Rad Onc Twitter

  • Thread starter Thread starter deleted1002574
  • Start date Start date
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Members don't see this ad.
radiation said:
I don't really care for her, but Reshma Jagsi's highest cited paper is from NEJM and is along the similar vein of research
Click to expand...
Stephen A Smith Eye Roll GIF by ESPN
 
When I was looking to switch, I was interested in Jersey. There are two Summit medical group jobs listed for last 6-8 months at least. I applied (was pain in the ass). No response. They are still listed - again on Astro. Anyone know if it’s a real job or something else going on?
 
lol
TheWallnerus said:
Stephen A Smith Eye Roll GIF by ESPN
Click to expand...
RealSimulD said:
When I was looking to switch, I was interested in Jersey. There are two Summit medical group jobs listed for last 6-8 months at least. I applied (was pain in the ass). No response. They are still listed - again on Astro. Anyone know if it’s a real job or something else going on?
Click to expand...
I applied to those many years ago. Also no response
 
Ray D. Ayshun said:
I need people like this out there to make some of the weird decisions I've made look less problematic by comparison.
Click to expand...
Oh man...I can think of at least 5 stories off the top of my head that are equivalently bad. I would say we should make a whole thread about it but I suspect attorneys would want to include SDN in discovery/depose the moderators etc so let's not do that.
 
RealSimulD said:
There was a guy in upstate NY who recently lost his license for very bad radiation oncology work. Including whole brain x 2 at high dose...
Click to expand...
I haven't done this even once? I think the highest I have given for WBRT is 20 x 2 Gy. I did this once, 2013. The patient is still alive and in remission.
 
I'm doing a resbrt plan right now because a fortune cookie I got at a Thai restaurant last week made me think the area still had some cancer. I'm sure others have done similar things.
 
Palex80 said:
I haven't done this even once? I think the highest I have given for WBRT is 20 x 2 Gy. I did this once, 2013. The patient is still alive and in remission.
Click to expand...
You're assuming it was done with thoughtful intent/consideration.

Whether it's in academia or the community, people do whack ****. The difference is how they justify it. Not sure what it's like for you in Europe, but perhaps these hold true there as well:

In academia, there's usually a cadre of students/residents around (at minimum) and wildly poor decisions require justification. During intern year and residency I saw/was a part of countless treatment decisions I didn't agree with, some were terrifying. Two things would happen: first, there would be some flimsy retrospective chart review or Phase I study whipped out and used as the rationale, which is basically bulletproof at a local level. Second, the institution protects itself. Wagons will be circled and even if something terrible is done it will take an act of God for there to be consequences.

In the community...well, people are on their own. ESPECIALLY in Radiation Oncology, if you're a solo doc in a freestanding center or a small hospital, virtually no one for 100 miles in any direction knows what you're doing. Our specialty is so arcane that even other types of physicians who are particularly interested in radiation barely understand. Throw into the mix: it's almost impossible to kill someone with radiation while on beam (compared to a surgeon slicing an important in the OR), and cancer is notoriously difficult to treat. So there's little feedback to an individual RadOnc.

Example: Neurosurgeon goes to the OR with a tricky GBM case. While attempting to attain a GTR, the surgeon cuts the optic chiasm and blinds the patient. Alternatively, the surgeon punctures a main artery and the patient dies on the table. Everyone can understand what happened, from the scrub tech to the front desk. The surgeon KNOWS what happened was a direct consequence of their actions.

Now, what if the surgery goes fine, and that same GBM patient comes to a RadOnc in your average freestanding community center in their local community serving 50,000 people. This RadOnc has been practicing at this same hospital for 20-25 years. Maybe they have a partner, or maybe the hospital hires locums to cover vacations, but this person has been essentially practicing solo that entire time. They "taught themselves" IMRT and modern treatment planning because it was developed after they graduated residency.

