Healthcare deserves its own thread

[hoosier]

As far as where there are patients doctors will follow, that is great in a capitalist model, but you aren't advocating that. You can have a billion patients and if you cap the pay of doctors none will follow. They have to be allowed to make what their services are worth.

Bobblehead, you keep making these silly statements that show that you very limited knowledge of what you're talking about re. healthcare. First off, if it were true that caps on payments would doom our medical system then we would have already destroyed it. How do you think reimbursements work for providers under our current system? Why do you think it is that, as Ty suggested, medical professionals are among those complaining loudest about the grave problems of our current system? Are you really thinking about what you're writing or are you just regurgitating some lesson from your Microeconomics textbook?

Second, of course what I'm talking about is a capitalist model. If it involves laborers (doctors) selling their labor to the highest bidder then by definition it's capitalist. Take a deep breath and remember that capitalism wasn't invented in Chicago by Milton Friedman in 1965.

[hoosier]

I hadn't said a word about use of ERs for routine stuff, although obviously it happens, and it is one way for poor people to backdoor the system. As inefficient as that is, I'm not gonna judge it, as it may be the only way for some people--part of what I refer to as informally getting the task done of covering those who can't afford it. It's ironic that it's elitist liberal idiots such as yourself that whine about poor people doing what it takes to survive, and not our side.

Nobody's asking you to "judge" it, just to recognize--along with everyone else who has a pulse--that using ER for primary care is both inefficient and unwise, and that nobody who had a choice would choose to do so. That's the unpleasant truth that you keep trying to weasel your way out of: using the ER as a source of primary care is a desparate measure taken by people who have no other choice. You want to deny that such desparation exists in this society and pretend that everything is done by choice.

Only partly true. There are definitely people w/ the means/ability to pay for hc that use ERs because they're too lazy to get a primary MD or they can't stand waiting one day to get their service (or use an urgent care clinic, etc.).

AND there are some alternatives to ERs for people that don't have the means. I did 2 days of work last year pro bono for St. Johns Well Child center in/near Compton (feature this past week in WSJ). Really no requirement to pay anything and all state/federally funded - and about 90% undocumented aliens.

I've implemented processes to screen/triage then discuss finances and possibly defer care for non-urgent/emergent cases - result - ER volumes remain slightly less (meaning urgent ppl get served faster) and a push to scheduled care.

It all goes back to what many of us here have said - where did responsibility for average US (or long-term 'residents') go?

Responsibility, or lack of it, is undoubtedly part of the problem of using ER as primary. But 35% of Americans reportedly uninsured or underinsured is scandalous, and that's not a problem that personal responsibility or volunteerism (as important as they are) can solve alone.

[bobblehead]

As far as where there are patients doctors will follow, that is great in a capitalist model, but you aren't advocating that. You can have a billion patients and if you cap the pay of doctors none will follow. They have to be allowed to make what their services are worth.

Bobblehead, you keep making these silly statements that show that you very limited knowledge of what you're talking about re. healthcare. First off, if it were true that caps on payments would doom our medical system then we would have already destroyed it. How do you think reimbursements work for providers under our current system? Why do you think it is that, as Ty suggested, medical professionals are among those complaining loudest about the grave problems of our current system? Are you really thinking about what you're writing or are you just regurgitating some lesson from your Microeconomics textbook?

Second, of course what I'm talking about is a capitalist model. If it involves laborers (doctors) selling their labor to the highest bidder then by definition it's capitalist. Take a deep breath and remember that capitalism wasn't invented in Chicago by Milton Friedman in 1965.

And again you have proven that you don't read most of my posts and only grab one line outta one post. Have I not complained over and over about how much of the problems we have now are because gov't got involved with the HMO bill?? Haven't I said doctors are getting crushed under legions of paperwork and regulatory burden NOW? Haven't I complained that doctors are being turned into nothing more than employees of HMO's? Didn't I point out that a doctor can make like 180 on an emergency appendectomy but the hospital makes 17grand?

I make the point because in england they had to import hundreds of doctors from poorer middle eastern countries because they weren't paying them enough to inspire their own youth to go to med school. I make the point because we are at the point where we aren't getting enough doctors graduating and are importing them from india. We are short on nurses too, we are importing them from the phillipines by the thousands.

You are really good at ripping me when I make points of economics, but I haven't heard you offer up ONE idea on this. If you aren't advocating national health care, what are you talking about? In this post you almost sound like an advocate for the current situation. Dude, sack up and make a point or arguement, and get rid of the hard on you have for me.

