Political agends in med school

[thedrjojo]

Suggestion: read a little more before spouting off about **** you apparently know nothing about. Look at the number of MC/MA enrollees and compare that to the number of private insurance enrollees. Next look at total healthcare expenditures. Try to draw an intelligent conclusion after looking at this set of figures.

You are correct in my mis-statement... mcare/caid had 43million enrolled (of 250-260mill total with healthcare in US) in 2006 and take up a larger portion of costs than the private market. I will admit defeat in this point.

I will counter it though, that if you adjust for age, and realize that most dollars are spent in the last 6 months of ones life and that eldery (all of which have access to medicare) in general utilize more healthcare dollars, then you can account for the difference.

Next -- study a little on the theory of subjective value -- as that is how all goods and services are valued in the world outside of state edict. Who died and granted you judge and jury domain over the relative merit of another's motivation or value scale? Surely by now you can appreciate the arrogance and inappropriateness of enforcing your particular value scale and priorities onto another who does not share in them?

I'm not entirely sure which part of my posts this is directed at. If it is my condemnation of people pursuing ROAD specialties for alterior motivations, or calling it the "conservative" mindset that drove them into that... well, i defined what I meant about the conservative mindset earlier in the thread and was essentially doing it to combat the equally judgmental and arrogant posts blaming all that is wrong with medicine on the equally poorly defined "liberal" term... and to that point, I stand by my opinion of it and no one is forcing anyone to listen or believe my opinion. If it was about my medicare for all type comment, I never said anything about how good it would actually work outside of my opinion and will also not stop giving that, no matter how ill-informed it is. Your last sentence as well, everyone, no matter what ideology, when they try to enact that as the rule of the land, takes a certain amount of arrogance and, to others, a bit of inappropriateness. Doesn't matter liberal, conservative, socialist, totalitarian, libertarian... those that disagree will think it forced upon them and feel it inappropriate, because we all live within this government/nation/world.

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[glade]

i defined what I meant about the conservative mindset earlier in the thread and was essentially doing it to combat the equally judgmental and arrogant posts blaming all that is wrong with medicine on the equally poorly defined "liberal" term.

Except that the problem is that, as I explained, the entire system is broken by liberalism and conservatives are forced to exist within it. And your view is to blame the conservatives for not "going along with the system" rather than to identify the system being broken.

 

[MOHS_01]

You are correct.

Fixed it for you.

...but then you have to go and double down.

I will counter it though, that if you adjust for age, and realize that most dollars are spent in the last 6 months of ones life and that eldery (all of which have access to medicare) in general utilize more healthcare dollars, then you can account for the difference.

Is that how you believe an effective argument is waged?
How exactly does one "adjust for age" when the two systems being compared are delineated by age? Even with the "last six months of life" increase in expenditures you still have a greater consumption per enrollee than that which is observed in privately insured populations -- a finding that is largely the reflection of the need for intervention that results from aging (as you alluded to). I believe that what you are basing your opinion on, and correct me if I am wrong, is the fees incurred per unit service; this, however, is a very inappropriate metric for determining system efficiency for a number of reasons that I cannot take the time to spell out right adt this moment (I have a child aged one and three hanging from either arm at the moment).

A question, though -- are you familiar with the concept of privatizing the profits while socializing the losses? Can you somehow apply this to our current payer setup?

I'm not entirely sure which part of my posts this is directed at. If it is my condemnation of people pursuing ROAD specialties for alterior motivations, or calling it the "conservative" mindset that drove them into that... well, i defined what I meant about the conservative mindset earlier in the thread and was essentially doing it to combat the equally judgmental and arrogant posts blaming all that is wrong with medicine on the equally poorly defined "liberal" term... and to that point, I stand by my opinion of it and no one is forcing anyone to listen or believe my opinion. If it was about my medicare for all type comment, I never said anything about how good it would actually work outside of my opinion and will also not stop giving that, no matter ho
w ill-informed it is. Your last sentence as well, everyone, no matter what ideology, when they try to enact that as the rule of the land, takes a certain amount of arrogance and, to others, a bit of inappropriateness. Doesn't matter liberal, conservative, socialist, totalitarian, libertarian... those that disagree will think it forced upon them and feel it inappropriate, because we all live within this government/nation/world.

Break away from the BS false left/right paradigm for the love of all that is Holy for just a second... and yes, it was in response of assigning your relative "merit scale" of virtue to those factors motivating others. Once one evolves beyond some unrealistic and frankly naive world view (assuming one actually does, the failure to do so defines many on both ends of the false political spectrum mentioned above), they begin to realize that labor is an extension of the individual itself, wages are nothing more than a proxy for these labors, and the maximization of the return on these labors and investment is a logical and worthwhile endeavor. Taken further, it is more often than not the competition for this return that drives societal improvement, prompting individuals to seek out efficiencies and advances that eventually benefit all.

Another question -- how do you propose that any policy driven by the protection of individual liberty imposes any "disagreeable" or "inappropriate" limitations or requirements on them by force? Have you ever been privy to a sound discussion on what constitutes the rule of law, why it was developed, or why it is important? The societal role that law and government is meant to play in Western Liberal civilization?

 

[Regnvejr]

...Care to elaborate? I believe the biggest financial strain on our medical system is Medicare/caid. Aren't those government run?

