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Epic was a ****ing nightmare after we implemented it. The amount of paperwork we had to do more than quadrupled, as did the amount of data going in and the potential for charting mistakes.
Doctors refuse private insurance all the time.
Not all physicians treat medical emergencies. Most don't on a regular basis. I certainly don't plan to.
As for chemo, nope, I wouldn't. It's not a medical emergency and it's very often not life-saving, either. Nor should a doctor be forced to provide such treatment against his or her will.
Would you force a doctor to provide such services?
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I think you are getting into very tricky and dangerous waters. I'm no expert (as a man) on chemical engineering. but I highly doubt there are any serious biological differences that account for a woman's ability to be a chemical engineer, any more than I think it is less likely based on biologics that a woman can't discover a novel intervention for pancreatic cancer. I also don't believe there is any biologic reason a man can't be as good of a OBGYN.
A better question, from my perspective in this discussion, is why this topic of biological differences even arose here, and for what argumentative purpose?
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I just proposed a slightly less statist alternative to healthcare delivery than we do now 😛
Having an independent healthcare system wouldn't prevent people, such as yourself, from seeing low-income patients for free
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Depends. If the doctor worked for my company or in certain agencies, yes. If fully independent, no. And in the chemo example I mean any reasonable treatment that is known to have likely very positive results. And assume I am talking about whatever the top-tier insurance is. If a doctor accepts no insurance he or she is going to have a hard time.
Jesus Christ Lucca...
If rights don't force anyone into anything then why are we having this discussion? Holy **** what are you even talking about?
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To all of you who think that healthcare should be a right, think about this: What is healthcare? What services would a right to healthcare guarantee for the individual? Life-threatening only? All services? Preventative services? Does this involve paying for gym memberships and top-of-the-line organic food products? Will it pay for diabetes medication for people who eat carbs 24/7 instead of making a lifestyle change that would improve QOL and life expectancy in a way that no drug could come close to doing?
Should "right to healthcare" have no limit on the extent and pricing of medication? Should all cancer patients be given the brand-new $10k+ drug just because it has a chance of saving them?
Wake the **** up people, there isn't enough money to do all these things. We aren't living in a fairy tale where money grows on trees. So basically the ignorant, myopic lot of you who actually think healthcare should be a right aren't really arguing for a "right to healthcare" you're arguing for a right to decent minimum of healthcare. And then the problem becomes - who gets to decide what that minimum is? You can't - people will always want more. And the more you give the more you take away from someone else. As Margaret Thatcher said, socialism is great until you run out of other people's money.
Rights and compensation are intrinsically intertwined. In the words of Rand Paul, a right to healthcare would make physicians slaves, because we would be required to perform a service.
If rights don't force anyone into anything then why are we having this discussion? Holy **** what are you even talking about?
The aren't separate. Who gets to determine how much compensation is "enough?" Free market and competition are thrown out the window if you make healthcare a right. Healthcare becomes a monopoly, and since when do monopolies lead to efficiency? Never.
Medically necessary? Who gets to decide that O wise one? Jesus...
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To all of you who think that healthcare should be a right, think about this: What is healthcare? What services would a right to healthcare guarantee for the individual? Life-threatening only? All services? Preventative services? Does this involve paying for gym memberships and top-of-the-line organic food products? Will it pay for diabetes medication for people who eat carbs 24/7 instead of making a lifestyle change that would improve QOL and life expectancy in a way that no drug could come close to doing?
Should "right to healthcare" have no limit on the extent and pricing of medication? Should all cancer patients be given the brand-new $10k+ drug just because it has a chance of saving them?
Wake the **** up people, there isn't enough money to do all these things. We aren't living in a fairy tale where money grows on trees. So basically the ignorant, myopic lot of you who actually think healthcare should be a right aren't really arguing for a "right to healthcare" you're arguing for a right to decent minimum of healthcare. And then the problem becomes - who gets to decide what that minimum is? You can't - people will always want more. And the more you give the more you take away from someone else. As Margaret Thatcher said, socialism is great until you run out of other people's money.
