concept of communalism, everybody would work together to feed each other... guess what? they starved, year after year.... then they came up with the idea that each family would have its own piece of land... all of a sudden motivation kicked in, productivity increased and the rest is history....

why can't we learn from the past?
 

ampaphb

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the problem with socialism or state welfare system is that you suck out entrepreneurship. Human nature is simple ... if i knew that all my needs would be taken care of, do you think i would work 70-80 hours a week ...
No, but I also think your colleagues who over-utilize, and do ridiculous numbers of procedures, or charge 5x as much as you do for the same procedure, and then tack on a $15k facility fee, would be reigned in. You may not like the solution currently enacted, but please don't even try to make the case that the current system is in anyway sustainable. Our lack of oversight of our feral colleagues have brought us to this precipice.

You can and should make a good living doing what we do. You are not, however, entitled to rape and pillage the system.
 

hyperalgesia

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No, but I also think your colleagues who over-utilize, and do ridiculous numbers of procedures, or charge 5x as much as you do for the same procedure, and then tack on a $15k facility fee, would be reigned in. You may not like the solution currently enacted, but please don't even try to make the case that the current system is in anyway sustainable. Our lack of oversight of our feral colleagues have brought us to this precipice.

You can and should make a good living doing what we do. You are not, however, entitled to rape and pillage the system.
To me the best way to domesticate a feral animal is let him loose in the free market. Adding more middle-men to the system by enforcing the employer-based, private insurance model with the Medicare-fiscal intermediary component only provides more cover for the parasites. The ONLY one to motivated enough to reduce fraud and abuse is the consumer himself. And he has to be the one being abused, not some distant, faceless taxpayer.
 

ampaphb

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To me the best way to domesticate a feral animal is let him loose in the free market.
Yes, I see how well that worked with Credit Default Swaps :bang:
 

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Yes, I see how well that worked with Credit Default Swaps :bang:
In a way your example backs up his point. Credit default swaps were for some reason not held to the same standards as insurance policies even though they behave in much the same way. After the financial collapse some people said NO company is too big to fail especially if their damage is self inflicted and that there shouldn't be a bailout. I find it hard to imagine there wouldn't have been other companies ready to fill the void. So in a way the "feral animals" would have been left to their own demise had the govt just allowed them to fail. Hyperalgesia's method wouldn't have allowed for a bailout. A part of me thinks that in the short term it would have hurt more but in the long term (5-10 yrs) the country would have been better off.
 

ampaphb

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In a way your example backs up his point. Credit default swaps were for some reason not held to the same standards as insurance policies even though they behave in much the same way. After the financial collapse some people said NO company is too big to fail especially if their damage is self inflicted and that there shouldn't be a bailout. I find it hard to imagine there wouldn't have been other companies ready to fill the void. So in a way the "feral animals" would have been left to their own demise had the govt just allowed them to fail. Hyperalgesia's method wouldn't have allowed for a bailout. A part of me thinks that in the short term it would have hurt more but in the long term (5-10 yrs) the country would have been better off.
His point was that an unfettered free market resolves all issues. My point is, left to their own devices, such ferals with blow up the system.

AS for letting all the banks fail, look how close we came to a depression when ONE midsize entity (Lehman) failed. Now imagine the world-wide financial chaos that would have ensued if B of A, Citi, AIG, Goldman, etc had also collapsed. not a country on this globe has the resources that would have been necessary to put that Humpty Dumpty back together again.
 

hyperalgesia

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His point was that an unfettered free market resolves all issues. My point is, left to their own devices, such ferals with blow up the system.

AS for letting all the banks fail, look how close we came to a depression when ONE midsize entity (Lehman) failed. Now imagine the world-wide financial chaos that would have ensued if B of A, Citi, AIG, Goldman, etc had also collapsed. not a country on this globe has the resources that would have been necessary to put that Humpty Dumpty back together again.
I don't endorse a completely unregulated free market. But I would certainly argue that the whole too big to fail business model was nurtured with government intervention and encouragement. Lending money to sub-prime borrowers is not in a capitalist bank's best interest. They did it, and continue to do it, only with the encouragement of social justice pushers who have a pre-conceived notion that everyone, no matter how poor, has a right to own their own home. I strongly support anti trust laws and would support limiting the size of banks and insurance companies, even car companies. Especially since their assumption that they are not bound by the laws of the free market, were absolutely confirmed when Washington bailed them out.