Biggest problem is uncovered patients. Just wait till you get out on your own and need to find care for a patient that is not covered.

 

[thedrjojo]

Except that the problem is that, as I explained, the entire system is broken by liberalism and conservatives are forced to exist within it. And your view is to blame the conservatives for not "going along with the system" rather than to identify the system being broken.

When have I stated that anyone should going along with the system? When has anyone in this thread suggested a way to go change the system, instead of just pitching and moaning about how liberals messed up their wonderful field of medicine? I think my suggestion of medicare for all was the only "solution" even presented on this thread, which is fitting because it isn't a thread about how to fix the system, instead it was about the political agendas in medical school...

My entire original involvement in this thread was to counter the view of blame the liberals for all that is wrong with medicine (but you could enter any term here). The original thread blamed liberals in medicine for all of it, which I sucessfully shifted to blaming both liberals and conservatives in politics, quoting when it was Republicans, including some conservative champions like Reagan and Nixon, whose name is on the laws that you seem to blame for many of the issues, and also accepted that many liberal things also have messed up medicine, including Teddy and his HMO bill (but, as I mentioned, Nixon also had failed HMO bills prior to Teddy passing his) and it was capitalism of HMO's and physician complatency that lead to the state of constant denials now (there was once a time that HMO's didn't automatically deny every claim...)

Is that how you believe an effective argument is waged?
How exactly does one "adjust for age" when the two systems being compared are delineated by age? Even with the "last six months of life" increase in expenditures you still have a greater consumption per enrollee than that which is observed in privately insured populations -- a finding that is largely the reflection of the need for intervention that results from aging (as you alluded to). I believe that what you are basing your opinion on, and correct me if I am wrong, is the fees incurred per unit service; this, however, is a very inappropriate metric for determining system efficiency for a number of reasons that I cannot take the time to spell out right adt this moment (I have a child aged one and three hanging from either arm at the moment).

So, your saying that our entire argument about this pointless. We started down this path because someone mentioned that Medicare/caid were the biggest financial strain on the system, and I objected to that... initially I was wrong and you corrected me in the total enrollment numbers, and then I tried to clarify the thought process I was having (somewhere I knew that medicare enrollment was indeed less... )... my opinion is a combination of what you believed me to be arguing, fees per unit service, as well as the fact that the medicare population is an inheritently more expensive population, and, In my opinion, if the private market was in charge of insuring them, would incure a higher cost then currently incured by the government - mainly because the difference in overhead costs (advertised as 4% for Medicare[I know this is a false number], where for private insurance agencies are upwards of 30%+) and supported by the medicare advantage data that shows increased costs without increased results/satisfaction/services. The difference wouldn't be +26% as suggested from the data, because I understand private companies would be more efficient (the only real advantage of having a private company involved IMO), probably deny more claims, etc but it would still be more costly. I agree medicare is broken and needs fixing. I also, though, believe that the private, for profit insurance system is broken for the consumers (working perfectly for the companies right now) and broken even more for the providers.

A question, though -- are you familiar with the concept of privatizing the profits while socializing the losses? Can you somehow apply this to our current payer setup?

Yes and yes. And there are 2 options to deal with this concept. Socializing the profits or privatizing the losses. The government just decided to socialize the profits for student loans. I think the government should socialize the profits of health insurance, which would be, just like the student loan issue, assume the role of the issuer of health insurance. Correct me if I am wrong (but I doubt it), you are in support of the opposite approach, entirely privatizing the payer system and sticking them with both the profits and losses, as this is not a function or job of the government in your opinion.

 

[MOHS_01]

So, your saying that our entire argument about this pointless.

No, I'm saying your "once you adjust for age" premise was nonsensical. I was merely offering you an out with the per unit pricing point... Here are a couple of things that you may not have had the chance to encounter yet: First, MC often saves via their price fixing fee schedule on a per unit basis; in turn, more services are often provided per enrollee, leading to a net increase in expenditures. MC also claims to enjoy significantly lower administrative (overhead) costs. I believe this too to be a fallacy, but, assuming for a moment it is true, how do they manage that? They don't police appropriately the administration of the funds -- they cut corners. This is why the system is so fraught with fraud and abuse -- there exists no sound mechanism to prevent it. Have you never wondered why "fraud and abuse" are not major issues with private insurance? Why is that? It's because they make sure their money is being spent on their enrollees, that's why. I would also suggest that you look at administrative costs per enrollee -- not the percentage of expenditures cost, as this number would more accurately reflect the administrative premium one has to pay to enjoy the plan....

Yes and yes. And there are 2 options to deal with this concept. Socializing the profits or privatizing the losses. The government just decided to socialize the profits for student loans. I think the government should socialize the profits of health insurance, which would be, just like the student loan issue, assume the role of the issuer of health insurance. Correct me if I am wrong (but I doubt it), you are in support of the opposite approach, entirely privatizing the payer system and sticking them with both the profits and losses, as this is not a function or job of the government in your opinion.

Yes, I believe that the government should GTFO of healthcare other than those limited and specific applications pertaining to public health. I am actually in shock that you would advocate the nationalization of a private industry -- how utterly communistic of you (not that it is any worse than the fascist "cooperation" we have in place today).