I'm wondering why you find it so hard to believe that there might be a chance of cognitive differences between men and women. Genetics certainly gives rise to vast numbers of gender derived physical proclivities - why would you assume the brain is any different? I'm just wondering what evidence you have that points to the contrary. If I had to make an educated guess, I would say gender differences don't end at physical attributes, why don't you?
I didn't take a position on EMR. Let's just be clear about where all of these "advances" or developments came from. They're not all from the big, bad government. Many come from the private sector. Should we get into why novel drugs are sold for outrageous sums of money? Do you want your family member denied that new cure medicine just because your insurance won't cover it and you can't cover it?
Again I just dont know enough about the field of ChemE itself. I just dont think its fair to assume the gap in men vs women is only due to "unfair discriminatory" practices, even if it may be one factor.
I think we're taking things a little too far when we suggest somebody who holds the position that biological differences matter is saying "one gender is more likely to discover a novel intervention for pancreatic cancer".
I dont really know how the discussion of biological characteristics came up. That's something ZedsDed can answer better than me because he was the one who brought it up. But I just dont buy that gaps in performance are due to discriminatory factors only. Now there are other "social factors" and "cultural factors" as well that provide explanations in gaps of performancce beyond mere racial discrimination, but even having said that I dont think that alone explains as much of the gap as many might think. As an example, I dont buy that the big gap in Asian vs URM performance on the MCAT is due to just "racism" or these other social/cultural factors that come up from different races etc. This is even more so when I know what I know about the type of test the MCAT is(a logic, reasoning test where content and background knowledge doesnt play a major role at all and the skills cant be "taught" or memorized per se) amongst other things and how data shows even amongst those at the bottom of income status, minorities such as Asians still perform better than URMs in academic performance.
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I know plenty of doctors that do quite well for themselves not accepting insurance. @AtlasMD is one such example around SDN. Not only that but he provides his patients with care that is cheaper and higher in quality than one would get with insurance. I know a few PP FPs and psych doctors in the NE that also make great money with small patient panels while also not having to deal with the hassles of insurance.
Insurance, believe it or not, is not the only way to do things. We've just been conditioned to think of it as such because that's the way we've been doing health care for longer than anyone on this forum has been alive.
The mandate is from the government, and is a part of the ACA.
http://www.medicalrecords.com/physicians/electronic-medical-records-deadline
This is a very slippery road to a lot of really, really bad things....
Chemical engineering? What if there was a "study" suggesting women for biological reasons shouldn't be physicians? One you start taking positions like this they tend to develop of a life of their own. Maybe you've notice how women are treated (and abused and killed) in many non-Western parts of the world.
As for the rest, don't forget that physicians need people who need health care. You are dependent on that dynamic (instead of immune to it).
What kinds of companies or agencies? If the doctor has voluntarily signed a legal employment contract which requires him to provide emergency services as a condition of employment, then the doctor could be expected to provide those services or risk termination of the contract. Is that what you mean?
Yours is a reasonably moderate stance if you believe that doctors should still be allowed to work independently and set their own rates for the services they provide to their patients. Unfortunately, that's not how it is in many other countries which recognize a universal "right" to healthcare. And there are actually a number of doctors in family medicine, OMT, and psychiatry who do not take any form of insurance.
I think there are a lot of good things about it. But the point I'm making is that Silicon Valley is just as implicated in it existing as the government.
The problem with your reasoning is that you're letting the consequences that would arise from these differences influence your estimation on whether or not the objective reality is or is not true. This is wrong because nature doesn't give a crap whether or not good or bad things would come from it or what you think. Just because topics like intelligence and other cognitive functions aren't PC to talk about (or would lead to problems) doesn't mean they don't exist. I would have expected you to not to fall into this type of thinking...
Whether or not we should do research and delve into these questions is an entirely different question, however.
