A Forum for Grinches and Ho-Ho-Hoes

[Replaced_Texan]

Originally posted by Mmmm, Burger (C.J.)
I assume you mean as a political matter. Canada seems to be able to do it by making them wait. That solves (in a financial sense) many of the problems.

As an ethical matter.

[Mmmm, Burger (C.J.)]

Originally posted by Replaced_Texan
If people move from payor to payor or from health system to health system, there's no incentiveto the healthcare providers to keep the population healthy.

That seems right, yet oddly my insurance covers all preventative care more generously than anything else (e.g., annual checkups and the like have no copay/deductible). They must see some benefit in catching problems before they become more costly. Obviously they know I'll be on medicare before cancer becomes an issue, but that kind of prevention requires them to deal with mcdonalds and RJR.

[Mmmm, Burger (C.J.)]

Originally posted by Replaced_Texan
As an ethical matter.

whose ethics (or under what ethical system)? IF they don't get to see a doctor, then the doctor's ethics aren't implicated.

[ltl/fb]

Originally posted by Bad_Rich_Chic
Hence the attractions of a single-payor, no-opt-out system. It forces rational rationing (as opposed to economic rationing, which is basically what we have). Problem is, as GGG pointed out, a single payor has WAY too much power over pricing and ends up depressing innovation because innovators aren't inspired by potential huge profits. That said, most innovation in the US system is in ... well, elder care generally and end of life care specifically, because that's where the money is. Which means the innovation is of limited benefit to the rest of us, so I'm not sure how I'd weigh its loss.

Is the money in elder care because people pay outside of Medicare for extra care, or because of Medicare, a single-payor system? In any event, Medicare is apparently in far worse shape financially than the OASDI part of Social Security, so the crash and burn of that may affect the money flowing into elder care.


On a slightly different note, I read this in BNA P&B Daily today:

• While President Bush has urged federal limits on medical lawsuits, including a $250,000 cap on patients' noneconomic damages, Sens. Patrick Leahy (D-Vt.) and Edward M. Kennedy (D-Mass.) are seeking reforms in the medical malpractice insurance industry.
  
  Leahy and Kennedy Jan. 13 circulated a letter to members of Congress soliciting cosponsors for a bill that would limit an exemption from antitrust laws that has existed for the insurance industry since 1945. The text of the bill they plan to introduce is less than two pages in length and is the same as unsuccessful legislation (S. 352) they offered in the previous Congress.

http://pubs.bna.com/ip/BNA/pbd.nsf/is/a0b0h0n3d8 , but most of you probably can't access that.

Anyway, what's the deal with this antitrust exemption? Rs are apparently "cool to the idea of chipping away at the antitrust exemption."

I tend to think the insurance industry as a whole is not the most honest or consumer-friendly industry, and that they are very, VERY fond of pushing through and keeping in place legislation that benefits only them. So I am suspicious that this is just another backstop against any efforts to keep them from screwing customers.

But, I'm interested in background/discussion on the exemption if anyone knows about it b/c of either healthcare or antitrust experience (or both).

[Replaced_Texan]

Originally posted by Mmmm, Burger (C.J.)
whose ethics (or under what ethical system)? IF they don't get to see a doctor, then the doctor's ethics aren't implicated.

The system's ethics. Hell, we have a problem terminating whatshername Shivo's (very expensive) care in Florida because someone thinks she's benefiting from it.

I don't have a problem with healthcare rationing per se (I was and continue to be in love with the Oregon model that Bush I slapped down as barbaric), but I do have a problem with cutting people off because of class or age, and no one has been able to show how it's possible to cut people off.

When most end-of-life treatment starts, the caregivers don't know it's the end of that patient's life, and a hell of a lot of patients in the same situation pull through. The physicians', nurses' and other allied health professionals' ethics get involved with withdrawing that care.

[Greedy,Greedy,Greedy]

Originally posted by Bad_Rich_Chic
That said, most innovation in the US system is in ... well, elder care generally and end of life care specifically, because that's where the money is. Which means the innovation is of limited benefit to the rest of us, so I'm not sure how I'd weigh its loss.