Again, if you can find a way to offer any service your heart desires -- without abrogating contracts, annexing property or person, and while operating within the both the confines and the intent of the rule of law -- feel free to do so. As long as it requires a disproportionate levying of taxes, prevents free and open association, the ability to openly and freely negotiate and enter into contracts, etc, it is a wholly inappropriate use of force in the cause of redistribution and vote buying.

 

[DoctwoB]

Yes and yes. And there are 2 options to deal with this concept. Socializing the profits or privatizing the losses. The government just decided to socialize the profits for student loans. I think the government should socialize the profits of health insurance, which would be, just like the student loan issue, assume the role of the issuer of health insurance. Correct me if I am wrong (but I doubt it), you are in support of the opposite approach, entirely privatizing the payer system and sticking them with both the profits and losses, as this is not a function or job of the government in your opinion.

What you're forgetting is that the government was already in the student loan business. The government gave the money to the private lenders at a sweetheart rate, and the private lenders lent it out at a much higher rate. Everyone got screwed (taxpayers who lent the money, recipients got higher rates) except for the lenders. The recent reforms just cut the lenders out of the equation.

 

[MOHS_01]

What you're forgetting is that the government was already in the student loan business. The government gave the money to the private lenders at a sweetheart rate, and the private lenders lent it out at a much higher rate. Everyone got screwed (taxpayers who lent the money, recipients got higher rates) except for the lenders. The recent reforms just cut the lenders out of the equation.

...and I'll add that the recipients were doubly screwed as this infusion of money that would be otherwise less available artificially drove up tuition prices... much like the housing market. Consumer loses, banks win -- sound familiar? All the while the return on the investment that is higher education becomes increasingly diluted, with college becoming grades 13-16... Government enacts a program "for the little guy" -- little guy gets screwed, banks win. Interesting. I think that I am beginning to see a pattern emerge.

 

[glade]

Yes and yes. And there are 2 options to deal with this concept. Socializing the profits or privatizing the losses. The government just decided to socialize the profits for student loans. I think the government should socialize the profits of health insurance, which would be, just like the student loan issue, assume the role of the issuer of health insurance. Correct me if I am wrong (but I doubt it), you are in support of the opposite approach, entirely privatizing the payer system and sticking them with both the profits and losses, as this is not a function or job of the government in your opinion.

This is the most ridiculous statement ever. We're sitting here discussing "socializing the profits or privatizing the losses." Socializing the profits? What kind of semantic bullcrap is that? That's called socializing the SYSTEM. What fool is going to care about profits if profits are socialized? Student loans are not "socialized." When the government "becomes the issuer of health insurance," that's not "socializing the profits." That's socialism. That's more of what I keep talking about: liberals creating a mess with the system and then complaining about it.

Once you bring the government into the mix as an insurer, what do you get? NO COMPETITION. How can private insurers compete against the government, which can set rates wherever it wants, can assume any loss it wants and pass it on to taxpayers, and basically can ignore any market forces? They can't. This is Obama-speak. Now we're just dressing up a pig and trying to pretend it's not a pig.

 

[Regnvejr]

....Once you bring the government into the mix as an insurer, what do you get? NO COMPETITION. How can private insurers compete against the government, which can set rates wherever it wants, can assume any loss it wants and pass it on to taxpayers, and basically can ignore any market forces? ....

So the Government can help people to get basic health care that they otherwise cannot afford?

What a great idea.

 

[glade]

So the Government can help people to get basic health care that they otherwise cannot afford?

What a great idea.

Yes, the government can do pretty much anything if you're the type of person who doesn't care about freedom or liberty. Like yourself or other liberals. That's why you guys get horny over socialist regimes.

 

[morning]

Once you bring the government into the mix as an insurer, what do you get? NO COMPETITION. How can private insurers compete against the government, which can set rates wherever it wants, can assume any loss it wants and pass it on to taxpayers, and basically can ignore any market forces? They can't. This is Obama-speak. Now we're just dressing up a pig and trying to pretend it's not a pig.

Insurance is already a monopoly in most markets. Look at California. They don't even compete against each other, let alone against the government. How many health insurance commercials do you see on TV? Compare it to auto insurance.

Again, you missed the socialism. The reason someone "else" is willing to work for less is purely due to socialism. Sounds convoluted, so let me explain. In general, there is relatively little deviation in reimbursements. For many reasons, and some of them complex. But let's over-simplify for the sake of understanding and say that you make ABOUT the same working in Montana as you do in New York City. (That's not entirely accurate, but it's OK for now.) So with that in mind, what to do? Because physicians won't go to Montana and liberals are unwilling to free the markets. Well, bring in these mid-levels, who are less qualified, but will work for less as a stop-gap. It's a capitalistic patch to a system broken by socialism. Then YOU bust on the capitalism and totally ignore the system that broke everything. See what I mean?

I'm pretty sure if doctors made a million to work in Montana, we'd still have NPs and PAs. You're right that I'm missing what you're trying to say. The idea that a "shortage" of physicians has made NPs necessary is fiction created by NPs and they KNOW it is fiction. This is not about patient care, it's about power and ego.

 

[Slack3r]

Yes, the government can do pretty much anything if you're the type of person who doesn't care about freedom or liberty. Like yourself or other liberals. That's why you guys get horny over socialist regimes.

At least he didn't say "cadre".

 

[glade]

Insurance is already a monopoly in most markets.

