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What will Pain Medicine Look Like Under Socialized Medicine?
- Thread starter drusso
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Wrong-ish.
Doctors should be allowed to discuss guns with their patients. Don't like it, find another doctor. I say this as a guy that does well child checks and should be able to ask whether guns in the house are out of reach of children either in a safe or on your person in such a way a kid can't easily get it.
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deleted480308
the argument wasn’t that doctors shouldn’t treat wounds, the argument was that doctors have no place treating a political argument as medical issue. They are different, and you know better
They get plenty of my time, thanks
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deleted480308
I agree with you on that (never liked that florida law).
But iirc, the NRA was largely responding to the incredibly overstepping position paper signed by the (was it 6?) societies/colleges of physicians
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deleted480308
VA just posted the info
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My memory is hazy, didn't the position paper basically say the CDC should be allowed to study the gun issue?
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deleted480308
My memory is also hazy at this point (I read the whope thing but it’s been awhile) but my memory is it both showed some blatant ignorance of gun terminology and seemed to call for restrictions on rights.
No, U.S is lagging far behind in healthcare:
New 11-Country Study: U.S. Health Care System Has Widest Gap Between People With Higher and Lower Incomes | Commonwealth Fund
" The U.S. ranks last overall on health care outcomes. Compared to other countries, the U.S. comes in last on infant mortality, life expectancy at age 60, and deaths that were potentially preventable with timely access to effective health care. However, there are some bright spots: the U.S. performs relatively well on certain clinical outcomes, such as lower in-hospital mortality rates for a heart attack or stroke, and is a top performer in breast cancer survival. "
U.S. health spending twice other countries' with worse results
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deleted480308
We don’t have worse outcomes because our care is worse, we have worse outcomes because we live worse
We lag in healthy culture, not health care. Our care is good
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Ugh, this will be the third forum on SDN where I've taken down this study. I'll address this later when I'm not doing it from my phone.
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OK so let's unpack that beast.
The study has essentially 5 categories it looks at: Care Process, Access, Administrative Efficiency, Equity, and Outcomes.
Care Process has 4 sub-domains, though its worth noting this is all survey based so take it with a grain of salt:
-Preventative Care: we rocked this one:
Talked with provider about things in life that cause worry or stress in the past two years, among those with a history of mental illness - 4th place at 64% but only 10% behind first place which was 74%
Talked with provider about healthy diet, exercise and physical activity in the past two years - 1st place by a lot, we hit 59%, next best was 41%.
Talked with provider about health risks of smoking and ways to quit in the past two years, among smokers - 1st place
Talked with provider about alcohol use in the past two years - 1st place at 33%, next best was 25%
Women age 50-69 with mammography screening in the past year - 1st place
Older adults (age 65 plus) with influenza vaccination in the past year - 4th place, 1st place was 75%, we were 68% so very close
-Safe Care: We jumped around in this one:
Experienced a lab/medication mistake: 2nd to last, though it does raise questions about Norway...
Primary care physician reports electronic clinical decision support in practice: 4th, though everyone who did worse than us did so by a large degree, percentages in order: 81, 72, 70, 60 (USA), everyone else was 28% or less.