But back to the healthcare plan, I'm not sure any of us will notice that much difference as physicians. I think the main point of it is to redirect money from those who are perceived to be able to give something up to those who seem to be in need. I just have a natural tendance as a taxpayer to resist any Washington interventions.
 

Tenesma

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i think there is a fundamental misjudgement of feral physicians/providers...

the typical response by big bureaucracy is to
1) reduce payments and thus make a certain scam less lucrative
2) increase restrictions, limitations, rules, etc to make certain activities more cumbersome and less attractive to the ferals

where does that leave us, the good guys? we get stuck holding the bag...

and how do we respond? we, in a way, become more feral...

if all of our procedures were cut by 50%, the first, instinctive, thing we'd do is to double our volume.... the smarter ones among us will look for alternative revenue streams...
 

Doctodd

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His point was that an unfettered free market resolves all issues. My point is, left to their own devices, such ferals with blow up the system.

AS for letting all the banks fail, look how close we came to a depression when ONE midsize entity (Lehman) failed. Now imagine the world-wide financial chaos that would have ensued if B of A, Citi, AIG, Goldman, etc had also collapsed. not a country on this globe has the resources that would have been necessary to put that Humpty Dumpty back together again.
hey ampaphb.....with the current SEC ruling against Goldman Sachs being guilty of having a huge part in our current financial crisis, and the intimate connection with Democrats and especially Rahm Emanuel and Obama with Goldman, what do u think about this?.....very interested in your perspective as you have a wealthy fund of knowledge. Didnt Obama go on and on in his State of the Union about the Supreme Court ruling on corporations donating to politicians?

http://www.washingtonexaminer.com/opinion/columns/TimothyCarney/Goldman_Sach_Will_Be_Sitting_Pretty_With_Emanuel_in_the_Obama_White_House_112108.html
 

ampaphb

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hey ampaphb.....with the current SEC ruling against Goldman Sachs being guilty of having a huge part in our current financial crisis, and the intimate connection with Democrats and especially Rahm Emanuel and Obama with Goldman, what do u think about this?.....very interested in your perspective as you have a wealthy fund of knowledge. Didnt Obama go on and on in his State of the Union about the Supreme Court ruling on corporations donating to politicians?

http://www.washingtonexaminer.com/opinion/columns/TimothyCarney/Goldman_Sach_Will_Be_Sitting_Pretty_With_Emanuel_in_the_Obama_White_House_112108.html
I'm curious, given that the events Goldman has been accused of took place in 2007, under the previous administration, how you are attributing Bush's malfeasance to the current White House staff?

As for your Washington Examiner article? I try and get my information from reputable purveyors - the Washington Examiner, the NY Post, and The National Enquirer are generally not reliable primary source material
 
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Doctodd

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I was hoping for some insight into my question. Not a rebuttal question. But to answer the connection between Goldman and Bush, I dont know. But back to my question.....shouldnt we look a little farther back in time and the roots behind Rahm Emanuel?

Regarding the reputation of the Washingtom Examiner, i didnt know they were a tabloid. If you are implying they are one-sided against Democrats, id have to disagree. They ripped Bush too.
 

ampaphb

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Regarding the reputation of the Washingtom Examiner, i didnt know they were a tabloid. If you are implying they are one-sided against Democrats, id have to disagree.
The Examiner's editorial page is heavily conservative; it is headed by Mark Tapscott, with American Spectator senior editor Quin Hillyer serving as its associate editor. The paper's national political coverage, which also appears in Examiner papers in Baltimore and San Francisco, was previously headed by Bill Sammon, a former Washington Times reporter who has written several books praising George W. Bush. (Sammon is now the deputy managing editor for Fox News Channel's Washington bureau.) Chris Stirewalt, who has been described as "a true conservative voice", is the Examiner's political editor. Mary Katherine Ham, former managing editor of the conservative Townhall.com], briefly served as the Examiner's online editor for a few months in 2008 before joining the Weekly Standard. Matthew Sheffield, executive editor of the Media Research Center blog NewsBusters, is in charge of the Examiner's website. Byron York, formerly of National Review, joined the paper in February 2009.

http://www.sourcewatch.org/index.php?title=Washington_Examiner
 

Doctodd

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ok fair enough....i should be more specific....the author who wrote the article. His previous book ripped Bush.