Uh, did you ever stop to think why that happened? I'll give you a little hint: trial lawyers. There are many areas where very few insurance companies venture because it's not profitable (I know the "p" word made a lot of people cry just now, sorry). And guess who sides with the trial lawyers? Liberals. Every time there is tort reform, insurance companies come back into the market. That's like blaming physicians for fleeing from high-lawsuit areas and going "look at the stupid doctors, there's a whole population of people to treat and they're so stupid they all go to Texas." Yeah, I wonder why ....

I'm pretty sure if doctors made a million to work in Montana, we'd still have NPs and PAs.

Not in Montana, you wouldn't, pal.

 

[morning]

Uh, did you ever stop to think why that happened? I'll give you a little hint: trial lawyers. There are many areas where very few insurance companies venture because it's not profitable (I know the "p" word made a lot of people cry just now, sorry). And guess who sides with the trial lawyers? Liberals. Every time there is tort reform, insurance companies come back into the market. That's like blaming physicians for fleeing from high-lawsuit areas and going "look at the stupid doctors, there's a whole population of people to treat and they're so stupid they all go to Texas." Yeah, I wonder why ....



Not in Montana, you wouldn't, pal.

Yeah, in Montana, because the hospitals wouldn't be willing to pay it.

Now we're back to trial lawyers and malpractice lawsuits - again, you're arguing FOR all that dirty government intervention, not against it. Trial lawyers aren't going to regulate themselves for the good of society.

 

[glade]

Yeah, in Montana, because the hospitals wouldn't be willing to pay it.

No offense, but that shows that you don't know what you're talking about. First of all, a lot of physicians aren't salaried by hospitals. And pay is via reimbursement in that instance, which would be dependent on regional insurance. Second of all, throw that all out and say that pay IS from hospitals. That shows you don't know how the free market works. It has nothing to do with what a hospital WANTS to pay. It has to do with what it NEEDS to pay.

Now we're back to trial lawyers and malpractice lawsuits - again, you're arguing FOR all that dirty government intervention, not against it. Trial lawyers aren't going to regulate themselves for the good of society.

Not really. I mean, sure, you can call tort reform "government intervention" and you'd be technically right. But all it would be is saying that lawyers play by the same rules as everyone else. I mean, "loser pays" isn't really an expansion of government, despite what you want people to believe.

 

[morning]

No offense, but that shows that you don't know what you're talking about. First of all, a lot of physicians aren't salaried by hospitals. And pay is via reimbursement in that instance, which would be dependent on regional insurance. Second of all, throw that all out and say that pay IS from hospitals. That shows you don't know how the free market works. It has nothing to do with what a hospital WANTS to pay. It has to do with what it NEEDS to pay.

If we're not talking about hospitalists or ED docs (remember that I was talking about the ED?) who usually are salaried...why on EARTH would insurance companies reimburse a physician more for working in Montana? Out of the goodness of their hearts? The government could do it, but then you're advocating for evil librul government intervention. If an insurance company reimburses at $1 million for practicing in Phoenix, AZ vs. $1 million for practicing in Crow Agency, MT, physicians will still be choosing AZ.

We were talking about hospitals paying salaries. There's never going to be some miracle situation where private insurance companies will pay someone more to go practice in Montana. They don't care where you practice or who it benefits.

The hospital has midlevels it can NEED to pay over a physician if the physician is too expensive. Personally, I find that unappealing. I bet you do, too. But you don't seem to realize that the solution involves some of that stuff you hate - legislation. Government.

 

[psychforme]

As usual, republicans ****ing things up and then blaming democrats. Nothing new here. Just make sure when you are attendings if you notice a med student is a ******ed republican. FAIL HIM WITHOUT REMORSE.

 

[MOHS_01]

As usual, republicans ****ing things up and then blaming democrats. Nothing new here. Just make sure when you are attendings if you notice a med student is a ******ed republican. FAIL HIM WITHOUT REMORSE.

Maybe post #1000 will mark the start of a new direction. Maybe post #1000 will be intelligible and contributory post #1.

Somehow, I doubt it.

 

[glade]

Ignore the guy, he's conflicted. I mean, if you look under his name it says he's "anti-******." He must go through the whole day stabbing himself in the head, which only sets up a vicious cycle and ends with him voting Democrat.

 

[glade]

why on EARTH would insurance companies reimburse a physician more for working in Montana? Out of the goodness of their hearts?

I think you're confusing the issue here, and perhaps it's my fault for bringing up two topics simultaneously, so I'll try to clarify for you.

The ONE issue here is the impact that malpractice has on insurance companies. That is, in areas without tort reform, insurance companies leave because it becomes unprofitable for them to be there. This in turn causes physicians to leave for two reasons: 1) they don't like being sued by *****s, either, and 2) the insurance company that is left usually reimburses poorly because 2a) it can and 2b) it's usually half broke, too, due to the aforementioned *****s who are suing.