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Well, in places with socialized healthcare drugs prices are kept down by limiting treatment options. The gov't negotiates low prices with pharm companies by agreeing to limit the market to only specific drugs. So that new cure might not be available under a gov't system anyways if that's not the pre-approved treatment. In that gov't system, it would only be those who can pay out of pocket for the new cure who would actually get it.
Strict and unavoidable capping of the prices that insurance companies can charge for drugs is one of the best ways to reduce drugs prices, imo. That forces insurance companies to negotiate lower prices with pharm companies since insurance companies want to limit the amount they need to payout.
We're conflating several different things, and you were right to try to slow things down. TALENT is a far different issue than justifications for depriving people of things. Do we really want to get into why there are more blacks in the NBA and NFL? Wouldn't you assume that if women can be very competitive (indeed equally competitive) candidates for MSTP programs that they very likely could do OK with chemical engineering? Do you see the risks of going down such slippery roads?
Ah, this is good, because your thinking is very short-sighted and flawed. Deciding that something is "true in some a priori reality" along these lines CREATES reality and is not just a consequence. Something can be reality and consequence simultaneously. Do you believe women aren't inherently capable voters? What if we had just presumed that the prevailing wisdom about women, blacks, etc are simply hard truths that can't be overcome? "Truths" get used. They DO things. People and socirty use them for things.
The government didn't create it, but they mandated that everyone use it, how it would be used, and what requirements the software would have.
There is nothing wrong with saying women have different intellectual talents than men. In fact, if I were a betting man I'd say that there is an extremely good chance that there is - this goes back to looking at what genetics and science has taught us and making an educated guess.
The thing is, making these types of statements isn't problematic because it doesn't say anything about the individual other than they are more or less likely to have some trait or quality. Sure it's possible for some Whites to play in the NBA, you just have a greater chance as a Black. In a similar way, I think it's O.K. to talk about gender and race differences, as long as we don't make the mistake of inferring that stereotypes and generalities dictate the individual's life. There is a vast difference between what intellectual professions men and women go into - sure, some (probably most) is environmentally determined, but it would be naive to believe that genetics plays no part in these patterns.
You're getting too philosophical. There is an objective reality. Whether or not we can ever truly see/understand it is up for debate, but what you said makes absolutely no sense and is definitely not a reason to believe that there aren't gender cognitive differences. Should we just throw science out the window?
If and when one of you has an autistic child down the road, do you think the government (school system) should be required to fund education and services for that child? Some of these cases bring school systems to their knees, but I've seen upper-middle to upper class parents who are right leaning demand that they get said services and go to court to make sure it happens.
I would disagree with you strongly that there is an objective reality, especially about these things. But even if I concede that are you going to deny that those alleged "realities" get used and abused in all kinds of ways....that is, co-opted to prop up agendas that have nothing to do with "objective realities"?
I agree we should slow things down but I dont get the connection between the examples I posted and what you posted here. If you want to argue this is all a slippery slope that's fine(I agree to some extent but I still think the role biological differences play should be acknowledged) but I dont really see how we can connect the exmaples I gave and what you just gave and say it's all part of a "slippery slope".
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I wish you had replied without reference to me mentioning the NBA....like the women in MSTPs vs chem engineering. There is some reason why we got into "biological differences" in what is a discussion about whether everyone should have at least a basic level of healthcare.
But, to continue that vein, what I'm arguing is that biological differences get used to justify bad policies. We can agree now that in general blacks dominate the NBA. There was a time when they couldn't even be in the NBA...and the justification for the exclusion was in part based on biological assumptions and falsehoods.
It's a different scenario- this child is entitled to primary and secondary education accommodations per the Americans with Disabilities Act. To not provide accommodations would be illegal because they are disabled, just as I could not refuse care to a patient that has the same insurance as another patient specifically because they were disabled (or any other protected characteristic).