The patient goes on beam. Treatment goes as expected, maybe some headaches, hair loss, nausea. Treated with dex and Zofran. Patient finishes, RadOnc drops a treatment summary which states "patient received a total of 60Gy in 30 fractions per Stupp protocol, with T2 FLAIR getting 46Gy followed by a 14Gy cone down to surgical cavity". Anyone reading that says "yup, standard of care, great job". Patient goes on to get adjuvant TMZ and dies 6 months later. "GBM is an aggressive cancer", everyone says, shaking their head. Case closed.

What literally no one will ever know is that the RadOnc drew their PTV completely incorrectly, missing half the cavity and the "Optic Chiasm" contour was actually the pituitary gland/cavernous sinus. If the patient lost vision shortly before death, it will be attributed to the cancer and not the fact that half the chiasm got 74.6Gy (because this RadOnc thinks that dose escalation in GBM is good and Dosimetry intentionally adds hotspots in the target volumes for the RadOnc).

It's not a problem unique to RadOnc, it's just that we're set up so 1) no one will see our errors and 2) even if they do, they won't understand. It's a lot easier to spot a "bad" surgeon.

The hilarious part (using "hilarious" ironically) is that our entire board certification process is set up so these people can "easily" sneak through and practice for 30 years. How many kids memorize a script for prostate brachy every year and dutifully recite the script at orals, despite never having done it themselves (or only seeing it a couple times)? The ABR waves this banner of "patient safety" around board certification, but really it's a way to absolve institutions from liability if things go poorly.

("Dr so-and-so had board certification that included pediatrics, how were we supposed to know they'd never done CSI on an infant before?")
 
elementaryschooleconomics said:
You're assuming it was done with thoughtful intent/consideration.

Whether it's in academia or the community, people do whack ****. The difference is how they justify it. Not sure what it's like for you in Europe, but perhaps these hold true there as well:

In academia, there's usually a cadre of students/residents around (at minimum) and wildly poor decisions require justification. During intern year and residency I saw/was a part of countless treatment decisions I didn't agree with, some were terrifying. Two things would happen: first, there would be some flimsy retrospective chart review or Phase I study whipped out and used as the rationale, which is basically bulletproof at a local level. Second, the institution protects itself. Wagons will be circled and even if something terrible is done it will take an act of God for there to be consequences.

In the community...well, people are on their own. ESPECIALLY in Radiation Oncology, if you're a solo doc in a freestanding center or a small hospital, virtually no one for 100 miles in any direction knows what you're doing. Our specialty is so arcane that even other types of physicians who are particularly interested in radiation barely understand. Throw into the mix: it's almost impossible to kill someone with radiation while on beam (compared to a surgeon slicing an important in the OR), and cancer is notoriously difficult to treat. So there's little feedback to an individual RadOnc.

Example: Neurosurgeon goes to the OR with a tricky GBM case. While attempting to attain a GTR, the surgeon cuts the optic chiasm and blinds the patient. Alternatively, the surgeon punctures a main artery and the patient dies on the table. Everyone can understand what happened, from the scrub tech to the front desk. The surgeon KNOWS what happened was a direct consequence of their actions.

Now, what if the surgery goes fine, and that same GBM patient comes to a RadOnc in your average freestanding community center in their local community serving 50,000 people. This RadOnc has been practicing at this same hospital for 20-25 years. Maybe they have a partner, or maybe the hospital hires locums to cover vacations, but this person has been essentially practicing solo that entire time. They "taught themselves" IMRT and modern treatment planning because it was developed after they graduated residency.

The patient goes on beam. Treatment goes as expected, maybe some headaches, hair loss, nausea. Treated with dex and Zofran. Patient finishes, RadOnc drops a treatment summary which states "patient received a total of 60Gy in 30 fractions per Stupp protocol, with T2 FLAIR getting 46Gy followed by a 14Gy cone down to surgical cavity". Anyone reading that says "yup, standard of care, great job". Patient goes on to get adjuvant TMZ and dies 6 months later. "GBM is an aggressive cancer", everyone says, shaking their head. Case closed.