If you read my posts, you will see I am not a fan of the current medical situation, but I make valid points about how the gov't getting involved has deteriorated our care and now they are using the problems they created to argue that they should be in charge of the whole damn thing. Please, tell me where you stand, I am curious. You state that caps would have already destroyed the system (implying they are just fine) then in the very next sentence you use ty saying the professionals are complaining the loudest about current problems....you don't think that sort of disproves your first statement? You ask if I am thinking about what I type, do you READ what you type??

Now go back, read the thread from the beginning and show me where I am advocating the current system...never, so using medical professionals screaming about the current system as some sort of admonishment to me is just assinine.

My point again....the current system is hurting due to the HMO act of 1973 that has regulated and pushed doctors into a situation where they are merely employees with little hope of working outside the network. This is in effect capping their payments to what the hospitals and HMO's want to give them. This is causing a shortage of doctors damaging the system further. It is also limiting competition...the very thing needed to be called capitalist. since capitalism was created in 1965 by milton freidman the act in 1973....relax I'm just kidding.

[Fosco33]

Responsibility, or lack of it, is undoubtedly part of the problem of using ER as primary. But 35% of Americans reportedly uninsured or underinsured is scandalous, and that's not a problem that personal responsibility or volunteerism (as important as they are) can solve alone.

45M uninsured, 25M underinsured - population of 301M = 26%

The current definition of underinsured uses varying rules - like spending 10% of income on hc - or having deductibles of 5% of income (some due to outlier cases by year and some due to high deductible plans).

Of the uninsured - 41% many are between 19 and 34 - when young people are not covered by parents or the State (usually) and don't get jobs (that come with insurance). Part of being responsible is getting a job.

21% are under 18 and could be eligible for most state/local coverage. Some of these are poor kids with ignorant/lazy parents that don't apply for Medicaid. Part of being a responsible parent.

Also - 28% of uninsured are in 300%+ FPL brackets - and not 'poor' and could afford employer provided insurance - their choice/responsibility.

And lastely - 21% of uninsured are not US citizens! And even then there are programs like CMS 1011 that provide coverage - and again EMTALA that provides ER service without questions.

You can't double count the above stats - but it clearly shows there is a small window of opportunity for society to further assist on insurance coverage. Young people without insurance (not kids) don't use much/any hc and the outliers are often covered by charity. And those that are uninsured may get charity (typically 3-5% of hospitals gross charges are written off to charity).

It's a 'problem' by definition only in my book. Many of the solutions go back to responsibility.

[texaspackerbacker]

I hadn't said a word about use of ERs for routine stuff, although obviously it happens, and it is one way for poor people to backdoor the system. As inefficient as that is, I'm not gonna judge it, as it may be the only way for some people--part of what I refer to as informally getting the task done of covering those who can't afford it. It's ironic that it's elitist liberal idiots such as yourself that whine about poor people doing what it takes to survive, and not our side.

Nobody's asking you to "judge" it, just to recognize--along with everyone else who has a pulse--that using ER for primary care is both inefficient and unwise, and that nobody who had a choice would choose to do so. That's the unpleasant truth that you keep trying to weasel your way out of: using the ER as a source of primary care is a desparate measure taken by people who have no other choice. You want to deny that such desparation exists in this society and pretend that everything is done by choice.

How exactly is what you are saying any different from what you just quoted me saying? Yeah, it's an act of desperation; Yeah, it's inefficient. I just said that. However, it is a way for poor and uninsured people to get health care.

I suppose some doctors complain about it--it makes more work for them. Generally, however, if they work in an ER, they are on salary, so it's not a matter of they, themselves, not getting paid. Taxpayers are NOT complaining. Why would they? They aren't paying the bills of these poor or uninsured. The hospitals eat the cost--or more accurately, figure it into the rates charged the rest of us--kinda like shoplifting in a store, where other customers pay in the form of higher prices.

My point is that as bad/inefficient/whatever as this is, it beats any alternative I've heard--most notably, the ridiculous government takeover of the whole system suggested by Obama, Hillary, and others. Paying slightly more to "informally" take care of the poor and uninsured is much more tolerable than the loss of freedom, convenience, and quality, and horrendously high cost to taxpayers that goes with these socialized medicine alternatives.

[LEWCWA]

Its past your bedtime Tex!!

[texaspackerbacker]

Its past your bedtime Tex!!