If I had to identify the most significant innovations today, I'd say they are in genetics and the development of genetic therapies, certainly not something limited to the elderly, and in medical information systems, especially "expert systems" screening software, also not limited to the elderly. We're now getting past the age of pharacological innovation, and while a lot of money is spent on oncology and cardiac care, I don't think we're getting enormous innovation in either area today (maybe 10 years ago, but today its mostly incremental change in those areas, like drug coated stents).

[Greedy,Greedy,Greedy]

Originally posted by Hank Chinaski
that sounds so barbaric, but check this out-

My grandmother was very frugal. Gramps died at like 44 so she was on her own for a long time. She took in laundry, she scrimped pennies, she walked instead of taking cabs. She did that for 40 years after he died. At 80 she had a stroke, went into a coma for a month, then died. We got the bill, all paid by Medi-whatever. The total was almost $200,000.

I can't put a value on my grandmother's life, and if there was a chance she could have come out of it, maybe it was "worth it." It just seemed so odd that this incredibly frugal women went on this lavish government sponsored bender the last month of her life.

Would it be better to give them $50000 at 75 and say good luck?

Too bad you couldn't have given her a choice before she went into a coma: (i) spend a bunch of money from a system she'd paid into for her whole life to try to save her and bring her back or (ii) send her grandson in with a magnum to take care of her.

[Bad_Rich_Chic]

Originally posted by ltl/fb
Is the money in elder care because people pay outside of Medicare for extra care, or because of Medicare, a single-payor system?

Both, really. Medicare effectively subsidizes non-efficient additional healthcare spending by the elderly. (Not that Medicare is that efficient, but you know what I mean.) It adds gov't-program-huge money to the rich-people-with-time-on-their-hands-huge money that would go into it anyway, rather overwhelming the dampering effect of the fact that Medicare does, to some extent, limit the care covered. (Note that the elderly are already the wealthiest demographic group in the country, and are the heaviest over-users* of healthcare.)

*I mean over-users, as in repeated doctor visits for minor ailments, aggressive treatments for non-serious conditions, over-prescription (admitted ultimately the Dr.'s responsibility, but often exacerbated by visits to multiple dr.s, pestering, demands for treatment where none is appropriate because the symptoms are of age not disease**), etc. - they are also the largest users, but their age and comparatively poorer health make that expected.

**Reminds me of a surgeon I know who tells the story of a patient's son who demand all her medical records because he mother had died and he was going to find out who was responsible. The mother was 97. Surgeon (replaced a crown) told the guy "your mother died because she was old" and refused to release the records, fought like hell all the way through court on it. Amazingly, he is still insured; even though he has a rather confrontational attitude that seems to inspire lawsuits, he invariably wins (so far).

[Tyrone Slothrop]

From yesterday's hearings:

• BIDEN: Now, how many [Iraqi forces] do you really think are trained that Allawi can look to and say, I can rely on those forces? What do you think that number is?
  
  ....RICE: We think the number right now is somewhere over 120,000.
  
  ....BIDEN: Well, I thank you for your answer. I think you'll find, if you speak to the folks on the ground, they don't think there's more than 4,000 actually trained Iraqi forces. I strongly urge you to pick up the phone or go see these folks.

Rice has obviously been getting her rosy view of the world from bilmore. Not that it matters, since she's not going to be near the reins of power.

[Greedy,Greedy,Greedy]

Originally posted by Tyrone Slothrop
From yesterday's hearings:

• BIDEN: Now, how many [Iraqi forces] do you really think are trained that Allawi can look to and say, I can rely on those forces? What do you think that number is?
  
  ....RICE: We think the number right now is somewhere over 120,000.
  
  ....BIDEN: Well, I thank you for your answer. I think you'll find, if you speak to the folks on the ground, they don't think there's more than 4,000 actually trained Iraqi forces. I strongly urge you to pick up the phone or go see these folks.

Rice has obviously been getting her rosy view of the world from bilmore. Not that it matters, since she's not going to be near the reins of power.

I don't think you can succeed in the Bush administration unless you are skilled at wish-think. It's a job requirement.

[Shape Shifter]

Originally posted by Tyrone Slothrop
From yesterday's hearings:

• BIDEN: Now, how many [Iraqi forces] do you really think are trained that Allawi can look to and say, I can rely on those forces? What do you think that number is?
  
  ....RICE: We think the number right now is somewhere over 120,000.
  