The SECOND issue here is that of no free market for jobs. I don't mean there's NO variance in salaries. You CAN get higher offers to work in West Virginia versus New York City. But the variance is rather limited. In other words, it's not a REAL free market. In a real free market, the price would continue to escalate until the supply met the demand. That's indisputable. If it TOOK $1 million, then it would go to that. Right now, it's more like the difference between $200K and $275K. The point is, we don't have a LACK of physicians, we have a maldistribution, where everyone wants to practice in Los Angeles and nobody wants to practice in backwater Alabama. Enter the NP/PA. But that's capitalism WITHIN a non-capitalistic system. It's capitalism in that the NP/PA costs less, so you can say it's "profit-driven," but you can see that the problem is that the overall system is not a true free market, which is what leads to the NP/PA "solution." Get it? I mean, sure, in a free market you still might get people saying "if the NP/PA is cheaper, I'll take their suckier clinical skills." We can't all shop at Nieman Marcus, some of us have to go to K-Mart. But it would be market driven, which it isn't right now.

 

[Regnvejr]

Yes, the government can do pretty much anything if you're the type of person who doesn't care about freedom or liberty.

AH yes, THAT'S really going to be a good argument there. I can say that you are the kind of heartless person who don't give a damn about other people suffering and dying, and that you should never ever be in any helping profession, that you are a blood sucking parasite. Does that help any here? Don't be an idiot. Stupid ad hominems. Just makes you sound dumb. Freedom and liberty is meaningless if you are severely sick and can't get care. So you must be the kind of selfish, right-wing narcissist who only care about your OWN freedom and liberty.

That's how we argue now, right!

Like yourself or other liberals. That's why you guys get horny over socialist regimes.

Unlike you FASCIST who love to see other suffer and be oppressed. Sheesh, what an idiotic argument.

 

[Regnvejr]

As usual, republicans ****ing things up and then blaming democrats. Nothing new here. Just make sure when you are attendings if you notice a med student is a ******ed republican. FAIL HIM WITHOUT REMORSE.

Unfortunately, there is an influx of uncaring, right-wing political dogmatists, who would rather let a person die than help them, unless they get paid for doing it. That's the sad direction these right-wing med students are taking us. Couldn't they ^$%$^$#^%%$ go into law or banking instead of screwing up patients lives?

 

[glade]

Unlike you FASCIST who love to see other suffer and be oppressed. Sheesh, what an idiotic argument.

Before you use words like "fascist" in a sentence, it's best if you try to learn the definition, kiddo. That's just good form, otherwise you look even more stupid than you already are.

 

[thedrjojo]

This is the most ridiculous statement ever. We're sitting here discussing "socializing the profits or privatizing the losses." Socializing the profits? What kind of semantic bullcrap is that? That's called socializing the SYSTEM. What fool is going to care about profits if profits are socialized? Student loans are not "socialized." When the government "becomes the issuer of health insurance," that's not "socializing the profits." That's socialism. That's more of what I keep talking about: liberals creating a mess with the system and then complaining about it.

Socializing the system would be a single payer option... yes, I agree. A single payer wouldn't be socialization of medicine (british system) as Physicians would have still be independent contractors (canadian system). If they leveled the playing field, where the government intervention would lead to either a gain or loss for the government, along with the private company involvement with full risk/reward, then it isn't socialism.

The student loan change is suppose to net something like $50 billion over the next 10 years that would have normally gone to the private banks that took no risk in these loans (because if students defaulted, uncle sam paid the debt off to the companies and then assumed the job of recollecting. So someone is caring about the profits here...

Once you bring the government into the mix as an insurer, what do you get? NO COMPETITION. How can private insurers compete against the government, which can set rates wherever it wants, can assume any loss it wants and pass it on to taxpayers, and basically can ignore any market forces? They can't. This is Obama-speak. Now we're just dressing up a pig and trying to pretend it's not a pig.

The whole point of the "public option" was that it was going to be required to NOT operate at a loss... it wasn't able to draw funds from elsewhere. Sure, premiums for those that were lower income were going to be subsidized, but we have that in the bill anyway via the exchange. I know you guys are skeptical (probably not even a strong enough word) of anything the government does or says, and I am becoming increasingly too...

And your no competition thing has been debunked in many other fields where there are both private and public options... two examples that come to the top of my head are Colleges/Universities, where there are high quality versions of both, and crappy versions of both, both able to function simultaneously, and the Postal Service, where the public option is failing pretty badly whereas the private competition does fairly well... both cases the public option is cheaper, more accessable, but because the private options offer something desirable, then they can function... so why not have a basic coverage thats public, and then the added coverage options can be purchased at a premium (so a pseudo swiss system that the new AMA president elect, a professor at my school, was so fond of and debated PNHP representatives in front of students about).

Uh, did you ever stop to think why that happened? I'll give you a little hint: trial lawyers. There are many areas where very few insurance companies venture because it's not profitable (I know the "p" word made a lot of people cry just now, sorry). And guess who sides with the trial lawyers? Liberals. Every time there is tort reform, insurance companies come back into the market. That's like blaming physicians for fleeing from high-lawsuit areas and going "look at the stupid doctors, there's a whole population of people to treat and they're so stupid they all go to Texas." Yeah, I wonder why ....