Nah. I can sleep all day if I want to.

Next thing the libs will be legislating when bedtime is.

[Tyrone Bigguns]

As far as where there are patients doctors will follow, that is great in a capitalist model, but you aren't advocating that. You can have a billion patients and if you cap the pay of doctors none will follow. They have to be allowed to make what their services are worth.

Bobblehead, you keep making these silly statements that show that you very limited knowledge of what you're talking about re. healthcare. First off, if it were true that caps on payments would doom our medical system then we would have already destroyed it. How do you think reimbursements work for providers under our current system? Why do you think it is that, as Ty suggested, medical professionals are among those complaining loudest about the grave problems of our current system? Are you really thinking about what you're writing or are you just regurgitating some lesson from your Microeconomics textbook?

Second, of course what I'm talking about is a capitalist model. If it involves laborers (doctors) selling their labor to the highest bidder then by definition it's capitalist. Take a deep breath and remember that capitalism wasn't invented in Chicago by Milton Friedman in 1965.

I make the point because in england they had to import hundreds of doctors from poorer middle eastern countries because they weren't paying them enough to inspire their own youth to go to med school. I make the point because we are at the point where we aren't getting enough doctors graduating and are importing them from india. We are short on nurses too, we are importing them from the phillipines by the thousands.

So? What is wrong with importing docs. If they are qualified i see no problem.

This is a global economy. That is capitalism. If the youth don't wanna work for those wages...they can do another job. Or they will readjust their thoughts.

The free market works...except when you don't like it? I don't think Adam Smith would be on your side on this one. The worker has the right to move to a better job..from anywhere. And, those british docs can move to our country if they want.

I highly doubt you are for propping up blue collar wages. Should i then expect you to want high wages for GM workers..to inspire kids to wanna work the line?

[texaspackerbacker]

We are already doing that, Tyrone--in large numbers from places like the Philippines, India, Korea, and the Caribbean.

I commend you for not spewing the usual liberal whine about "brain drain" and America exploiting other countries that way.

[bobblehead]

As far as where there are patients doctors will follow, that is great in a capitalist model, but you aren't advocating that. You can have a billion patients and if you cap the pay of doctors none will follow. They have to be allowed to make what their services are worth.

Bobblehead, you keep making these silly statements that show that you very limited knowledge of what you're talking about re. healthcare. First off, if it were true that caps on payments would doom our medical system then we would have already destroyed it. How do you think reimbursements work for providers under our current system? Why do you think it is that, as Ty suggested, medical professionals are among those complaining loudest about the grave problems of our current system? Are you really thinking about what you're writing or are you just regurgitating some lesson from your Microeconomics textbook?

Second, of course what I'm talking about is a capitalist model. If it involves laborers (doctors) selling their labor to the highest bidder then by definition it's capitalist. Take a deep breath and remember that capitalism wasn't invented in Chicago by Milton Friedman in 1965.

I make the point because in england they had to import hundreds of doctors from poorer middle eastern countries because they weren't paying them enough to inspire their own youth to go to med school. I make the point because we are at the point where we aren't getting enough doctors graduating and are importing them from india. We are short on nurses too, we are importing them from the phillipines by the thousands.

So? What is wrong with importing docs. If they are qualified i see no problem.

This is a global economy. That is capitalism. If the youth don't wanna work for those wages...they can do another job. Or they will readjust their thoughts.

The free market works...except when you don't like it? I don't think Adam Smith would be on your side on this one. The worker has the right to move to a better job..from anywhere. And, those british docs can move to our country if they want.

I highly doubt you are for propping up blue collar wages. Should i then expect you to want high wages for GM workers..to inspire kids to wanna work the line?

You gotta take my quote in context(all of it), I don't have a problem with importing qualified professionals in and of itself...but when we are doing it because we have damaged our medical profession with capped payments and diminished earnings due to gov't intervention I think it is a valid point.

We messed up the system, so we are trying to import cheap labor to sustain it. I would think you lefties who are all about bashing companies for going after cheap labor would be on my side on this one. What would you say if GM imported laborers to bust the union??

Don't make silly statements about the free market working except when I don't like it...I'll say it again...HEALTH CARE IS NOT A FREE MARKET INSTITUTION. It hasn't been since the HMO's continually gained power, or since medicare started trying to control costs for that matter. It was in my quote, you know, the part you didn't include.