Health care professional did not review medications in past year, among those taking two or more prescription medications: 1st place
-Coordinated care: Middle of the pack mostly:
Primary care doctor always or often receives timely and relevant information when needed after patient sees specialist: 6th
Primary care doctor is always or often informed of changes to a patient's medication or care plan after patient sees specialist: 8th
Specialist lacked medical history or regular doctor not informed about specialist care in the past two years: 7th
Experienced gaps in hospital discharge planning in the past two years: 1st
Doctor is always notified when patient is seen in ED and when patient is discharged from the hospital: 4th
Practice routinely communicates with home care provider about patient's needs and services: 5th
Practice frequently coordinates care with social services or community providers: 7th
-Engagement and patient preference: Also mostly middle of the pack
Regular doctor always or often knew important information about their medical history: 5th
Regular doctor always or often spent enough time with them and explained things in a way they could understand: 5th
With same doctor for five years or more: 10th, not a surprise given how often doctors move around
Specialist always or often told patient about treatment choices and involved patient in decisions about care and treatment, among adults age 65 and older: 1st
Doctors always treated the patient with courtesy and respect during their hospital stay: 5th
Chronically ill patients discussed with health professional their main goals and priorities in caring for their condition in the past two years: 5th
Chronically ill patients discussed with health professional their treatment options, including side effects in the past two years: 5th
Had a written plan describing treatment they want at the end of life, among adults age 65 and older: 2nd
Had a written plan naming someone to make treatment decisions for them if they cannot do so, among adults age 65 and older:1st
I want it noted that in areas that matter the most for outcomes from a primary care and longevity standpoint, we kick ass: preventative care, discharge planning, medication review, and end of life care.
Next up is Access which has 2 subgroups:
-Affordability: We lost this one handily, although in 2 categories we weren't absolutely last which I thought was weird.
Switzerland had worst in Out-of-pocket expenses for medical bills more than $1,000 in the past year, US$ equivalent and France was worst in Had serious problems paying or was unable to pay medical bills. Not sure what to make of that.
-Timeliness: We scored poorly in this one but we really shouldn't have. I'll explain in each group.
Have a regular doctor or place of care: Last, but this is nuts. Its not hard to establish with a PCP. As a PCP, I should know. If you don't have a PCP, its your fault for not getting one. I wouldn't be surprised in the European countries assign everyone a PCP like Medicaid does which would screw up this metric.
Regular doctor always or often answers the same day when contacted with question: 10th place, and yeah this isn't great I'll admit to that.
Saw a doctor or nurse on the same or next day, last time they needed medical care: 7th and shouldn't be. Urgent Cares are on every street corner, if you didn't get same day care its because you didn't want to wait in line for it.
Somewhat or very difficult to obtain after-hours care: 6th, similar to the previous one
Waited two hours or more for care in emergency room: 5th, not too bad truthfully
Doctors report patients often experience difficulty getting specialized tests (e.g., CT, MRI): 7th, y'all here get this too so this is problematic-ish though we probably over-order these - I know I do in our malpractice/patient-centric climate.
Doctors report patients often experience long wait times to receive treatment after diagnosis: 2nd
Waited two months or longer for specialist appointment: 4th, I bet we'd be better if not for dermatology
Waited four month or longer for elective/non-emergency surgery: 3rd
Practice has arrangement for patients to see doctor or nurse after hours without going to ED: Last, and I'll agree to that. Most European countries require their doctors to work evenings/weekends. I'm sure as hell not doing that.
So in this category we do OK in timeliness but suck at affordability which isn't a surprise.
Next up is administrative efficiency, this one shouldn't come as a shock to anyone:
Doctors report time spent on administrative issues related to insurance or claims is a major problem: 9th which surprised me as the countries we're close to in this ranking are often held up as good models: Germany, Holland, Switzerland
Doctors report time spent getting patients needed medications or treatment because of coverage restrictions is a major problem: Last and we deserve it
Doctors report time spent on issues related to reporting clinical or quality data to government or other agencies is a major problem: 9th, makes medicare for all sound great
Visited ED for a condition that could have been treated by a regular doctor, had he/she been available: Next to last behind Canada. My patients do this despite having multiple openings/day so not sure this is a system issue as much as a cultural one.
Tests results or medical records were not available at the time of patient's scheduled medical care appointment in the past two years: 10th, not sure I believe this one
Doctors ordered a medical test that patient felt was unnecessary because the test had already been done in the past two years: 10th, sure would be nice if that HITECH act had forced EMRs to be compatible with each other...