Really the reason I didnt bring up the MSTP vs chemE for women example is because I just didnt see what you were trying to get at. Why are we trying to relate them exactly? The issue was never about whether women could be great MSTPs or great ChemE. The issue was more is it more likely a men possesses the characteristics needed to be a great ChemE than a women? If I had to guess, I would say there is a chance this might be true and is one factor that accounts for the gaps in how many are represented in the field(with pure discrimination being another). Part of these are due to cultural/social factors? Sure. But I tend to think even still there is more to it than that. More importantly the question to ask is why is equal representation so important. Social/cultural factors that lead to men being more likely to become ChemE's and perhaps better ChemE's than women in of and themselves arent entirely problematic; even if we can identify that such factors are the key to difference in representation a) how do we know we can fully correct for them b) why is it so important to fully correct for them and all the effort it might take?
Look we all know racism still exists, which is precisely what you described "using biological differences to discriminate" such as "skin color" with the only reason being you just dont like/arent comfortable the black or mexican skin color. The point more here is to me that there are characteristics that can be inherited/have origin that can also be more likely in one population than another, and these characteristics can be crucial to success in a particular field. It doesnt sound like you agree with that which is fine. Im not sure if we have exahusted that particular point which is one I identified at the beginning as one we disagree with and is worth discussing, but if you feel there is more to add as to why you dont necessairly believe in why some groups of people are more likely to have characteristics, through inheritance/biology, that make them more likely to succeed at a job than another, then we can continue and see where it takes us.
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EXACTLY. And there will come a time when providing basic health care to everyone will be very similar to "entitled to primary and secondary accommodations...."
You get accommodations for disabilities in the hospital/healthcare already- assistive devices, access ramps, the inability to deny care based on disability, etc. You're misstating your own point.
I do not buy that men by virtue of biologics (at least biologics not socially constructed) are more "natural" for chem engineering. A place like RPI is 80/20 men/women, but I can virtually guarantee you that the 20% of women there are equal to the men in chem engineering, and the differential of gender in terms of matriculant breakdown is due to other factors.
To use one of your examples, there was a time when having a man as a OBGYN was preferred based on perceptions of biologic superiority. Women being predominant in this specialty actually is relatively new (past few decades).
No, I'm not, because there was a point in history where that was not true. It's called progress.
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Well the issue here isnt amongst the 20% who make the cut at RPI. It's rather in a class of 100 people if you had 80 men and 20 women but instead for the sake of creating "equality" or whatever buzzword we want to throw out there, it was 50 men and 50 women how would that change things? Would the 30 women replacing those 30 men in such a situation make for an overall class that's of the same quality? These 30 women who otherwise werent good enough to make the cut to get into such a class? In other words, there's a reason why that 80-20 gap exists to begin with.
The OBGYN example is interesting and yes you make a pretty solid point there. The question here though is why the drastic change? Why are women magically so drawn to the field and men not? Is it due to differences in our culture, our society etc? Something has to trigger such a change and honestly I dont have a great answer to that question. But whatever it is, I bet the answer is multifaceted and not dependent on just one or two simple variables.
You considering two unrelated things to be indicative of progress when they in no way support one another is kind of a pointless statement.
I mean, it's like saying "Remember when we didn't have airbags in cars, and now we do because the government mandates it? Yeah. Healthcare's gonna be like that." It's just a meaningless tangent/connection.
The reason is no different than with physicians. To be crude, there was a time when women were supposed to be housewives and have a nice hot meal ready when the smart, capable man came home. The reason the 80/20 gap is there has nothing to do with biologics. Have you seen any data that women score worse on SATs or MCATs? Do you really believe there is something intrinsic to being a woman that makes them less capable in math and STEM areas? Now we're sliding down that slippery slope.
At least we're making progress. So you believe that the disabled are entitled to healthcare regardless of socio-economic status and ability to pay? Are children born in abject poverty more accountable than the disabled in terms of receiving health care?
I never said that- I said that the disabled cannot specifically be denied healthcare because they are disabled. Like, you can't come to me with your insurance and have me be like, "dude, get out of my office, you have autism."