What literally no one will ever know is that the RadOnc drew their PTV completely incorrectly, missing half the cavity and the "Optic Chiasm" contour was actually the pituitary gland/cavernous sinus. If the patient lost vision shortly before death, it will be attributed to the cancer and not the fact that half the chiasm got 74.6Gy (because this RadOnc thinks that dose escalation in GBM is good and Dosimetry intentionally adds hotspots in the target volumes for the RadOnc).

It's not a problem unique to RadOnc, it's just that we're set up so 1) no one will see our errors and 2) even if they do, they won't understand. It's a lot easier to spot a "bad" surgeon.

The hilarious part (using "hilarious" ironically) is that our entire board certification process is set up so these people can "easily" sneak through and practice for 30 years. How many kids memorize a script for prostate brachy every year and dutifully recite the script at orals, despite never having done it themselves (or only seeing it a couple times)? The ABR waves this banner of "patient safety" around board certification, but really it's a way to absolve institutions from liability if things go poorly.

("Dr so-and-so had board certification that included pediatrics, how were we supposed to know they'd never done CSI on an infant before?")
Click to expand...
🖐🎤
 
elementaryschooleconomics said:
In academia, there's usually a cadre of students/residents around (at minimum) and wildly poor decisions require justification. During intern year and residency I saw/was a part of countless treatment decisions I didn't agree with, some were terrifying. Two things would happen: first, there would be some flimsy retrospective chart review or Phase I study whipped out and used as the rationale, which is basically bulletproof at a local level. Second, the institution protects itself. Wagons will be circled and even if something terrible is done it will take an act of God for there to be consequences.
Click to expand...
I have the impression that this is particularly an issue in palliative indications.

Your post is, as always, spot on!
 
seper said:
this is insane
Click to expand...
I am not so sure what to make out of it. We do not have all the details.

One thing that may be important:

A civil complaint filed by Eskew’s estate indicates that Eskew and his wife, Sandra, purchased a health insurance policy from Sierra Health in January 2016. "Beginning in or about 2015, Bill was diagnosed with lung cancer,” the complaint said.

Timing of insurance policy purchase and disclosure of pre-existing conditions may have been an issue as well.
 
Palex80 said:
I am not so sure what to make out of it. We do not have all the details.

One thing that may be important:

A civil complaint filed by Eskew’s estate indicates that Eskew and his wife, Sandra, purchased a health insurance policy from Sierra Health in January 2016. "Beginning in or about 2015, Bill was diagnosed with lung cancer,” the complaint said.

Timing of insurance policy purchase and disclosure of pre-existing conditions may have been an issue as well.
Click to expand...
I’m impressed that you knew pre-existing conditions were a thing in America. Thankfully, Obamacare banned insurance companies from denying coverage due to pre-existing conditions, so that wouldn’t have been an issue in this case.
 
grenz said:
I’m impressed that you knew pre-existing conditions were a thing in America. Thankfully, Obamacare banned insurance companies from denying coverage due to pre-existing conditions, so that wouldn’t have been an issue in this case.
Click to expand...

"Thankfully" may be a stretch. People tend to make poor decisions and waiting until you have a very expensive illness to sign up for health care creates moral hazard. It is like COBRA allowing you 2 months to purchase insurance when you leave your job. People just don't pay for insurance those two months and if they get sick, they retroactively pay the premiums. That isn't what insurance should be about. A person in their 50s or 60s that is able to suddenly purchase insurance after getting a lung cancer diagnosis shouldn't be considered a "feature" of a program. It sounds like a giveaway.

What is should have allowed is easy transition of insurance. If you've been paying into Aetna for years and have lung cancer, change jobs and have to get Cigna, then of course allow people to change without penalty.
 
RealSimulD said:
"Thankfully" may be a stretch. People tend to make poor decisions and waiting until you have a very expensive illness to sign up for health care creates moral hazard. It is like COBRA allowing you 2 months to purchase insurance when you leave your job. People just don't pay for insurance those two months and if they get sick, they retroactively pay the premiums. That isn't what insurance should be about. A person in their 50s or 60s that is able to suddenly purchase insurance after getting a lung cancer diagnosis shouldn't be considered a "feature" of a program. It sounds like a giveaway.