Spent a lot of time on paperwork or disputes related to medical bills: 10th, yep
Next up is Equity which I'm just going to skip altogether because of course this is a problem. Interestingly though, Canada is close to us in the majority of the group on this one
Last is outcomes which is the important one broken down into 3 groups:
-Population health
Infant mortality, deaths per 1,000 live births: Last, but take out SIDS and abuse and we actually do pretty well. We have huge SIDS campaigns and yet people still co-sleep. Not sure what else we can do.
Adults age 18 to 64 with at least two of five common chronic conditions: Last, but as we lead the OECD by a large amount in both diabetes and obesity, this isn't a shock. And as a PCP, I wish we had good treatment for obesity but we just don't. Its cultural.
Life expectancy at age 60 in years: Last but not by much. Half the countries beat us by less than a year on this so forgive me for not being impressed
-Mortality amenable to health care: part of the problem is I can't find what this actually means anywhere so not sure how to address it.
-Last is disease specific outcomes:
30 day in-hospital mortality rate following acute myocardial infarction, deaths per 100 patients: 3rd
30 day in-hospital mortality rate following ischemic stroke, deaths per 100 patients: 1st
Breast cancer five-year relative survival rate: 1st
Colon cancer five-year relative survival rate: 3rd
Basically we do well at preventative health and acute treatment, badly at cost and anything related to patient lifestyle.
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The study has essentially 5 categories it looks at: Care Process, Access, Administrative Efficiency, Equity, and Outcomes.
Care Process has 4 sub-domains, though its worth noting this is all survey based so take it with a grain of salt:
-Preventative Care: we rocked this one:
Talked with provider about things in life that cause worry or stress in the past two years, among those with a history of mental illness - 4th place at 64% but only 10% behind first place which was 74%
Talked with provider about healthy diet, exercise and physical activity in the past two years - 1st place by a lot, we hit 59%, next best was 41%.
Talked with provider about health risks of smoking and ways to quit in the past two years, among smokers - 1st place
Talked with provider about alcohol use in the past two years - 1st place at 33%, next best was 25%
Women age 50-69 with mammography screening in the past year - 1st place
Older adults (age 65 plus) with influenza vaccination in the past year - 4th place, 1st place was 75%, we were 68% so very close
-Safe Care: We jumped around in this one:
Experienced a lab/medication mistake: 2nd to last, though it does raise questions about Norway...
Primary care physician reports electronic clinical decision support in practice: 4th, though everyone who did worse than us did so by a large degree, percentages in order: 81, 72, 70, 60 (USA), everyone else was 28% or less.
Health care professional did not review medications in past year, among those taking two or more prescription medications: 1st place
-Coordinated care: Middle of the pack mostly:
Primary care doctor always or often receives timely and relevant information when needed after patient sees specialist: 6th
Primary care doctor is always or often informed of changes to a patient's medication or care plan after patient sees specialist: 8th
Specialist lacked medical history or regular doctor not informed about specialist care in the past two years: 7th
Experienced gaps in hospital discharge planning in the past two years: 1st
Doctor is always notified when patient is seen in ED and when patient is discharged from the hospital: 4th
Practice routinely communicates with home care provider about patient's needs and services: 5th
Practice frequently coordinates care with social services or community providers: 7th
-Engagement and patient preference: Also mostly middle of the pack
Regular doctor always or often knew important information about their medical history: 5th
Regular doctor always or often spent enough time with them and explained things in a way they could understand: 5th
With same doctor for five years or more: 10th, not a surprise given how often doctors move around
Specialist always or often told patient about treatment choices and involved patient in decisions about care and treatment, among adults age 65 and older: 1st
Doctors always treated the patient with courtesy and respect during their hospital stay: 5th
Chronically ill patients discussed with health professional their main goals and priorities in caring for their condition in the past two years: 5th
Chronically ill patients discussed with health professional their treatment options, including side effects in the past two years: 5th
Had a written plan describing treatment they want at the end of life, among adults age 65 and older: 2nd
Had a written plan naming someone to make treatment decisions for them if they cannot do so, among adults age 65 and older:1st
I want it noted that in areas that matter the most for outcomes from a primary care and longevity standpoint, we kick ass: preventative care, discharge planning, medication review, and end of life care.