Like I said, there will come a time when anyone not receiving health care will seem as foreign as not allowing women to vote or blacks to use our restrooms.
It's just the right thing to do.
OK, and autistic kids without insurance and/or without ability to pay for a private school/residential??? You already said autistic kids are entitled to (very expensive) educational services.
They're entitled to accommodations for any services they would otherwise be able to receive were they not disabled. That includes everything from expensive schooling to different sorts of things that can aid them at the workplace if they become employed. It's really just an apples to oranges comparison because they still would not be entitled to health care based upon their disability- they would merely be entitled to accommodations while receiving healthcare they were already able to receive via insurance or cash.
1) That's certainly one reason. But I dont buy its the only reason. And you are right in this case biologics isnt a major driving force. But I do think you could make a case there are characteristics of a women(outside of general social factors) that perhaps make them more likely to have the skills required for success in pediatrics, psychiatry and OBGYN where they are the majority. Like I said above I really havent done enough research on this to state anything definitively, but there is alot at play to create the gaps we see in fields like pediatrics(forget about OBGYN even). That their are factors beyond what could be identified as social/cultural factors playing some role in driving such a gap would not surprise me at all, even if you might describe them as "biological" in origin.
2) Women MD matriculants historically have about a 1.5 lower MCAT mean than males(I believe its 31.9 vs 30.4 last time I checked). I know of at least one school where someone who works there I know personally has told me they basically add a point or two to women's MCAT scores unofficially and that high scoring women MCAT scorers are less frequent to the point it provides them a real advantage in the admission process(beyond some 1-2 point bump in that case).
Here is the data on men vs women MCAT performance
https://www.aamc.org/download/321506/data/factstablea22.pdf
3) I think rather than framing the discussion here about whether there is something intrinsic that makes men "superior" at STEM let's try and come up with the reasons why men score on average somewhat higher than females? Ill let you list a few reasons you might think this is the case first and we can see if I agree and to what extent I agree/disagree.
We can do the same thing when comparing URMs vs whites vs asians where the gap in MCAT performance is far greater than it is for women vs men in general. Many will argue alot of it has to do with URMs being more likely to come from poorer backgrounds, discrimination etc but I dont really buy that as the driving force(particularly for the gap being as significant as it is) to the extent many presumably will.
Here is the MCAT data based on race.
https://www.aamc.org/download/321498/data/factstablea18.pdf
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I can't buy any of these suggestions....
I certainly don't buy that men scoring a point of point and a half higher on the MCAT means anything or at least certainly not anything intrinsic. If that MCAT data is still true in 25-30 years I'll be more persuaded.
I also can't endorse any suggestion that blacks are inherently/intrinsically less capable then whites/Asians.
Some seem to want to cling to an idea of absolutes where none exist. As we move forward where white, black, Asian, etc becomes more blurred in general I think you'll see the data change. There is always an interaction effect between genetics and environment. And all too often claims about absolutes are used in political and exploitative ways.
As an add-on I think you're inferences in other specialty areas are incorrect. Why would women be more suited to psychiatry than men? There was a time when psychiatry was very male-dominated, just like every other specialty. Be careful about suggesting that the alleged "'softer" specialties are better for women.
So the disabled are entitled to education but not health care? That's an interesting thing to argue with the autistic and other severe developmental disabilities when there is such a blurring of educational and medical services in those cases.
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@GrapesofRath you need to choose an avatar, so the intellectual circle jerk is complete.
Are you feeling left out? What's your expert take?
Funny you should mention special ed teaching. Both me and my mom have worked in special ed classes. Now they are being subject to performance based measurements (like medicine is starting to adopt). My mom is a nurse who works with a student and she talks about how the teacher spends almost the entire day documenting. She has to create individual goals for each student and continually update with their progress..... It is such a waste of resources. They are there forcing students to try to focus and learn math. These kids can't speak, can't walk, can't talk, randomly have seizures during class, and there the teacher is trying to lecture and then document. "Little Johnny, who suffers from irreversible brain damage and muscle atrophy, still hasn't learned to count to 3. Next week we will try using song to teach him. Still don't know how to test his counting since he still hasn't gained the ability to talk." When I was teaching, I always ignored the lesson plan. I'm not gonna force a non-communicative child to learn instead of allowing him to draw, which he loves. It's crazy.