You are going to have to explain to me how trial lawyers and malpractice suits have anything to do with health insurance/health insurance rates. Places that are very lawsuit happy, you have high malpractice rates for doctors, probably fewer malpractice insurers, but again, how does lawsuits effect the health insurance companies? They aren't paying anything in the settlements. They are not affected one way or another by suits. These companies have anti-trust exemption and so there is obviously collusion and they understand that not competing with each other is more profitable for all of them, so they have different areas of control, no competition, and so can also set whatever price they want and if people want to be insured, they have to take it. All these health insurance companies are bringing in record profits, yet still plan on increasing premiums upwards of 20% this year... you know why? Because they can and there is nothing anyone can do about it (at least the government is trying to do something about it now, but I doubt it will work). This is what happened when the REPUBLICANS/Conservatives thought it was a good idea to let companies regulate themselves (and this can apply to every area of the market, from banking, derivatives, oil, etc, etc).

 

[glade]

You keep talking about student loans and I don't think you realize that undercuts your argument. You know why the cost of education is skyrocketing? Because the government is involved (i.e., no free market). There's no market drive AGAINST higher costs. Ordinarily, at some point nobody would be able to afford the product (education) and the cost would be forced down. But since the government is involved, all they do is dole out more money THAT ISN'T THEIRS, which subsidizes all the universities. This allows people to keep attending college and graduate school and medical school and meanwhile places like Harvard have billion dollar endowments and YOU think it's a miracle or that, at worst, some "rich guy" had to do with one less tin of caviar, boo hoo.

That's the whole point. You keep talking about "no risk" or "socialized profits" or whatever. You keep acting like the government just HAS money by magic. The reason the government can do what it does is because it can IGNORE a budget and IGNORE massive losses, something a private company can't. That's why it's not "competition" to have the government involved as a public option, despite what Obama would have you believe. Sure, they're "competing" in a vague sense, but it's a rigged competition. So you're technically correct and realistically lying.

 

[glade]

You are going to have to explain to me how trial lawyers and malpractice suits have anything to do with health insurance/health insurance rates. Places that are very lawsuit happy, you have high malpractice rates for doctors, probably fewer malpractice insurers, but again, how does lawsuits effect the health insurance companies? They aren't paying anything in the settlements. They are not affected one way or another by suits.

Please tell me you're joking.

 

[Regnvejr]

Before you use words like "fascist" in a sentence, it's best if you try to learn the definition, kiddo. That's just good form, otherwise you look even more stupid than you already are.

before you turn MORE into a sniveling, snide *******, perhaps you should learn what good form is, stupid!

 

[Regnvejr]

Please tell me you're joking.

Tell me you have a friggin clue what you're talking about. Legal costs, premiums etc. are found to be less than 1% of healthcare costs.

 

[glade]

Hey, get this, everyone. This guy who claims he's an attending doesn't know what lawsuits have to do with the cost of healthcare. LOLZ.

That's why I come here. Entertainment.

 

[Slack3r]

AH yes, THAT'S really going to be a good argument there. I can say that you are the kind of heartless person who don't give a damn about other people suffering and dying, and that you should never ever be in any helping profession, that you are a blood sucking parasite. Does that help any here? Don't be an idiot. Stupid ad hominems. Just makes you sound dumb. Freedom and liberty is meaningless if you are severely sick and can't get care. So you must be the kind of selfish, right-wing narcissist who only care about your OWN freedom and liberty.

That's how we argue now, right!
Unlike you FASCIST who love to see other suffer and be oppressed. Sheesh, what an idiotic argument.

Ad hominen, ftw! By the way, that's four posts in a row without "cadre". New record?

 

[Rabbit Hole]

Ad hominen, ftw! By the way, that's four posts in a row without "cadre". New record?

I believe that is reserved for the SP forum.

 

[Regnvejr]

Ad hominen, ftw!

Sauce for the goose is sauce for the Gander, right? Or are you hypocritical?

 

[glade]

There was no ad hominem on my part. See, I correctly tagged you as both a liberal and a socialist, seeing as you are pro-collectivism. You, on the other hand, returned by saying that I'm a fascist "who love to see other suffer and be oppressed." Which:

a) doesn't define fascism;
b) is the end result of socialism; and
c) more accurately defines you, since you are pro-government control of private enterprise, which is "fascism."

So it was a massive self-ownage. Also, arguing by saying people who don't agree with you "are for suffering and oppression" is pretty much the most ******ed form of debate. It's similar to when liberals say that people who disagree are all racists. All it demonstrates is that your intellect is close to zero.

 

[Regnvejr]

There was no ad hominem on my part. See, I correctly tagged you as both a liberal and a socialist, seeing as you are pro-collectivism. You, on the other hand, returned by saying that I'm a fascist "who love to see other suffer and be oppressed." Which:

a) doesn't define fascism;
b) is the end result of socialism; and
c) more accurately defines you, since you are pro-government control of private enterprise, which is "fascism."

So it was a massive self-ownage. Also, arguing by saying people who don't agree with you "are for suffering and oppression" is pretty much the most ******ed form of debate. It's similar to when liberals say that people who disagree are all racists. All it demonstrates is that your intellect is close to zero.

Amazing example of projection that you display here.

 

[glade]

Good job at failing. I like how your arguments are built on the kind of strong logic that you see in kindergarten.

 

[womp]

Anyone who has been treated at a local hospital abroad (not those resort hospitals that cater exclusively to foreigners with USD) knows what third world ratholes most of them are.