Next up is Access which has 2 subgroups:
-Affordability: We lost this one handily, although in 2 categories we weren't absolutely last which I thought was weird.
Switzerland had worst in Out-of-pocket expenses for medical bills more than $1,000 in the past year, US$ equivalent and France was worst in Had serious problems paying or was unable to pay medical bills. Not sure what to make of that.
-Timeliness: We scored poorly in this one but we really shouldn't have. I'll explain in each group.
Have a regular doctor or place of care: Last, but this is nuts. Its not hard to establish with a PCP. As a PCP, I should know. If you don't have a PCP, its your fault for not getting one. I wouldn't be surprised in the European countries assign everyone a PCP like Medicaid does which would screw up this metric.
Regular doctor always or often answers the same day when contacted with question: 10th place, and yeah this isn't great I'll admit to that.
Saw a doctor or nurse on the same or next day, last time they needed medical care: 7th and shouldn't be. Urgent Cares are on every street corner, if you didn't get same day care its because you didn't want to wait in line for it.
Somewhat or very difficult to obtain after-hours care: 6th, similar to the previous one
Waited two hours or more for care in emergency room: 5th, not too bad truthfully
Doctors report patients often experience difficulty getting specialized tests (e.g., CT, MRI): 7th, y'all here get this too so this is problematic-ish though we probably over-order these - I know I do in our malpractice/patient-centric climate.
Doctors report patients often experience long wait times to receive treatment after diagnosis: 2nd
Waited two months or longer for specialist appointment: 4th, I bet we'd be better if not for dermatology
Waited four month or longer for elective/non-emergency surgery: 3rd
Practice has arrangement for patients to see doctor or nurse after hours without going to ED: Last, and I'll agree to that. Most European countries require their doctors to work evenings/weekends. I'm sure as hell not doing that.
So in this category we do OK in timeliness but suck at affordability which isn't a surprise.
Next up is administrative efficiency, this one shouldn't come as a shock to anyone:
Doctors report time spent on administrative issues related to insurance or claims is a major problem: 9th which surprised me as the countries we're close to in this ranking are often held up as good models: Germany, Holland, Switzerland
Doctors report time spent getting patients needed medications or treatment because of coverage restrictions is a major problem: Last and we deserve it
Doctors report time spent on issues related to reporting clinical or quality data to government or other agencies is a major problem: 9th, makes medicare for all sound great
Visited ED for a condition that could have been treated by a regular doctor, had he/she been available: Next to last behind Canada. My patients do this despite having multiple openings/day so not sure this is a system issue as much as a cultural one.
Tests results or medical records were not available at the time of patient's scheduled medical care appointment in the past two years: 10th, not sure I believe this one
Doctors ordered a medical test that patient felt was unnecessary because the test had already been done in the past two years: 10th, sure would be nice if that HITECH act had forced EMRs to be compatible with each other...
Spent a lot of time on paperwork or disputes related to medical bills: 10th, yep
Next up is Equity which I'm just going to skip altogether because of course this is a problem. Interestingly though, Canada is close to us in the majority of the group on this one
Last is outcomes which is the important one broken down into 3 groups:
-Population health
Infant mortality, deaths per 1,000 live births: Last, but take out SIDS and abuse and we actually do pretty well. We have huge SIDS campaigns and yet people still co-sleep. Not sure what else we can do.
Adults age 18 to 64 with at least two of five common chronic conditions: Last, but as we lead the OECD by a large amount in both diabetes and obesity, this isn't a shock. And as a PCP, I wish we had good treatment for obesity but we just don't. Its cultural.
Life expectancy at age 60 in years: Last but not by much. Half the countries beat us by less than a year on this so forgive me for not being impressed
-Mortality amenable to health care: part of the problem is I can't find what this actually means anywhere so not sure how to address it.
