Politically Correct Medicine

[penguins]

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I am so offended, Panda Bear! I feel like I was just accused of being a liberal! Ah!!!!!!! 😡

 

[McDoctor]

Do we really need to take it up a notch and create a fitness beauracracy to spend even more money chasing another unsolvable problem?

.

I actually advocate that we take the bureacracy down a notch and encourage a system whereby the poor have access to healthcare funding accounts that can be used as they see fit. I don't know where you are coming up with this advocating a fitness bureacracy. Our current system is the bureacratic nightmare.

What I said was that we have a system that basically provides handouts in the form of our tax dollars to the pharmaceutical companies to make their products exclusively available to people on medicare and medicaid. I would rather see the people have that money in form of a voucher and have the option to spend the money on a generic medicine if they see fit and at least have the option to apply some of the money to fitness programs or any other reasonable preventative medicine strategy.
Currently we have this convoluted system whereby nongeneric drugs are on formulary and covered even when a generic equivalent exists and YOU are paying the cost for that. Is this a legitimate use of tax dollars?

If you think that Statins or any other pills are superior to regular exercise in primary prevention of cardiovascular events then I'm not sure you've read any studies not sponsored by a drug rep and that wasn't accompanied with a fancy pen. You have to have a healthcare system that at least gives people the option to take part in a structured diet and exercise program, whether they choose to utilize it or not.

 

[McDoctor]

I don't think it would matter how much money we threw at the problem, it wouldn't go away. If people had to pay for their own Lipitor and CABGs then that might help. I certainly don't want a fitness enforcing branch of the government.

Yet, my point is that you continue to throw money at the problem. And nobody is talking about a fitness enforcing branch of the government. I'm providing an example of a basic cost effective service (access to a health club) that isn't provided by medicare or medicaid. Whether people choose to utilize that service or not is not my problem.
Again, my point being that the benefits of exercise equals or exceeds the benefits of current pharmacologic strategies for cardiovascular disease. Its not enough to pay lip service, you have to provide a mechanism whereby reasonable fitness equipment is available so that people can put our exercise recommendations into practice. The cost of this per month would be minimal compared to the egregious amounts we spend on medications.

 

[VA Hopeful Dr]

I'll boil this down nice and simple.

In our country, there are people who take ZERO responsibility for their own well being. They prioritize in ways that many of us find stupid (I'll smoke 3 packs per day then complain about my $2 medicaid co-pay as being outrageous and unfair). They ignore all rational advice (see the EM thread "Things I learn from my patients). And they are incredibly selfish (3 packs again, but this time sacrifice children's health doing so AND complain about how expensive inhalers are).

No matter what we do, you can't help everyone.
Should there be a system set up to help people who are honestly just down on their luck and need assistance for a bit? Yes
Should we help those who are content to live on welfare/food stamps/medicaid for the rest of their lives? I'm not sure. Part of me says yes, part says no.
Can we help those who won't a) accept our advice b) use common sense c) listen to rason? No

I'd love to think that everyone got all the care they could ever need and that we could fix everyone's problems, but it just won't happen. Some people are just too stupid/lazy/selfish, or all of the above.

 

[penguins]

Yet, my point is that you continue to throw money at the problem. And nobody is talking about a fitness enforcing branch of the government. I'm providing an example of a basic cost effective service (access to a health club) that isn't provided by medicare or medicaid. Whether people choose to utilize that service or not is not my problem.
Again, my point being that the benefits of exercise equals or exceeds the benefits of current pharmacologic strategies for cardiovascular disease. Its not enough to pay lip service, you have to provide a mechanism whereby reasonable fitness equipment is available so that people can put our exercise recommendations into practice. The cost of this per month would be minimal compared to the egregious amounts we spend on medications.

If you think this is important, here is what you do:
Write out a check to your local YMCA or YWCA. They take donations and then offer sliding scale or free memberships to anyone who applies. There you go.

 

[McDoctor]

If you think this is important, here is what you do:
Write out a check to your local YMCA or YWCA. They take donations and then offer sliding scale or free memberships to anyone who applies. There you go.

But why should I have to make a donation beyond what I already pay in taxes toward medicare and medicaid? Why not have that money go to the recipient (in the form of a voucher) who can then decide if he or she would like to apply it to a membership at the YMCA? This puts the onus of responsibility on the recipient to make choices in his or her healthcare.