Did YOU even read what I wrote, I clearly said its not free market in its present form and you go right on with implicating me for just the opposite....man, I know why tex starts calling names. (although for your convenience, you chopped off that portion of my quote as then you wouldn't be able to try and twist my words and arguement.)

Last point, I am not in any way shape or form advocating "propping up" wages, I am for letting the FREE MARKET set them. I am against artificially DEFLATING them. Again, read my post, understand it, then respond to my actual points, not the straw man points you set up.

[bobblehead]

So? What is wrong with importing docs. If they are qualified i see no problem.

I guess I can play it your way too.

Who said its wrong? I didn't say its wrong.

[texaspackerbacker]

I almost let this slip by unchallenged, Bobblehead.
-----------------------------------------------------------
And lastly, tex, the patriot act was the worst "quantum leap size grab at OUR freedom" that I can recall, so its both sides on that one.....oh look tyrone, I disagreed with tex AGAIN.
------------------------------------------------------------
First of all, the Patriot Act probably deserves it's own thread too. I'll leave that for one of you detractors of it to start one, though.

Bobblehead, have YOU lost any freedom because of the Patriot Act? I sure as hell haven't. The ONLY people who have had freedom or rights curtailed by the Patriot Act are the terrorist enemies who are actively trying to destroy this country and kill our people.

Do YOU communicate with known terrorist numbers, addresses, or emails outside the country? If not, then the provision about moniitoring that kind of communications doesn't effect you.

Are YOU one of the non-citizen terrorists locked up in Guantanamo? No? Then the depriving to them of OUR rights of due process, Habeus Corpus, etc., and well as various kinds of harsh treatment--which still falls WAY SHORT of the traditional definition of torture--has NO negative effect on you. On the contrary, it just might have the very positive effect of saving your life from the acts of terror past, present, and future that are prevented.

Does the various other forms of enhanced security deprive YOU of any rights and freedoms? Yeah, the right to not have to wait in line, be searched, go through metal detectors, bring liquids onto planes. I'm sure that's all there in the Constitution somewhere.

The point is, hell no, we normal Americans have NOT lost any rights and freedoms as a result of the Patriot Act--even liberals and libertarians have lost no rights and freedoms.

This is in contrast to the Obama, Hillary, and other Dem/lib advocated health care programs which would drastically reduce freedom of choice for medical providers, as well as greatly curtailing convenience and availability of health care of all kinds. Yeah, I suppose there is nothing in the Constitution about that stuff either.

[Tyrone Bigguns]

As far as where there are patients doctors will follow, that is great in a capitalist model, but you aren't advocating that. You can have a billion patients and if you cap the pay of doctors none will follow. They have to be allowed to make what their services are worth.

Bobblehead, you keep making these silly statements that show that you very limited knowledge of what you're talking about re. healthcare. First off, if it were true that caps on payments would doom our medical system then we would have already destroyed it. How do you think reimbursements work for providers under our current system? Why do you think it is that, as Ty suggested, medical professionals are among those complaining loudest about the grave problems of our current system? Are you really thinking about what you're writing or are you just regurgitating some lesson from your Microeconomics textbook?

Second, of course what I'm talking about is a capitalist model. If it involves laborers (doctors) selling their labor to the highest bidder then by definition it's capitalist. Take a deep breath and remember that capitalism wasn't invented in Chicago by Milton Friedman in 1965.

I make the point because in england they had to import hundreds of doctors from poorer middle eastern countries because they weren't paying them enough to inspire their own youth to go to med school. I make the point because we are at the point where we aren't getting enough doctors graduating and are importing them from india. We are short on nurses too, we are importing them from the phillipines by the thousands.

So? What is wrong with importing docs. If they are qualified i see no problem.

This is a global economy. That is capitalism. If the youth don't wanna work for those wages...they can do another job. Or they will readjust their thoughts.

The free market works...except when you don't like it? I don't think Adam Smith would be on your side on this one. The worker has the right to move to a better job..from anywhere. And, those british docs can move to our country if they want.

I highly doubt you are for propping up blue collar wages. Should i then expect you to want high wages for GM workers..to inspire kids to wanna work the line?

You gotta take my quote in context(all of it), I don't have a problem with importing qualified professionals in and of itself...but when we are doing it because we have damaged our medical profession with capped payments and diminished earnings due to gov't intervention I think it is a valid point.

We messed up the system, so we are trying to import cheap labor to sustain it. I would think you lefties who are all about bashing companies for going after cheap labor would be on my side on this one. What would you say if GM imported laborers to bust the union??