-Last is disease specific outcomes:
30 day in-hospital mortality rate following acute myocardial infarction, deaths per 100 patients: 3rd
30 day in-hospital mortality rate following ischemic stroke, deaths per 100 patients: 1st
Breast cancer five-year relative survival rate: 1st
Colon cancer five-year relative survival rate: 3rd
Basically we do well at preventative health and acute treatment, badly at cost and anything related to patient lifestyle.
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I sincerely hope you cut and pasted most of this. Most of the people arguing with you are only able to process abstracts. Battle of the conclusions...
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I did. This has already come up in SPF and the Psychiatry forum.
great post, and a lot of good information.
you do mention a lot of "qualifiers", however. if it wasnt for X, then we would be better. thats not really how it works.
but, if nothing else, you do make a case that the quality of healthcare is multifaceted and cannot easily be ranked. you cant just say "it is good" or "it is bad", but rather, it is good at doing X, but not at doing Y
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It kinda is though, at least some times.
For example: our measles vaccination rate is below everyone in that study except for France. Does that mean our system is worse at vaccinating kids? Of course not. It means we have more stupid people who refuse to vaccinate their kids. Doctors push vaccination hard. The CDC does too. We're even passing laws making it harder to refuse, but their are enough shyster pediatricians that this might still not get us up to European numbers on this.
Same kinda thing with infant mortality. Our biggest issues there are SIDS and abuse. I did a lot of peds in residency and talked all the time about things like co-sleeping, proper cribs with no padding, not smoking. If you've bought a crib or bedding for one in the last decade, you can see that the packages are covered with warnings about avoiding SIDS. But at least once every few months, a dead infant would end up in the ED because they were smothered while co-sleeping. As far as abuse, we work on that too. Don't shake the baby and what not. But lots of that is a result of parts of our society being broken. I'm not sure what the healthcare system can do about those beyond what we're already doing.
That all aside, you do hit the main point - every system has its trade offs and so is good at some stuff and less so at others.
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as an former ER physician that has seen multiple gunshot wounds, you are completely wrong.
don't tell me that those 10 or so ppl Ive seen through my former ER career who have shot their testicles out have not had some effect on their health...
don't tell me that those 10 or so ppl Ive seen through my former ER career who have shot their testicles out have not had some effect on their health...
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deleted480308
That’s like saying docs should support bans of soda because people get fat....not our job
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For the comparative resources they have, I think it is more of an indictment of our own Healthcare system
You should stop thinking then. There’s no way Cuba is superior at anything and there’s no way the statistics are accurate or credible. The only thing the Cuban people have going for them is they have no fast food and no obesity. They are really good at working with what they have which is like saying you get really good at making fire with two sticks.
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clearly what other countries are doing better than the US is preventative medicine. unfortunately, that doesn't pay as well in a fee for service system.
that is our job as a healthcare system.
as a doctor, dont you tell them not to use cocaine, heroin, other peoples pills? don't you tell people not to smoke? don't you tell people to wear seatbelts when they drive?
don't you tell them to do their stretches, their exercises for their back pain?
if you are not, you aren't doing your job.
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There is no way the Cuban Healthcare should be anyway near ours in any category( But they are).
You are wrong despite what your Americancentic mind tells you
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FWIW by CIA World Facts data, Cuba is ranked better than US in under 5 mortality. 4.4 (43rd) vs. 6.9 (56th) and very similar (31st compared to 32nd) in the UN data.
we should be comparing ourselves to countries such as the best in healthcare. Finland, Norway, Sweden. the fact that we are compared at all to a country such as cuba is a negative.
we should be comparing ourselves to countries such as the best in healthcare. Finland, Norway, Sweden. the fact that we are compared at all to a country such as cuba is a negative.
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Except that Commonwealth Fund that everyone keeps posting shows that we actually do very well at preventative medicine. So no, that's not clear.