Sincerely....id like to know your thoughts on the message instead of the messenger. 3 years ago I was even less informed than i am now, and you seem to shed light on subjects that i am ignorant about. Id like to know what you think about today's ruling and their relationship with Rahm Emanuel, and how they are interconnected with our current financial crisis.
 

Mister Mxyzptlk

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As for your Washington Examiner article? I try and get my information from reputable purveyors - the Washington Examiner, the NY Post, and The National Enquirer are generally not reliable primary source material
You mean like with the John Edwards adultery scandal? Where was the MSM then?

Did you read the NYT during the Henry Gates debacle? For days there was nothing, and then when they were forced to cover it by virute of the fact that everyone else was they gave 90% of the coverage to what Gates said, and the cop's version was maybe a paragraph of "oh, by the way".

I don't think there are any "reputable purveyors". I just try to read a mix. usually Washington Post, WSJ, The Economist, and several blogs on a daily basis. Yes, I admit I'm a news junkie.

And as much as the MSM hate him, Drudge usually knows what's interesting and important. It really chaps their asses that he gets more eyeballs per day than they do.
 

Mister Mxyzptlk

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As for the Goldman/Bush/Obama business:

I think we are going to find that Goldman (and others of that ilk, but especially Goldman) are the closest thing we have had to the Illuminati. These guys spend their time at GS and then go out into the world to become politicians, national or international advisers, etc, but they don't forget their roots and they stay connected. Do a little research on Goldman alumni and see how they are found in the halls of government.

It's old news that Goldman was up to its eyeballs in the mortgage blowup. You are going to see in the near future the extent of their malignant infiltration of every level of the world economy.

Greece is just the tip of the iceberg but it serves as the paradigm for what has transpired just about everywhere. Basically GS offers politicians ways to hide debt on the books using swaps and derivatives. When those leveraged, complicated instruments that the politicians really didn't understand implode the town, county, company, state or country that they suckered goes broke.

It's documented that this has happened in diverse places such as Greece and Birmingham Alabama, as well as evolving stories of Goldman's fingerprints seen in European cities' financial woes.

It is incredible to me how they have spread their tentacles everywhere. History will remember them as the most vile company of the century - both 20th and 21st.
 

drusso

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I don't think that's the ideal plan. Go to sermo and read what the FPs are saying. They are going to be competing with NPs and PAs. There are FPs out there making less than the PAs they hire. I'm sure that reflects a poor business model, but its not a good sign.

I'd say surgery is still the best bet. Appendectomies, craniotomies, and all other emergent stuff will always need to be done. The key is that surgery is still a sacred medical art, so NPs and PAs will always be excluded from doing cases on their own. Why is it sacred? Because arrogant surgeons wouldn't THINK of letting a PA do a case independently. To them, a PA is just that - an assistant. Physicians, on the other hand, sold their souls by letting NPs and PAs completely take over THEIR jobs. It was a greedy move by docs, allowing them to "see" more patients per day, but it permanently screwed the profession. There are urgent care clinics in my town that docs don't even step a foot into. Letting a PA with two years of medical training handle URGENT medical situations has to be damn near the most stupid thing I can think of. So now anything a NP or PA has ever been allowed to do is considered menial labor - that includes everything from clinical evaluations to all the procedures we as interventionalists do every day....and physicians wonder why they don't get respect in the clinic anymore.
Unless you're a salaried surgeon, even doing the "emergent stuff" is not going to cut it. Getting up at 2AM to suck a clot of a drunk driver's skull on medicaid...yikes...

I would look into medico-legal work and health care related MBA programs.