Take Japan, the second wealthiest country in the world. Democrats and bleeding heart premeds like to say Japan spends half as much as the US. Have any of them actually been to Japan? Most Japanese clinics are the size of a small 2br apartment and packed. Many Japanese doctors operate half a dozen vending machines in the clinic and $5/hr parking in order to break even. Have an emergency? Good luck getting any local Japanese hospital to admit you. Hundreds of Japanese hospitals have shut down their ERs due to unprofitability. It takes trying an average of three different hospitals to get an ER to admit you. About a quarter of patients with a medical emergency never find an ER that will take them, and some die as a result. Two-thirds of Japanese hospitals are insolvent.

China is even worse. Chinese doctors with a decade of experience make $4000 a year, about 20% more than a Foxconn sweatshop factory worker (Foxconn is the manufacturer of your iPhone, where a recent spate of suicides took place). The salaries are so pathetically low that many Chinese doctors take bribery money ("red envelopes") for surgeries and consultations. What if you can't afford bribery money? Well you get to wait in the back of the line and you'd be lucky if the physician had even read your chart before doing the surgery. Meanwhile, hospital administrators (bureaucrats) make twice as much as the actual medical providers.

Europe isn't much better.

It's absurd to expect our costs to be in line with those conditions.

Anyone who thinks the US health care system is the worst in the developed world needs to spend some quality time abroad as both a patient and as a provider.

Don't throw the baby out with the bath water.

 

[glade]

The funniest part is when liberals will say that Cuba represents one of the best healthcare systems in the world and they'll do that without batting an eye. They're going with the mentality that if they're bold enough people will just go along with them, no matter how stupid they sound. And believe me, they sound quite stupid.

 

[Regnvejr]

Good job at failing. I like how your arguments are built on the kind of strong logic that you see in kindergarten.

STILL projecting. Do you have anything to actually contribute?

 

[Regnvejr]

...Europe isn't much better....

A fascinating claim, INCREDIBLY low on substance.

....Anyone who thinks the US health care system is the worst in the developed world needs to spend some quality time abroad as both a patient and as a provider.

Don't throw the baby out with the bath water.

No need to. In the US, that baby died. Infant mortality being so much worse than in Europe, and so on.

 

[womp]

No need to. In the US, that baby died. Infant mortality being so much worse than in Europe, and so on.

One would think an attending like you would be a little more careful handling statistics without context.

Regarding our high infant mortality, we also have higher obesity, higher teenage pregnancies and a higher percentage of preterm babies compared to Europe. One in 8 births in the US are preterm, compared to 1 in 18 in Ireland. Preterm deaths account for over two-thirds of our infant mortality. Wouldn't that significantly affect infant mortality rankings which is measured per 1000 live-births?

A recent study in Epidemiology has shown babies born to obese women were at greater risk of death in their first year, and were also more likely to die in their first 28 days of life than infants born to normal-weight women.

Of course, you can debate whether obesity and teenage pregnancy should be in the realm of public policy or solely be the responsibility of American medicine.

 

[Regnvejr]

One would think an attending like you would be a little more careful handling statistics without context.

Are you denying the numbers, that our ability to keep neonates alive is tremendously worse than in the rest of the Western world?

Regarding our high infant mortality, we also have higher obesity, higher teenage pregnancies and a higher percentage of preterm babies compared to Europe.

Exactly my point. Our health care here is so much worse. In the rest of the Western world, these factors are much better controlled.

One in 8 births in the US are preterm, compared to 1 in 18 in Ireland. Preterm deaths account for over two-thirds of our infant mortality. Wouldn't that significantly affect infant mortality rankings which is measured per 1000 live-births?

And we are not able to avoid pre-term babies because... Oh yeah, our health care system really isn't that good.

A recent study in Epidemiology has shown babies born to obese women were at greater risk of death in their first year, and were also more likely to die in their first 28 days of life than infants born to normal-weight women.

Of course, you can debate whether obesity and teenage pregnancy should be in the realm of public policy or solely be the responsibility of American medicine.

NO KIDDING!!!!!! But yeah, medical problems that the health care system is treating, they are much worse in the US than in the rest of the Western world. So people here, claim once more that we got the "best" system, and you frankly sound stupid.

(Now what was it that you said about attendings? You made yourself sound stupid. Perhaps you should lay off the ad hominems and not sound like a silly kid.)

 

[glade]

As usual, the liberal has the analytical ability of a dung beetle. Liberals ALL throw those stats around, but none of them know what they mean. Mostly because they're stupid. The liberals demand that America absorb the world's poor and indigent. We do so far in excess to other countries and that's frankly because other countries suck in comparison to America. Try to send a bunch of Haitian refugees to the Netherlands. Nope. Vietnamese to Sweden? Uh uh. These liberal utopias have tightly controlled populations that are renowned for being completely homogenous, so much so that they are used as control groups for studies. Meanwhile, the same liberal idiots carefully ensure that minorities exist in just-above-poverty circumstances in ghettos where they aren't accountable for any actions and consequently alcoholism, drug use, poverty, teenage pregnancy, and child deaths are rampant. Then they turn around and say that proves America is horrible.

Here's the key: none of these liberal ******s would ever leave America to get healthcare at these great places, like Cuba.

 

[Regnvejr]

Ah, more Ad Hominems. We have come to expect those.

 

[ABCZXX]

Tell me you have a friggin clue what you're talking about. Legal costs, premiums etc. are found to be less than 1% of healthcare costs.