What is should have allowed is easy transition of insurance. If you've been paying into Aetna for years and have lung cancer, change jobs and have to get Cigna, then of course allow people to change without penalty.
Click to expand...

There are many ways to improve our system, but thankfully everyone now agrees with the pre existing conditions part, being that it’s highly popular now, and even the GOP stopped trying to get rid of it.

So I agree with Grenz.

You have the private insurance lobby to thank for not allowing the things that make sense, though, as I agree with you that insurance shouldn’t be tied to employment at all. What a complete total joke of a sick system
 
RealSimulD said:
"Thankfully" may be a stretch. People tend to make poor decisions and waiting until you have a very expensive illness to sign up for health care creates moral hazard. It is like COBRA allowing you 2 months to purchase insurance when you leave your job. People just don't pay for insurance those two months and if they get sick, they retroactively pay the premiums. That isn't what insurance should be about. A person in their 50s or 60s that is able to suddenly purchase insurance after getting a lung cancer diagnosis shouldn't be considered a "feature" of a program. It sounds like a giveaway.

What is should have allowed is easy transition of insurance. If you've been paying into Aetna for years and have lung cancer, change jobs and have to get Cigna, then of course allow people to change without penalty.
Click to expand...
So continuous coverage or GTFO? The list of reasons poor people might not be able to be continuously insured for their entire lives is very, very long. I’m sure there are straight free loaders out there who could afford insurance but choose not to buy, but I suspect they are a small minority of the uninsured population.
 
Isn't January like open enrollment for insurance? Maybe he just switched from one insurer to another for whatever reason (including, potentially his condition). The list is long.

However, protons wasn't saving this guy's life or preventing his esophagitis.
 
grenz said:
So continuous coverage or GTFO? The list of reasons poor people might not be able to be continuously insured for their entire lives is very, very long. I’m sure there are straight free loaders out there who could afford insurance but choose not to buy, but I suspect they are a small minority of the uninsured population.
Click to expand...
Do you think "any coverage any time or GTFO" has its drawbacks?

I suspect that the uninsured, healthy between the ages of 26 and 50 are not a small minority of the uninsured population. I imagine we can figure this out pretty easily?
 
grenz said:
I’m impressed that you knew pre-existing conditions were a thing in America. Thankfully, Obamacare banned insurance companies from denying coverage due to pre-existing conditions, so that wouldn’t have been an issue in this case.
Click to expand...
Interesting! I didn't know that. So how does this work?
You don't have to disclose to the insurance company that you suffer from a condition when you are considering buying a policy?
And they can't deny coverage for anything you did not disclose?

It is definetely a thing in Europe when you are looking into private insurance policies. If you don't disclose that you suffer from diabetes when signing a private insurance company, they may deny paying for the insuline.
 
Palex80 said:
Interesting! I didn't know that. So how does this work?
You don't have to disclose to the insurance company that you suffer from a condition when you are considering buying a policy?
And they can't deny coverage for anything you did not disclose?

It is definetely a thing in Europe when you are looking into private insurance policies. If you don't disclose that you suffer from diabetes when signing a private insurance company, they may deny paying for the insuline.
Click to expand...
Well, that makes sense, because it is no longer "insurance". It's asking for a company to pay for your known health costs at a heavy discount. The idea of health insurance is to mitigate risk across the population.

If everyone always waited until they were sick to get insurance, well ... that would be a great way to destroy health care.
 
RealSimulD said:
Do you think "any coverage any time or GTFO" has its drawbacks?

I suspect that the uninsured, healthy between the ages of 26 and 50 are not a small minority of the uninsured population. I imagine we can figure this out pretty easily?
Click to expand...
www.kff.org

Key Facts about the Uninsured Population | KFF

This issue brief describes trends in health coverage in 2023, examines the characteristics of the uninsured population ages 0-64, and summarizes the access and financial implications of not having coverage.
www.kff.org www.kff.org

Figure 7. 74% uninsured bc too expensive. At most 21% uninsured because they just don’t think they need/want it.