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deleted480308
Of course I tell people to make good decisions with the patient autonomy.
You know what I don’t do? Send the police to slap a cupcake out of their hand. I also don’t jail someone for smoking. I don’t try and make them a criminal for not stretching.
People have freedoms that are important. Restricting their rights to firearm access is not at all part of my jurisdiction as a doctor. I do talk about voluntary safe storage techniques and encourage handing firearms to a responsible party for people at risk...I don’t try to ban ownership
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sure you do ...c'mon man you are a resident
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you wouldn't be restricting their rights to firearm access, unless you choose to actively involve yourself in politics. no one is telling you to do that.
individual physicians and physician groups should advocate for patient safety, and that includes making sure that firearms are not in the hands of those who are not trained or could potentially harm people. you don't have to be a member if you disagree.
we do have a few firearm restrictions right now, both with the types of firearms (ie cant own an RPG or nuke) and with who can own them (ie convicted felons, children under 18 cant own a handgun).
individual physicians and physician groups should advocate for patient safety, and that includes making sure that firearms are not in the hands of those who are not trained or could potentially harm people. you don't have to be a member if you disagree.
we do have a few firearm restrictions right now, both with the types of firearms (ie cant own an RPG or nuke) and with who can own them (ie convicted felons, children under 18 cant own a handgun).
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In fairness, residents are often the only ones who have enough time to do all of that. When I was an intern all of our office visits were 60 minutes the first 6 months.
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deleted480308
no firearm rights unless you are "trained"?
I'm going to stop you right there and say you don't know what you are too far philosophically from a gun rights perspective for us to have common ground on this one.
I'll keep saying it's inappropriate for doctors to try and restrict rights while hiding behind their white coats. You may use your freedom to say otherwise.
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deleted480308
I take firearm responsibility very seriously. And I absolutely talk about it with patients
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What specialty are you in training for?
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So an intern or resident in our specialties who probably doesn't know their a$$ from the hole in the ground when starting has time to talk about gun safety?
Much different training than I had and not sure why it would ever come in to play in a PMR and Anesthesiology residency
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As I am in neither anesthesiology or PMR, I couldn't say if it comes into play in either of those fields.
President Trump hit another milestone in his efforts to reshape the federal judiciary, with the Senate clearing his 100th judicial nominee Thursday.
The president and Republican-controlled Senate have made judicial nominations a top priority, and the confirmation of Rodolfo Ruiz(once again proving Trump is a racist) to the U.S. District Court for the Southern District of Florida brought the number of Trump's judicial appointments into triple digits.
In addition to confirming Ruiz, the Senate is also set to clear two more nominees to federal district courts in Puerto Rico and Pennsylvania. If those two nominations win approval, Trump will have tapped 102 judges to the federal bench
Trump’s judicial appointments include two Supreme Court justices, Neil Gorsuch and Brett Kavanaugh, 37 federal appeals court judges, and 61 federal district court judges.
In anticipation of the milestone, the president lauded the work of the Senate in confirming his judicial nominees, telling attendees of a dinner for the National Day of Prayer on Wednesday that “we’re breaking records.”
While Trump has seen great success in remaking the federal bench, his efforts have been met by resistance from Senate Democrats, who have criticized the president for the lack of diversity among his judicial picks. Trump’s judicial nominees are also young, ensuring they will leave a conservative stamp on the federal courts that will endure for decades.
Democrats attempted to slow the pace of judicial confirmations by using the full 30 hours of debate time for judicial nominees. They have also sought to block nominees by not returning their so-called blue slips to the Senate Judiciary Committee.
But Republicans have used their power as the majority party to diminish Democrats’ leverage.
Last month, the GOP-controlled Senate changed the chamber’s rules to speed up confirmation of Trump’s nominees by lessening debate time to two hours.