  ....BIDEN: Well, I thank you for your answer. I think you'll find, if you speak to the folks on the ground, they don't think there's more than 4,000 actually trained Iraqi forces. I strongly urge you to pick up the phone or go see these folks.

Rice has obviously been getting her rosy view of the world from bilmore. Not that it matters, since she's not going to be near the reins of power.

Did she get Iraq confused with Chicago? Maybe now isn't the time for diplomacy.

[Replaced_Texan]

Originally posted by Greedy,Greedy,Greedy
If I had to identify the most significant innovations today, I'd say they are in genetics and the development of genetic therapies, certainly not something limited to the elderly, and in medical information systems, especially "expert systems" screening software, also not limited to the elderly. We're now getting past the age of pharacological innovation, and while a lot of money is spent on oncology and cardiac care, I don't think we're getting enormous innovation in either area today (maybe 10 years ago, but today its mostly incremental change in those areas, like drug coated stents).

I see innovation in ancillary services, molecular medicine, and cardiac care (of course, I work in one of the most heart oriented cities in the country, so I may be seeing things a bit skewed).

Ancillary services. That's where the money is in healthcare these days. Apparently DHHS recommended yesterday that the specialty hospital moritorium be extended for another 18 months, though it would take an act of Congress to do so. There are a lot of physicians out there chomping at the bit to go out and build their own hospitals.

There's HUGE money in molecular medicine. If Kay Bailey runs / wins in Texas, I wouldn't be surprised to see her trying something similar to what Ahnold did in California with the stem cell legislation. She was here two weeks ago, meeting with every Texan member of the National Academy of Sciences, and I believe she's trying to court the reality based vote.

[Hank Chinaski]

Originally posted by Greedy,Greedy,Greedy
Too bad you couldn't have given her a choice before she went into a coma: (i) spend a bunch of money from a system she'd paid into for her whole life to try to save her and bring her back or (ii) send her grandson in with a magnum to take care of her.

We didn't care, there were some really cool machines. And, it was all free!

[The Larry Davis Experience]

Originally posted by Tyrone Slothrop
From yesterday's hearings:

• BIDEN: Now, how many [Iraqi forces] do you really think are trained that Allawi can look to and say, I can rely on those forces? What do you think that number is?
  
  ....RICE: We think the number right now is somewhere over 120,000.
  
  ....BIDEN: Well, I thank you for your answer. I think you'll find, if you speak to the folks on the ground, they don't think there's more than 4,000 actually trained Iraqi forces. I strongly urge you to pick up the phone or go see these folks.

It was also interesting that earlier in the exchange he took the time to point out her prior statements on the subject when she was campaigning for GWB.

Biden's statements aside, does anyone here have reason to believe that the Iraqis have more than 25,000 people under arms who can be depended upon in a fight? I just can't imagine that there are a bunch of police academies churning out top flight security forces over there, esp when the numbers they were floating pre-election were clearly inflated, as if they really expected us to believe that there were 100,000 trained Iraqi troops walking the beat alongside the Marines.

I have concerns about the political structure in place and the real effectiveness of next week's elections. But as I think more about it, I almost don't care about the elections so much as I want our troops out of there, because whatever political equilibrium is reached with our troops keeping the peace is just going to have to be reestablished once we leave. The only question is how much we have to spend in troops and cash before the training wheels come off. (Note that I'm not advocating a withdrawal, I just want things speeded up to get to where we can withdraw with some confidence that the government can keep the peace.)

And, on another tangent entirely, can anyone tell me why Biden is not more of a national player? Is it the plagiarism thing, or something else? Whenever I see him speak I am struck by how articulate he is. Also a little arrogant, but Dem beggars can't be choosers when it comes to serviceable pols these days.

[Replaced_Texan]

Originally posted by The Larry Davis Experience
And, on another tangent entirely, can anyone tell me why Biden is not more of a national player? Is it the plagiarism thing, or something else? Whenever I see him speak I am struck by how articulate he is. Also a little arrogant, but Dem beggars can't be choosers when it comes to serviceable pols these days.

He was on the Daily Show during the Dem convention and I sort of got the impression that he, like Bob Kerrey, speaks his mind now because he's lost his shot at being a national player.

Frankly, I like both of them and wish the Dems would let them back into the game.