Not sure why you’re limiting this to 26-50 and healthy population. Under your proposed policy, 60yo and unhealthy would be treated the same as young and healthy if they weren’t continuously insured.
 
grenz said:
www.kff.org

Key Facts about the Uninsured Population | KFF

This issue brief describes trends in health coverage in 2023, examines the characteristics of the uninsured population ages 0-64, and summarizes the access and financial implications of not having coverage.
www.kff.org www.kff.org

Figure 7. 74% uninsured bc too expensive. At most 21% uninsured because they just don’t think they need/want it.

Not sure why you’re limiting this to 26-50 and healthy population. Under your proposed policy, 60yo and unhealthy would be treated the same as young and healthy if they weren’t continuously insured.
Click to expand...
LOL. I am not smart enough to have "a policy". I did economics and focused on health econ as an undergraduate, but my brain cannot comprehend making a health care plan. I didn't even have one suggestion to fix it. What I was focusing on is your "thankfully" comment. I know every card carrying Dem (including me) have to be full-throated cheerleaders for the ACA and that every part of it is perfect and has solved all the bad things, but is it unreasonable to say that certain parts of the plan had some flaws?
 
RealSimulD said:
"Thankfully" may be a stretch. People tend to make poor decisions and waiting until you have a very expensive illness to sign up for health care creates moral hazard. It is like COBRA allowing you 2 months to purchase insurance when you leave your job. People just don't pay for insurance those two months and if they get sick, they retroactively pay the premiums. That isn't what insurance should be about. A person in their 50s or 60s that is able to suddenly purchase insurance after getting a lung cancer diagnosis shouldn't be considered a "feature" of a program. It sounds like a giveaway.

What is should have allowed is easy transition of insurance. If you've been paying into Aetna for years and have lung cancer, change jobs and have to get Cigna, then of course allow people to change without penalty.
Click to expand...
I understand your reasoning but disagree with your conclusions. The punishment of being uninsurable in a system where you preexisting conditions aren’t protected is FAR worse than the crime of letting coverage lapse… One bump in the road can lead to financial ruin.

Moral hazard is the lesser of two evils… when the alternative is being forced to jump out of a plane, even after you explain that you forgot your parachute
 
RealSimulD said:
LOL. I am not smart enough to have "a policy". I did economics and focused on health econ as an undergraduate, but my brain cannot comprehend making a health care plan. I didn't even have one suggestion to fix it. What I was focusing on is your "thankfully" comment. I know every card carrying Dem (including me) have to be full-throated cheerleaders for the ACA and that every part of it is perfect and has solved all the bad things, but is it unreasonable to say that certain parts of the plan had some flaws?
Click to expand...
The moral hazard is why the law also mandated everyone have health insurance coverage, so there wouldn’t be any freeloaders. That feature has been gutted, and also isn’t feasible in many states that refuse to expand Medicaid eligibility.
 
Fair enough

3 pillars of health care

Cost
Access
Quality

Allowing anyone to join at any time with no penalties - increases access, but increases cost.

If you’re saying someone has a 6 month gap and gets cancer - yah I hear you. If you’re talking about someone with an income that has never been insured, deciding to buy insurance when they get sick, how do you call that insurance?
 
grenz said:
The moral hazard is why the law also mandated everyone have health insurance coverage, so there wouldn’t be any freeloaders. That feature has been gutted, and also isn’t feasible in many states that refuse to expand Medicaid eligibility.
Click to expand...
Exactly! If everyone has to buy, then it works.
 
I vote Dem but can we all agree that the Affordable Care Act has been an unmitigated disaster to the end of making Care Affordable?