The Republican leaders of the Senate Judiciary Committee, former Chairman Chuck Grassley, R-Iowa, and current Chairman Lindsey Graham, R-S.C., have also said an unreturned blue slip would not preclude nominees to the federal appeals courts from receiving confirmation hearings.
The blue slip is a Senate practice under which home-state senators can voice their support or opposition to a judicial nominee on a blue form. Some previous Judiciary Committee chairman have allowed home-state senators to effectively veto a nominee by not returning their blue slips.
More than three dozen judicial nominees are still awaiting votes on the Senate floor, including two of the president’s picks for the 9th U.S. Circuit Court of Appeals. The San Francisco-based court is often the target of Trump’s frustration, as it has ruled against a number of the administration’s policies, and is considered the country’s most liberal appeals court.
But if the Senate approves Trump’s two nominees to the 9th Circuit, it would bring the court closer to parity.
Last month, Trump flipped his first appeals court, the 3rd U.S. Circuit Court of Appeals, which now has a majority of Republican-appointed judges.
MAGA...baby..! Screw yer blue slip....
More coming.
Nice and easy now that the Senate uses the nuclear option that Harry Reid so kindly enacted. Democrats going to have years and years and years of President Trumps picks to contend with..
The president and Republican-controlled Senate have made judicial nominations a top priority, and the confirmation of Rodolfo Ruiz(once again proving Trump is a racist) to the U.S. District Court for the Southern District of Florida brought the number of Trump's judicial appointments into triple digits.
In addition to confirming Ruiz, the Senate is also set to clear two more nominees to federal district courts in Puerto Rico and Pennsylvania. If those two nominations win approval, Trump will have tapped 102 judges to the federal bench
Trump’s judicial appointments include two Supreme Court justices, Neil Gorsuch and Brett Kavanaugh, 37 federal appeals court judges, and 61 federal district court judges.
In anticipation of the milestone, the president lauded the work of the Senate in confirming his judicial nominees, telling attendees of a dinner for the National Day of Prayer on Wednesday that “we’re breaking records.”
While Trump has seen great success in remaking the federal bench, his efforts have been met by resistance from Senate Democrats, who have criticized the president for the lack of diversity among his judicial picks. Trump’s judicial nominees are also young, ensuring they will leave a conservative stamp on the federal courts that will endure for decades.
Democrats attempted to slow the pace of judicial confirmations by using the full 30 hours of debate time for judicial nominees. They have also sought to block nominees by not returning their so-called blue slips to the Senate Judiciary Committee.
But Republicans have used their power as the majority party to diminish Democrats’ leverage.
Last month, the GOP-controlled Senate changed the chamber’s rules to speed up confirmation of Trump’s nominees by lessening debate time to two hours.
The Republican leaders of the Senate Judiciary Committee, former Chairman Chuck Grassley, R-Iowa, and current Chairman Lindsey Graham, R-S.C., have also said an unreturned blue slip would not preclude nominees to the federal appeals courts from receiving confirmation hearings.
The blue slip is a Senate practice under which home-state senators can voice their support or opposition to a judicial nominee on a blue form. Some previous Judiciary Committee chairman have allowed home-state senators to effectively veto a nominee by not returning their blue slips.
More than three dozen judicial nominees are still awaiting votes on the Senate floor, including two of the president’s picks for the 9th U.S. Circuit Court of Appeals. The San Francisco-based court is often the target of Trump’s frustration, as it has ruled against a number of the administration’s policies, and is considered the country’s most liberal appeals court.
But if the Senate approves Trump’s two nominees to the 9th Circuit, it would bring the court closer to parity.
Last month, Trump flipped his first appeals court, the 3rd U.S. Circuit Court of Appeals, which now has a majority of Republican-appointed judges.
MAGA...baby..! Screw yer blue slip....
More coming.
Nice and easy now that the Senate uses the nuclear option that Harry Reid so kindly enacted. Democrats going to have years and years and years of President Trumps picks to contend with..
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More good news..