 

[Gut Shot]

Ah, I fondly remember my summer job (less than 10 years ago by far) where people would come cash out the "living expenses" portion of their welfare checks and as I counted the money for each girl in the group - I overheard them designating who was getting the liquor, who was paying cover, who was grilling the steaks.
Another job at the grocery store. People buying up to 20 steaks, name brand chips, salsa, coke, one person even bought caviar!, and then they swiped their welfare card. They would even talk amongst themselves about how they got the good steaks! What the heck? You are using semantics if you think those days are really gone.

I have no doubt that people abuse assistance programs, but food stamps are a pretty minor benefit. According to the federal guidelines, a single person who meets all eligibility requirements and makes $0 a month can qualify for a maximum food stamp benefit of $152 a month. In other words eating on $5 a day, and that's the maximum benefit. As income increases the benefit decreases until it vanishes at a net monthly income threshold of $798. Therefore, if you net more than a whopping $9,576 a year you don't qualify at all.

When people on this thread complain about folks who are "content getting by on welfare," do you really think they're talking about $5 a day (max) in food stamps? No, they're complaining about the idea that there are lazy, unemployed people who are lying at home, in their own filth, collecting and endless stream of government checks by virtue of their own sloth. Sorry, those days went the way of the USFL.

 

[Gut Shot]

In our country, there are people who take ZERO responsibility for their own well being. They prioritize in ways that many of us find stupid (I'll smoke 3 packs per day then complain about my $2 medicaid co-pay as being outrageous and unfair). They ignore all rational advice (see the EM thread "Things I learn from my patients). And they are incredibly selfish (3 packs again, but this time sacrifice children's health doing so AND complain about how expensive inhalers are).

I think that sums it up nicely. There is a percentage of the population that is comprised of unabashed, unredeemable social parasites, and that's that.

Why are these people so disturbing to us? I think part of the reason is that we see them on a day to day basis, and they stand out to us. The magnitude of their collective parasitism thus becomes inflated. Same thing with all the crap on the evening news, which would make Mayberry seem like a dangerous place to live.

To put it in perspective, the largest welfare program in existence is the AFDP (Aid to Families with Dependent Children). The government bailout during the S&L scandal cost taxpayers $500 billion. That sum would have funded the AFDP for twenty years, and yet I rarely see people on these forums get very passionate about white collar crime. Perhaps this is because such crime is usually invisible to us (unlike poor folks buying steaks with their "welfare cards").

 

[penguins]

I have no doubt that people abuse assistance programs, but food stamps are a pretty minor benefit. According to the federal guidelines, a single person who meets all eligibility requirements and makes $0 a month can qualify for a maximum food stamp benefit of $152 a month. In other words eating on $5 a day, and that's the maximum benefit. As income increases the benefit decreases until it vanishes at a net monthly income threshold of $798. Therefore, if you net more than a whopping $9,576 a year you don't qualify at all.

When people on this thread complain about folks who are "content getting by on welfare," do you really think they're talking about $5 a day (max) in food stamps? No, they're complaining about the idea that there are lazy, unemployed people who are lying at home, in their own filth, collecting and endless stream of government checks by virtue of their own sloth. Sorry, those days went the way of the USFL.

I don't know where you are getting those numbers but I don't buy it. I know people who have been on welfare recently.

 

[Qafas]

I'm providing an example of a basic cost effective service (access to a health club) that isn't provided by medicare or medicaid. Whether people choose to utilize that service or not is not my problem.
Again, my point being that the benefits of exercise equals or exceeds the benefits of current pharmacologic strategies for cardiovascular disease. Its not enough to pay lip service, you have to provide a mechanism whereby reasonable fitness equipment is available so that people can put our exercise recommendations into practice. The cost of this per month would be minimal compared to the egregious amounts we spend on medications.

First, even people who can comfortably afford health club membership don't do it. Second, you don't need a health club to exercise and be fit - all that you need are a pair of sneakers, the sidewalk, and the motivation to do something about your health. I suspect that even if every single American were to have his own personal fitness room in the basement, Americans as a whole would still be unhealthy and sales of statins wouldn't dip nearly enough for anyone to notice.

 

[Gut Shot]

I don't know where you are getting those numbers but I don't buy it.

Fine. You can review the eligibility requirements and benefits yourself on the USDA's food stamp website.

I know people who have been on welfare recently.