It's cool to say that more people are covered with insurance products that are only loosely definable as insurance via the marketplace, but it is literally choking business owners/families with ever escalating premiums (it's gotta be 10% per year since ACA). Meanwhile, insurance companies reporting record profits and large not for profit hospital systems are buying up every practice around them.
 
  • Like
Reactions: OTN
Lamount said:
I understand your reasoning but disagree with your conclusions. The punishment of being uninsurable in a system where you preexisting conditions aren’t protected is FAR worse than the crime of letting coverage lapse… One bump in the road can lead to financial ruin.

Moral hazard is the lesser of two evils… when the alternative is being forced to jump out of a plane, even after you explain that you forgot your parachute
Click to expand...
This also is like the language of sugar subsidies or other distributed costs issues - i.e. the American consumer doesn't feel the surcharge, but the economy as a whole pays a large cost. Lesser of two evils in this case depends on perspective. Individual who can't get coverage due to some random condition? Terrible. Tens of thousands a people buying coverage when they just got sick and now need coverage? Terrible, too.
 
RealSimulD said:
This also is like the language of sugar subsidies or other distributed costs issues - i.e. the American consumer doesn't feel the surcharge, but the economy as a whole pays a large cost. Lesser of two evils in this case depends on perspective. Individual who can't get coverage due to some random condition? Terrible. Tens of thousands a people buying coverage when they just got sick and now need coverage? Terrible, too.
Click to expand...
…but don’t most people have insurance the way it is now, despite there being protection for preexisting conditions? It’s not lot most people are forgoing coverage. How would removing that protection improve the system as a whole?… and at what cost.

From a utilitarian perspective, it seems likely that our society is far better off with that protection in place.
 
Lamount said:
…but don’t most people have insurance the way it is now, despite there being protection for preexisting conditions? It’s not lot most people are forgoing coverage. How would removing that protection improve the system as a whole?… and at what cost.

From a utilitarian perspective, it seems likely that our society is far better off with that protection in place.
Click to expand...
I think that every regulation has pros and cons, and I brought up that this has some negative consequences...
 
RealSimulD said:
I think that every regulation has pros and cons, and I brought up that this has some negative consequences...
Click to expand...
Thinking about this, one “fair” solution would be if someone lets coverage lapse, they can re-enroll despite preexisting conditions BUT they have to pay up to 1 year of back premiums, in addition to current premiums (on a payment plan, of course). This way, there are some consequences for letting lapse. (1 year may not be the right period of time… I was NOT a Econ major haha)
 
RadOncDoc21 said:
I tend to have more of a socialistic ideology but hard to get anything done in a capitalistic market without having a significant amount of push back. Frankly speaking, the system is broken!
Click to expand...
There are multiple lines of evidence that health care is somewhat overrated across the population. Eg oregon had a medicaid lottery, and turns out no difference in health outcomes between recipients and non-recipients. Or european (UK i think) data looking at mortality during doctor "strikes" -- mortality actually goes down. Not sure how much I believe it, but food for thought.

In any case health care in the US is much more of a socialistic than capitalist scheme. Pessimistic view is that sooner or later when people are spending someone else's money, it will eventually run out. Rationing, increased costs, decreased coverage will set in at some point. Or taxes increases: eg see the additional 0.9% ACA medicare tax that surely most of you pay.
 
temujim said:
There are multiple lines of evidence that health care is somewhat overrated across the population. Eg oregon had a medicaid lottery, and turns out no difference in health outcomes between recipients and non-recipients. Or european (UK i think) data looking at mortality during doctor "strikes" -- mortality actually goes down. Not sure how much I believe it, but food for thought.

In any case health care in the US is much more of a socialistic than capitalist scheme. Pessimistic view is that sooner or later when people are spending someone else's money, it will eventually run out. Rationing, increased costs, decreased coverage will set in at some point. Or taxes increases: eg see the additional 0.9% ACA medicare tax that surely most of you pay.
Click to expand...

Data hasn't shown a benefit to regular check ups with primary care in healthy adults who don't need chronic conditions covered.