Yes the direct costs are found to be less than 1% of heatlhcare costs. What about indirect costs? (including, but not limited to, extra unnecessary procedures i.e. defensive medicine and redundant tests that don't actually help the patient) Any estimate for the indirect costs? What say you--10% or 15% maybe? If so, what is your basis for calculating the indirect costs as a percentile of total healthcare costs?

OR

Why did you blatantly and nonchalantly ignore the indirect costs? They are real costs which do relevantly make healthcare more expensive, Reggie. Even before Obama care, the good or service was artificially and arbtirarily made more expensive than what it costs to produce that good or service. Indirect costs drive a wedge in between what the patient gets (health care services) and what the doctor provides (health care services) and indirect costs simply make health care more unaffordable as doctors have MASSIVE INCENTIVE to provide unnecessary services that reduce their liability risks, yet the patient doesn't really linearly benefit from the extras which are passed on to him. It's like a customer buying a plain hot dog and being forced to purchase the "combo basket" which includes chips and a bottled water... Do you see my point? I'm the only one trying to be peaceful and civil. The total costs of health care are driven upward by direct costs (which I agree with you at about ~1%) but the indirect costs are extremely difficult to calculate and the data is always an educated guess spit out by a computer statistical modeling function.

 

[oldbearprofessor]

Are you denying the numbers, that our ability to keep neonates alive is tremendously worse than in the rest of the Western world?

I'm curious what technology or other medical skills the rest of the Western world has to keep neonates alive that we don't have. Do you mean we have more small preterm infants and therefore more deaths of preterm infants than some Western countries? That is true and undeniable. But your comment above seems to imply that at any given gestational age, our medical care is worse than in other Western countries. If that is what you mean, what is it that "we" lack and how should we get it?

If it is our rate of prematurity that is high (it is), what specific things are physicians not doing that are within the bounds of the law and could lower this rate? I am NOT challenging the idea that we have a high rate of prematurity in the US, I'm asking what YOU think specifically physicians such as me should do about it outside of political action?

 

[MOHS_01]

I'm curious what technology or other medical skills the rest of the Western world has to keep neonates alive that we don't have. Do you mean we have more small preterm infants and therefore more deaths of preterm infants than some Western countries? That is true and undeniable. But your comment above seems to imply that at any given gestational age, our medical care is worse than in other Western countries. If that is what you mean, what is it that "we" lack and how should we get it?

If it is our rate of prematurity that is high (it is), what specific things are physicians not doing that are within the bounds of the law and could lower this rate? I am NOT challenging the idea that we have a high rate of prematurity in the US, I'm asking what YOU think specifically physicians such as me should do about it outside of political action?

Yes the direct costs are found to be less than 1% of heatlhcare costs. What about indirect costs? (including, but not limited to, extra unnecessary procedures i.e. defensive medicine and redundant tests that don't actually help the patient) Any estimate for the indirect costs? What say you--10% or 15% maybe? If so, what is your basis for calculating the indirect costs as a percentile of total healthcare costs?

OR

Why did you blatantly and nonchalantly ignore the indirect costs? They are real costs which do relevantly make healthcare more expensive, Reggie. Even before Obama care, the good or service was artificially and arbtirarily made more expensive than what it costs to produce that good or service. Indirect costs drive a wedge in between what the patient gets (health care services) and what the doctor provides (health care services) and indirect costs simply make health care more unaffordable as doctors have MASSIVE INCENTIVE to provide unnecessary services that reduce their liability risks, yet the patient doesn't really linearly benefit from the extras which are passed on to him. It's like a customer buying a plain hot dog and being forced to purchase the "combo basket" which includes chips and a bottled water... Do you see my point? I'm the only one trying to be peaceful and civil. The total costs of health care are driven upward by direct costs (which I agree with you at about ~1%) but the indirect costs are extremely difficult to calculate and the data is always an educated guess spit out by a computer statistical modeling function.

You two fine gentlemen (ladies?) must be new to Reggie -- he can be a fine enough fellow from time to time, but he suffers from a horrendous case of social, political, and economic delusions that preclude him from critical thought. Perhaps he is so invested in this religion of the social welfare state that any challenge to it is deemed unacceptable, something that is best cast into the fires of Hades (he has a fire fetish as well, which has caused him a little trouble from time to time on the forum).

In any event, I believe that I have read several sources, backed by significant research data, that has demonstrated a statistically -- and clinically -- significant advantage for US neonatal mortality when adjusted for various confounding criteria.

As for the topic of defensive medicine -- the costs are truly incalculable for a variety of reasons, but they are easily higher than most estimates for the simple fact that defensive medicine is built into our practice patterns. They permeate every single "standard of care" and "care guidelines" issued and accepted. It is reflected in every textbook and expert opinion piece authored. The costs associated with defensive medicine are incalculable because we cannot, at this time, tease out what is "truly necessary" from that which is driven by marginal returns -- be they under the guise of patient safety, medicolegal implications, etc.

 

[glade]

Translation: the guy is liberal and therefore he doesn't know **** from shinola.

 

[Regnvejr]

Translation: the guy is liberal and therefore he doesn't know **** from shinola.

It is amazing, the level you bring the discussion to.

 

[glade]

Rest assured, after your comments on how law suits have no impact on medical costs and that healthcare in America is worse than in other countries, there's nowhere to go but up.