I never said that welfare was abolished, just that it ain't what it used to be. From a 2002 article by the MDRC:

The federal welfare reform law - the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) - is slated for reauthorization later this year. When the act passed in 1996, policymakers, journalists, and academics characterized it as "revolutionary," "sweeping," and "pathbreaking." Indeed, the law entailed a significant leap of faith. Little was known then about the likely effects of some of its most important provisions: a five-year life-time limit on the number of months federal funds could be used to pay a family's welfare benefits; a daunting requirement that states involve at least 50 percent of single-parent welfare recipients (90 percent of two-parent household heads) in 30 hours per week of work or related activities; tough restrictions on the type and amount of education and job search activities that could count as meeting the work participation requirement; and incentives to reduce out-of-wedlock parenting and promote marriage.

In addition to these work- and family-focused provisions, the new act abolished the open-ended entitlement to benefits and replaced it with a fixed-dollar or capped block-grant amount to each state. These block-grant provisions afforded states remarkable flexibility in the design and structure of programs for the poor. States capitalized on the new flexibility in both predictable and surprising ways. As expected, some states immediately set shorter time limits on welfare receipt and tightened sanctions for noncompliance, including use of full-family sanctions that end the entire welfare grant if the parent failed to meet participation requirements. More surprising, nearly all states set out to make work pay by allowing more welfare recipients to mix work and welfare benefits, at least temporarily, by increasing the amount of earnings that would not be counted against their benefits when welfare recipients took jobs. In another surprising change for its magnitude and pervasiveness, many states opted to transfer nearly a third of their block-grant resources to child care, child welfare, and other related program areas.

 

[penguins]

Fine. You can review the eligibility requirements and benefits yourself on the USDA's food stamp website.



I never said that welfare was abolished, just that it ain't what it used to be. From a 2002 article by the MDRC:

The federal welfare reform law - the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) - is slated for reauthorization later this year. When the act passed in 1996, policymakers, journalists, and academics characterized it as "revolutionary," "sweeping," and "pathbreaking." Indeed, the law entailed a significant leap of faith. Little was known then about the likely effects of some of its most important provisions: a five-year life-time limit on the number of months federal funds could be used to pay a family's welfare benefits; a daunting requirement that states involve at least 50 percent of single-parent welfare recipients (90 percent of two-parent household heads) in 30 hours per week of work or related activities; tough restrictions on the type and amount of education and job search activities that could count as meeting the work participation requirement; and incentives to reduce out-of-wedlock parenting and promote marriage.

In addition to these work- and family-focused provisions, the new act abolished the open-ended entitlement to benefits and replaced it with a fixed-dollar or capped block-grant amount to each state. These block-grant provisions afforded states remarkable flexibility in the design and structure of programs for the poor. States capitalized on the new flexibility in both predictable and surprising ways. As expected, some states immediately set shorter time limits on welfare receipt and tightened sanctions for noncompliance, including use of full-family sanctions that end the entire welfare grant if the parent failed to meet participation requirements. More surprising, nearly all states set out to make work pay by allowing more welfare recipients to mix work and welfare benefits, at least temporarily, by increasing the amount of earnings that would not be counted against their benefits when welfare recipients took jobs. In another surprising change for its magnitude and pervasiveness, many states opted to transfer nearly a third of their block-grant resources to child care, child welfare, and other related program areas.

Sorry, should have been more clear. I know people who have been on welfare recently and I know how much they are getting!! It is more than $5 a day for food!
You are right, it isn't what it used to be.

 

[Flopotomist]

I also wanted to point out (just to irritate the arch conservatives on here) that it was President Clinton that slashed welfare.

 

[8744]

I also wanted to point out (just to irritate the arch conservatives on here) that it was President Clinton that slashed welfare.

Doesn't that also irritate the arch-liberals here?

 

[Flopotomist]

Doesn't that also irritate the arch-liberals here?

probably...

 

[Gut Shot]

Sorry, should have been more clear. I know people who have been on welfare recently and I know how much they are getting!! It is more than $5 a day for food!

If they are collecting both food stamp and AFDP benefits, then yes, it would be more. There is also unemployment, but that's a temporary payout. For elderly and/or disabled, there is always SSI and disability, but it's usually quite tough to qualify for those, even if you're dirt por and/or have significant medical problems.

 

[penguins]

I also wanted to point out (just to irritate the arch conservatives on here) that it was President Clinton that slashed welfare.

I would argue that had a heck of a lot more to do with the Congress he sserved with, but whatever.