Medicare would have worked as program if they followed the original rules: It was designed to kick in 5 years before average life expectancy, as was social security, at age 65.

Average life expectancy was 70 at that time: United States: life expectancy 1860-2020 | Statista.

Since then, life expectancy has gone up, but the age at which people can collect Medicare or SS has not. Going to be interesting to see what happens when the Medicare Trust Fund for hospital payments runs dry in 2026
 
RealSimulD said:
Click to expand...
OTN said:
Data hasn't shown a benefit to regular check ups with primary care in healthy adults who don't need chronic conditions covered.

Medicare would have worked as program if they followed the original rules: It was designed to kick in 5 years before average life expectancy, as was social security, at age 65.

Average life expectancy was 70 at that time: United States: life expectancy 1860-2020 | Statista.

Since then, life expectancy has gone up, but the age at which people can collect Medicare or SS has not. Going to be interesting to see what happens when the Medicare Trust Fund for hospital payments runs dry in 2026
Click to expand...

@OTN - so what is your solution, people work into their 70s so they can continue to have insurance? It sounds like this is what you are suggesting?
 
He’s not suggesting anything

He’s saying a fact

The designers did not imagine life expectancy would reach as high level as it is now, without adjustment of retirement age.

If I offered Medicare in 1600s when life expectancy was in the 30s at age of 28, the budget will look terrible after public hygiene hits the scene
 
I mean ****

Now people want to save up and FIRE out at 45 and then complain about no Medicare until 65. I have a suggestion. Continue to work or buy insurance or pay out of pocket.
 
Lamount said:
Thinking about this, one “fair” solution would be if someone lets coverage lapse, they can re-enroll despite preexisting conditions BUT they have to pay up to 1 year of back premiums, in addition to current premiums (on a payment plan, of course). This way, there are some consequences for letting lapse. (1 year may not be the right period of time… I was NOT a Econ major haha)
Click to expand...
Now this is thinking like an economist
 
RealSimulD said:
I mean ****

Now people want to save up and FIRE out at 45 and then complain about no Medicare until 65. I have a suggestion. Continue to work or buy insurance or pay out of pocket.
Click to expand...


I am sure millions of Americans are really taking your suggestion to heart as they go to bed tonight.

talk about out of touch.

Insurance needs to be wholly divorced from place of employment. It makes no sense. All it does is serve to raise healthcare costs, and that money is not going to me, you, or OTN.
 
OTN said:
Data hasn't shown a benefit to regular check ups with primary care in healthy adults who don't need chronic conditions covered.

Medicare would have worked as program if they followed the original rules: It was designed to kick in 5 years before average life expectancy, as was social security, at age 65.

Average life expectancy was 70 at that time: United States: life expectancy 1860-2020 | Statista.

Since then, life expectancy has gone up, but the age at which people can collect Medicare or SS has not. Going to be interesting to see what happens when the Medicare Trust Fund for hospital payments runs dry in 2026
Click to expand...
When social security started life expectancy was 60. There were something like 10+ workers for each beneficiary. Now its more like 2-3:1. It will run dry in 2033 or sooner.

But apparently democracy means everything you want is a right that must be provided by the government. Math be damned.
 
RealSimulD said:
He is stating a fact. It’s not solvent. It used to be.
Click to expand...


I don't think you understand what solvent means. If you did, then this would mean in 4 years health care is over, because medicare will no longer be able to pay

you dont believe that.

and, again 'would have worked' is not a fact.
 
You must log in or register to reply here.

Similar threads

uchihastan
Rad Onc vs. Heme/Onc
Replies
16
Views
2K
medgator
M
B
Rad Onc Procedures and RVUs
Replies
35
Views
5K
CurbYourExpectations
CurbYourExpectations
D
Saving Rad Onc
2
Replies
60
Views
7K
RickyScott
R
TheWallnerus
Rad Onc is in a dark place
Replies
13
Views
3K
RickyScott
R
M
Rad Onc Oral Boards: To quote or not quote studies?
Replies
5
Views
754
RSAOaky
R
Top