Job Security

[coprolalia]

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Hey Fakin', Good point there about how it is a waste of money when gloves and wrappers go into the sharps bin. But, for you and the other MS-3s out there, NEVER take the needle off the syringe after its been used. You should also NEVER put the cap back on the needle esp. if you are holding the cap with your other hand. Both are ways that people get needle stick injuries.

I almost always re-cap. Rarely does the needle actually touch the patient. And, even then, disease transmission from getting stuck is incredibly low.

I'm not advocating against "universal precautions". I am advocating for taking care and being careful in how you practice - thinking about what you're doing before you do it. Too often we mandate specific policies that are aimed at taking human error out of the system. The result is taking personal responsibility away from individuals. A universal solution is offered for a problem that is inherent in usually identifiable individuals. We'd be better served, in many cases, instead by indentifying those individuals and giving them specific training to improve their deficiencies rather than punishing everyone else. This is a HUGE problem with regards to "bureaucratic creep" that agencies such as JCAHO engender and promote. What they often don't realize is their "solutions" often create a whole new set of unforeseen problems.

-copro

 

[coprolalia]

And while health insurance companies reduce reimbursements to physicians and increase premiums on everyone, they have been turning record profit margins (I read this on an AAMC STAT report about two months ago, but can't find the link now).

How about these articles?

http://www.nytimes.com/2007/07/31/business/31humana.html

http://www.redorbit.com/news/health...ds_managedcare_groups_produce_record_profits/

And, regardless of what you might personally think of the politics of the American Spectator, this is a great article that sums up the problem in a nutshell:

http://www.spectator.org/dsp_article.asp?art_id=11691

Requiring and providing incentives for individuals to buy their own healthcare insurance would solve a lot of this problem. Imagine if we had to get our car insurance through the company we work for? This would force companies to compete for individual business, and they would be forced to be individually comptetive. My other solution would be that the individual would be able to write-off 100% of this cost on their yearly taxes. Your employer would not be compelled to provide this benefit, and you would maintain portability if/when you changed jobs removing the need to find "new doctors" and "new hospitals/services" when networks (etc.) changed with employment. You could also better taylor your individual coverage to meet your own and your family's healthcare needs. Right now, you pretty much only have one (or very few) choices: those your employer offers to you. And, you can't change unless you change jobs.

Talk about a racket.

-copro

 

[johankriek]

your posts are spot on copro...

I have been jaded and bitter ever since I saw the light and saw how ****ed up things were I guess during my third year of medical school.. As physicians for some reason you are expected to eat **** every single day. you are a target.. perfection is the default expectation even when it is not attainable.. You are right.. Im saving every penny.. def retire before the age 50 maybe 45 make some wise investments and watch how the burreacrats screw medicine up further. its a terriblle thing.

 

[fakin' the funk]

Hey Fakin', Good point there about how it is a waste of money when gloves and wrappers go into the sharps bin. But, for you and the other MS-3s out there, NEVER take the needle off the syringe after its been used. You should also NEVER put the cap back on the needle esp. if you are holding the cap with your other hand. Both are ways that people get needle stick injuries.

Where I've been, they either use those 1-cm-long clear plastic "vial access cannulas" or blunt 1.5-inch metal "needles" to draw up and give most drugs. I would think that these are probably safe to stab yourself freely without more than a dent.

Obviously, real needles are another story.

 

[coprolalia]

your posts are spot on copro...

I have been jaded and bitter ever since I saw the light and saw how ****ed up things were I guess during my third year of medical school.. As physicians for some reason you are expected to eat **** every single day. you are a target.. perfection is the default expectation even when it is not attainable.. You are right.. Im saving every penny.. def retire before the age 50 maybe 45 make some wise investments and watch how the burreacrats screw medicine up further. its a terriblle thing.

Well, the fact that insurance is purchased by employers and offered as a "benefit" to it's employees is another way insurance companies can collectively bargain, something we're not allowed to do.

That's the biggest part of being a target. And, now MilitaryMD informs us that they are cutting reimbursements to specialty centers in favor of fully funding regular hospitals. More is being taken away. We're just a bunch of patsies, aren't we? And, the consumer has less and less choices in the end.

-copro

 

[gasnewby]

the guvernator at work.

http://www.nytimes.com/2007/12/18/us/18care.html?ref=health

California Moves Toward Universal Health Care

California moved significantly closer to enacting a broad expansion of health insurance coverage Monday when the Democratic-controlled Assembly passed legislation that has the backing of the Republican governor, Arnold Schwarzenegger.

But it is far from certain that the Legislature will give final approval to the measure, which would provide coverage to an estimated 70 percent of the 5.1 million persistently uninsured Californians.

The bill must first gain passage in the Senate, also controlled by Democrats, where there are deep concerns about the measure’s impact on the state’s widening budget gap. And even if the Senate ultimately joins with Mr. Schwarzenegger and the Assembly, state leaders then must persuade California voters to support billions of dollars in new taxes and fees in a November referendum.

The Senate president pro tem, Don Perata, has said he will not bring his members back to Sacramento until the 2008 session begins on Jan. 7.