America the Productive
New reports show U.S. workers getting more done and receiving better pay.
By James Freeman
Updated May 2, 2019 1:02 p.m. ET
Telecommunications workers install a new 5G antenna system in downtown San Diego last week. PHOTO: MIKE BLAKE/REUTERS
Small U.S. firms continued adding workers and continued raising wages in April. That’s according to the latest employer survey from the National Federation of Independent Business, due out later today. Also, a new government report shows that workers at businesses of all sizes are getting more done.
NFIB Chief Economist William Dunkelberg says that small companies participating in the organization’s survey added a net 0.32 workers per firm in April. This represents healthy job creation though at a somewhat slower pace than in the previous two months. He notes more good news for the people occupying these jobs:
Meanwhile across the U.S. economy as a whole, workers have lately been enjoying wage gains above the rate of inflation. And a new government report says that workers are earning these raises by getting more done on the job. The Journal’s Eric Morath reports:
America the Productive
New reports show U.S. workers getting more done and receiving better pay.
By James Freeman
Updated May 2, 2019 1:02 p.m. ET
Telecommunications workers install a new 5G antenna system in downtown San Diego last week. PHOTO: MIKE BLAKE/REUTERS
Small U.S. firms continued adding workers and continued raising wages in April. That’s according to the latest employer survey from the National Federation of Independent Business, due out later today. Also, a new government report shows that workers at businesses of all sizes are getting more done.
NFIB Chief Economist William Dunkelberg says that small companies participating in the organization’s survey added a net 0.32 workers per firm in April. This represents healthy job creation though at a somewhat slower pace than in the previous two months. He notes more good news for the people occupying these jobs:
Demand for both skilled and unskilled workers remains robust, adds the NFIB economist:
Perhaps not surprisingly given a continuing challenge in finding new workers to fill the available jobs, NFIB President Juanita Duggan reports that owners are spending significant time training new employees.
Meanwhile across the U.S. economy as a whole, workers have lately been enjoying wage gains above the rate of inflation. And a new government report says that workers are earning these raises by getting more done on the job. The Journal’s Eric Morath reports:
We seem to recall the Trump White House arguing in 2017 that a cut in the corporate income tax rate would increase incentives for businesses to invest in making their workers more productive, which would in turn lift wages. To be fair, the White House was making the case that such progress would happen over the long haul, not immediately. So it’s too early to render a final judgment, but so far so good.
D
deleted480308
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I dont believe you are a real doctor, maybe a chiropractor but with nearly 20,000 posts ....not a real doctor
D
deleted480308
Fine with me
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Does not compute.
The poster with the highest post count (67k) is a pulm/CC guy, I know him in real life.
Second highest at 58k is a psychiatrist, he went to my med school 3 years behind me.
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Classic ad hominem
I don’t believe you’re an American, and if you are you certainly shouldn’t be
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I believe that is a personal attack that shows how much this thread had devolved.
fwiw: some of these are painful to watch. don't tell me that everyone should be allowed to use guns.
and this: New study lists top causes of deaths for children
fwiw: some of these are painful to watch. don't tell me that everyone should be allowed to use guns.
and this: New study lists top causes of deaths for children
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Wow you can post something other than " Commie"... Bravo
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What does telling us his specialty have to do with his anonymity?
I was inquiring because he says he talks to pts about Gun safety. As having been in the field of Pain Mgmt for greater than 15 years as well a a PMR residency and in a Pain Fellowship this issue has never ever come up with a patient and me .
D
deleted480308
None of your patients are suicidal or mentally ill? At risk of personal violence?
I’m cool if you don’t have a reason to talk to yours about it or even just choose not to do so, but it’s not unbelievable to think some of do
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Home - Coalition Against Socialized Medicine
The Coalition Against Socialized Medicine (CASM) was established to address the increasing public policy threats to America’s market-oriented healthcare system and government sponsored programs such as Medicare.
nosocializedmedicine.org