Don't make silly statements about the free market working except when I don't like it...I'll say it again...HEALTH CARE IS NOT A FREE MARKET INSTITUTION. It hasn't been since the HMO's continually gained power, or since medicare started trying to control costs for that matter. It was in my quote, you know, the part you didn't include.

Did YOU even read what I wrote, I clearly said its not free market in its present form and you go right on with implicating me for just the opposite....man, I know why tex starts calling names. (although for your convenience, you chopped off that portion of my quote as then you wouldn't be able to try and twist my words and arguement.)

Last point, I am not in any way shape or form advocating "propping up" wages, I am for letting the FREE MARKET set them. I am against artificially DEFLATING them. Again, read my post, understand it, then respond to my actual points, not the straw man points you set up.

Who cares why we import them...i certainly don't. If it lowers costs..that is the point.

I dont' think it is a valid point, sorry.

Free market: Agreed. So, then let's move on and get doctors anyway we can. Is there some sort of benefit to the PATIENT, INSURANCE COMPANIES, OR HOSPITALS if they all come from their native country...i don't see it.

The point would be is that HMOs aren't going anywhere. Are they? If you are against them..great, but Pancho Villa...you think you can take those windmills? Yikes.

Free market: it is as free as any other. Plenty of docs don't have to be in HMOs..one, that is their choice..two, they can choose a field where they can do elective work..ie, plastic surgery.

Or they can just make a free market choice..hang out a shingle...and see who comes a calling. nothing stopping you and the rest of the revolution from patronizing them..is there?

If they are good docs...and your health is important..i think you'll go to them if the other docs aren't as good. If you don't..then you are telling the us that healthcare isnt' that important.

For me, this is a strawman. And, once expectations are lowered...there still will be docs. That is the nature of choice. Those with a calling to serve their fellow man will still become docs, those who want a very nice living will still become docs...and those who became docs because of the high pay..they will move on to other professions...and be happy..and create glorious new things for our civilization..who knows what is being denied us because of the high pay for docs. (see, it is so great being Tex!!).

GM: When the conservs make that stand..i'll be glad to address it. But, you and i both know that the owners care about the bottom dollar. And, i have constantly heard how unions ruin things. If you wanna play devil's advocate..then you wanna dance with the devil..and you gotta start admitting that perhaps the almighty dollar isn't the sole criteria.

And, the fact is that...that companies do it all the time.

Companies hire illegals all day long to save money....yet, i hear most of the blame from conservs at the illegal...rarely at the business owner who knowingly does it.

The gov't sets prices in many areas...they won't pay more than X amount for things in the defense industry...and, like i pointed out before...i certainly don't see those companies struggling, lacking employees, etc.

To single out this field..when we have tariffs, subsidies, etc. for other industries strikes me as disengenous.

I'm all for the free market. Yet, i rarely see it practiced. And, it is conservs who don't fight to change it. Remind me when McCain comes out against corn subsidies/ethanol.

[bobblehead]

Tyrone:

1) I don't care if they import them...you missed the entire point. They fixed prices and are forced to import cheap labor now.

2) you may accpet it, I choose to point out the flaws and offer solutions.

3) It is not as free as any other, not even close. Not sure how you can draw that conclusion.

4) Yes, there is something stopping them from hanging out a shingle. Patients are locked into managed care situations and a doctor under the current system will be hard pressed to make money without playing ball.

5) Yes, they will move on to other professions. Not sure on your point. My point is that if the free market forces them to other professions, fine, if its HMO caps and a closed system, not so fine.

6) I have constantly said its the companies fault for our illegal situation. If I were in mexico I would try to sneak over here too, no question. It is up to us to make them come the right way, not them. Blaming the illegals for trying to better their life is just stupid.

7) When the gov't fixes prices in defense they are the buyer. Its not called fixing the price, its called the demand factor...when an HMO fixes the price for a service and the person getting the service has no input, it is very different. Also when you have taken competition out of the market it changes the parameters. Basically we are at a point now where the HMO's are the only buyers left (well, not quite, but you get the point), but the demand is there.

And finally I am fighting to change it, it is you who said...."The point would be is that HMOs aren't going anywhere. Are they? If you are against them..great, but Pancho Villa...you think you can take those windmills? Yikes"

[bobblehead]

Tex-

How will you feel in 2009 when Barrack Obama has the power to listen in on any phone calls he wants without a warrant?