Though Mr. Perata, a Democrat from Oakland, has endorsed the plan’s general concept, he is worried that the state’s budget problems make it impractical. On Monday, he asked legislative fiscal analysts to study the Assembly bill’s long-term fiscal implications, particularly in light of any cuts in social services that may be made to bring next year’s budget into balance.

Nonetheless, Monday’s passage by the Assembly, on a party-line vote of 46 to 31, culminated nearly a year of negotiation that began in January, when Mr. Schwarzenegger proposed an audacious plan to insure all Californians. Three other states — Massachusetts, Maine and Vermont — had passed similar plans in recent years, but all are significantly smaller than California, which is the country’s largest state, and have lower proportions of uninsured residents.

Assembly Speaker Fabian Núñez, in the floor debate Monday afternoon, called the bill “truly a historic effort” and rejected Republican assertions that its passage was “more for public relations than for policy,” as it was put by the Assembly Republican leader, Michael Villines.

“There is hope through this bill,” Mr. Nuñez said, “that never again in California will someone be kicked to the curb by an insurance company.”

The plan created by Mr. Schwarzenegger and Mr. Nuñez, first during the regular legislative session and then in a special session called by the governor in September, draws from both Democratic and Republican ideas.

Its fundamental structure mimics the plan adopted last year by Massachusetts and embraced by several Democratic presidential candidates. Like that state, California would force insurers to offer policies regardless of a consumer’s age or health status, and it would require most individuals to obtain basic health coverage. Senator Hillary Rodham Clinton and former Senator John Edwards support such a mandate, and Senator Barack Obama has proposed mandatory coverage for children.

As in Massachusetts, some Californians would be granted exemptions if their income is too low to afford premiums but too high to qualify for heavy government subsidies. Assembly aides said that about 15 percent of those left uninsured by the plan would be illegal immigrants, though children in the country illegally would be offered coverage.

A major sticking point in the negotiations, and a major concern for the labor unions that provide California Democrats with their most reliable support, has been whether the mandated policies would be affordable for middle-income workers. The California plan would offer state subsidies to purchasers with incomes below 250 percent of the federal poverty level, or $51,625 for a family of four.

A number of large unions ultimately supported the bill, including the state’s largest, the Service Employees International Union, whose president, Andrew L. Stern, attended a buoyant news conference after the vote with Mr. Schwarzenegger and Mr. Nuñez.

But the plan also would use tax credits, a concept backed by President Bush and the leading Republican presidential candidates, to make policies more affordable for the middle class. Those earning between 250 percent and 400 percent of the poverty level ($82,600 for a family of four) would be able to deduct premium costs that exceed 5.5 percent of their incomes.

The cost of the plan, which would take effect in 2010, is pegged at $14.4 billion. But none of the financing mechanisms were included in the bill passed Monday. California requires a two-thirds vote of both chambers to approve tax increases, and it became apparent last summer that the Republican minority would not provide the votes needed to reach that threshold.

That left Mr. Schwarzenegger and Mr. Nuñez, a Democrat from Los Angeles, to devise a two-step approach: legislative approval of the mechanics of the health care plan, followed by a November 2008 referendum with voters asked to approve tax increases to pay for it.

Among the taxes is a $1.50 increase in the 87-cent levy on tobacco products, which would raise about $1.5 billion, and a 4 percent levy on hospital revenues, which would raise $2.3 billion. The hospital dollars are one component that would help the state leverage an additional $4.6 billion in federal financing.

Mr. Schwarzenegger has promised repeatedly not to raise taxes, but he has said that passage of the referendum would equate to voters raising taxes on themselves.

In addition to the tax changes, employers would either have to spend a fixed percentage of their payrolls on health coverage for employees or pay a comparable amount into a state insurance pool that would provide subsidized coverage.

During negotiations over the bill, Mr. Nuñez dropped his initial opposition to Mr. Schwarzenegger’s insistence that individuals be required to have insurance. The governor, meanwhile, demonstrated flexibility concerning revenue sources, dropping proposals to tax doctors and to use lottery proceeds before agreeing to the tobacco tax increase.

Because it can take months to collect the more than 700,000 signatures needed to place the revenue measures on the ballot, aides to Mr. Schwarzenegger and Mr. Nuñez said it was critical that the bill win Senate approval quickly.

But Mr. Perata poured cold water on the emerging health care compromise last week by announcing that “it would be imprudent and impolitic to support an expansion of health care” before the state addressed a wide gap that has opened in next year’s budget.

The governor’s office projects the budget gap, which has worsened because of the housing slump, could reach $14 billion, or nearly 13 percent of the state’s estimated $111 billion general fund for 2008-09.

Mr. Schwarzenegger argues that the health plan is intended to bring down costs by encouraging healthy habits, better management of chronic diseases and electronic record-keeping. That, he says, should help California fix its structural budget problems.

 

[urge]

California Moves Toward Universal Health Care

That's a requirement for any civilized society. We are getting there.

 

[kraphtymac]

I recently spoke with an anesthesiologist who practiced in England for 7 years and called the NHS a "tragically expensive failure of an experiment". Go Universal healthcare, whatever that is.