Soon medicine will be like that. "Dr. MansaMusa, your alcoholic patient was found on the side of the road again. Obviously his relapse is because you didn't properly instruct him on the dangers of drinking with stage 4 cirrhosis, so we are going to cut your reimbursements for treating him today."
Well we're clearly not going to agree on much on this topic(which is fine) so Ill posit this; what reasons do you suggest are the reasons for the gap in performance we see? We can use the MCAT when comparing URMs vs non URMs and women vs men as one main example since we just brought that up and the data clearly indicates a significant gap. If you dont think the reasons for the gap are significant, does that to you suggest the MCAT is not a meaningful tool for evaluation by ADCOMs or that it should be used to the degree it is used in evaluation?
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No, I think the MCAT is very meaningful, if still a bit overemphasized. My guess is that 1 to 1.5 point difference will evaporate over the next decade or two. To believe what I think you are suggesting is a road I don't really want to go down. What genetic conclusions would you suggest be drawn about gender based on that data?
They're entitled to accommodations for both. I don't understand how that is so difficult to comprehend. Just like a person pulled over by a police officer is entitled to accommodations for the hearing impaired if they are deaf, or a person is entitled to fair hiring treatment and assistive services under the ADA. The job applicant isn't entitled to a job- they're entitled to fair treatment, nothing more. An autistic person is not entitled to health care, they are entitled to fair treatment within the health care system, nothing more.
1. No one is saying the women aren't qualified, we're saying men are probably more likely to possess the qualities necessary to succeed in that field.
2. Re: bold - how can you virtually guarantee this? What evidence do you have? The truth is, we know so little about the brain that this statement reeks of hubris.
3. Women actually do worse than men on the science parts of the MCAT by a significant amount. (Edit: I see this was already mentioned)
Look, I get it - you want to believe women are 100% similar to men because you think acknowledging differences could lead to a society where women are treated differently (perhaps poorly). This literally has nothing to do with whether or not women are different from men. This has nothing to do with the scientific method period, other than whether or not certain subjects should be researched or not.
If I'm reading you correctly (re: all the "constructed reality" talk) you're afraid that we make our own reality, aka we anticipate a result and look for evidence supporting that. The scientific process naturally weeds this kind of faulty logic down because once a study gets published, other scientists challenge it by reproducing it with the eventual goal of improving it.
I think it is a real red herring and strawman to turn this into a political, anti-government thing. If some of you don't want healthcare to be a "right" but instead just want everyone to receive appropriate services anyway then that's good enough for me.
Well I think largely your taking what I was suggesting to an extreme. Way too much to an extreme if you think Im suggesting a 1.5 difference is due to genetic differences or that URMs vs non URMs difference is to non URMs "being biolgically superior". This whole discussion started because I dont buy that large gaps and inequality arent just due to "discrimination" amongst other things.
I buy biological factors as one factor amongst many that can explain gaps in performance. I think that's where we disagree and where largely you are strawmanning if you suggest Im giving more importance to biological factors than that. As much as anything, Im acknowledging it is theoretically possible biological factors can be one factor that explains gaps in representation or even performance(for specifics like I said with ChemE I just dont know enough about the field). I think you have a rather wrong idea if you think Im suggesting bio factors as the primary influence that explains difference as some form of universal rule. Not even close. I just think biological factors are one consideration amongst a number of others when evaluating differences in gaps amongst genders, race etc. Obviously we dont see eye to eye but we can at least try and recognize what each other's point is and not take it to the extreme.
I dont think these gaps in MCAT performance are going to evaporate in the next decade or two. And the data showing these gaps goes well beyond 5-10 years like those links I had showed.
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