Controlling Health Care Costs

[Zipp0 1]

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And my comparison of doctors and medicine men, in the context I framed it, and for the reasons stated, is a perfectly fair analogy.

Sure it's fair, and I think it's a reasonable place for people to go for healthcare if they don't want to pay a real doctor.
.

You have totally missed my point on this subject. Totally.

I stand by everything I have said. Maybe 'Thou dost protest too much'??

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Chuck Norris doesn't do push-ups, he pushes the Earth down.

[billvon 3,078]

>I don't know how to underscore this--it's an extremely difficult
>problem and probably not solvable.

I believe it is. Other countries have. And despite what some people think, the US is not the only country to have problems with poverty, obesity, cigarette smoking, and taxes.

As I've said before, other countries take less of their citizen's money for medical care and provide better services, based on people living longer and fewer babies dying. We should learn from that rather than deciding "that's probably impossible."

[Zipp0 1]

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>I don't know how to underscore this--it's an extremely difficult
>problem and probably not solvable.

Send 20,000 more troops!!! Oops....sorry. Wrong issue.

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I believe it is. Other countries have.

Me too, which is why I started the thread. So far, the answer from the right seems to be "not fixable, the poor are screwed, so shut up. It's a free market."

I have superb health care myself. Maybe I should stop giving a shit.......

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Chuck Norris doesn't do push-ups, he pushes the Earth down.

[billvon 3,078]

>You can't take away the incentives for the providers and expect the
>same caliber of care.

But you can remove mandated expenses and get the same care for less money. If we require providers to do less paperwork, they will be able to provide the same actual care for less money.

[kelpdiver 2]

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Whoa there Nelly! Taking this discussion personally are we? Chill the fuck out.

I was not the one saying that financial gain is the main reason for the actions of doctors and eveyone else in the "free market." That is what others were saying.

You did very clearly refer to doctors as money seeking primitive medicine men. What sort of reaction would you expect from one? For the hours being put it, the rate of pay isn't really outstanding, esp when you add in the malpractice costs and typical med school debt.

The so called high financial gain is rather necessary- without it no one would put up with the institutional hazing (physical, mental, financial) put on would be doctors.

If the desire is to lower the cost of paying doctors, then the school tuitions and working hours need to be lowered. And more or larger schools created.

[Zipp0 1]

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You did very clearly refer to doctors as money seeking primitive medicine men.

I most certainly DID NOT. I was simply saying that primitive medicine men didn't get into the field for a big payday. I was saying, mostly to the "free market" folks, that doctors are driven by more factors than simple economics. I used the medicine man argument to counter the incorrect claims that without big paychecks there would be no doctors.

If you find out your doctor went into medicine for the money, run.

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Chuck Norris doesn't do push-ups, he pushes the Earth down.

[SpeedRacer 1]

I agree with you that Doctors didn't become doctors just for the $.

Medical school is long, difficult and very expensive, and if they just wanted to make big$, there's much easier ways of doing that.

That doesn't mean that good quality medical care is cheap. One way or another, all that education & training of doctors, and all the research of new medicines/surgical techniques have to all be paid for.

Speed Racer
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[nathaniel 0]

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I believe it is. Other countries have.

No, I meant making comparisons between other countries and the US on the basis of raw healthcare figures. That's never been done, and to the extent that amateurs like us try it's meaningless. It's an extremely difficult academic problem, and as such it forces to zero the relevance of doing so in debates about US healthcare.

My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?

[freethefly 6]

Would these be the blinders you speak of?

"...And once you're gone, you can't come back
When you're out of the blue and into the black."
Neil Young

[billvon 3,078]

>That's never been done . . .

A simple search will point you to a wide variety of comparisons that treat the issue as superficially or in as detailed a manner as you like.

>It's an extremely difficult academic problem, and as such it forces to
>zero the relevance of doing so in debates about US healthcare.

I agree it's a difficult problem. And the more we think that our problems are completely unique and that we have nothing to learn from the experiences of others, the closer to zero our odds become of doing anything about the problem.

[nathaniel 0]

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wide variety of comparisons

Your point, what is it? What comparison would you now put forth, and how would you show it accounts for the systematic differences in healthcare needs between the US and its peers?

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I agree it's a difficult problem. And the more we think that our problems are completely unique and that we have nothing to learn from the experiences of others, the closer to zero our odds become of doing anything about the problem.

Ever heard the one about the drunk searching for his keys underneath a lamppost? Lost them in the bar but the bar's closed... There are real differences between the US and parts of the world with "better" healthcare. Ignoring them is the surest way to perpetuate our healthcare woes.

My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?

[Lindsey 0]

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You have totally missed my point on this subject. Totally.

I don't think I've missed your points at all.

There was
Make malpractice a criminal issue, and eliminate any possibility of monetary payouts.

and
The doc thinks it won't hurt them, and when the drug rep sees the doc writing his drug, he brings an extra special lunch to the entire office or hires the doc to speak to other doctors about the drug.

and (again)
There would be no malpractice insurance. Malpractice would not be a civil issue any more, but criminal.

and
Maybe that's why medicine is no linger curing diseases, only treating them. It's more profitable, and tackling the easy maladies for a quick buck make good financial sense.

and (yet another time....) Do you think that when things go wrong in medicine that physicians REALLY should go to jail???? That really boggles my mind.

It prevents him from harming other people and punishes his negligence. This is why we have jails.

and
Healing the sick is the incentive. Did the unpaid village medicine man in centuries past do it for the money? No. The world can change, we just have to be willing to change it.

I'm not seeing the parts where you talk about how physicians really are your friends.... Maybe it was between the lines somewhere though. Idealism can be a good thing. Progress is made by people who have strong ideals and who drive their points home....especially when those ideals are grounded in reality.

I think you'd find that many, if not most, physicians want to see the healthcare become more affordable. I think you'd also find that many of the "mistakes" (or would-be criminal events) that physicians make are trade-offs....trying to do the right thing. Let me give you this example....one that you might think I should be held criminally liable for had the outcome not been good: Same small-town ER that I was talking about before. One night I needed a chest tube. The nurse couldn't find one. So I rigged one (a chest tube's a pretty simple device), placed it in the man's chest, we stabilized him and shipped him to a better-equipped hospital. Had he died with my chest tube in, I'm well-aware that I could've been sued. Without a chest tube at all, his chances were worse I believe. There's likely an attorney who could argue a good case against my belief in this case had the guy died. But I didn't have time to research the odds. I had time to make a decision....right then.

That, under your plan, could easily put me in jail. I'd gladly gamble with the hopes of not losing money in a malpractice case. I wouldn't so easily gamble with my freedom. But then maybe that makes me selfish for not placing a patient's life above my freedom....

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A conservative is just a liberal who's been mugged. A liberal is just a conservative who's been to jail

[nathaniel 0]

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Battier than claiming the US doesn't have very good healthcare due to poverty?


Food for thought.

Variability and Vulnerability at the Ecological Level: Implications for Understanding the Social Determinants of Health.
Karpati A, Galea S, Awerbuch T, Levins R.
Am J Public Health. 2002 Nov; 92(11): 1768-1772.

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A general process underlying these observations
has been articulated by Link and Phelan,
who postulated that access to protections
and avoidance of harms underlie health outcomes
that are sensitive to SES.

...

Populations
enduring social or economic deprivation
will be more vulnerable to potential
stressors than will populations of higher status.
Thus, acute outbreaks of infectious diseases,
environmental risks, or transient gaps
in public health services will likely affect an
economically deprived population to a greater
degree than they would a less marginalized
population.
We note, however, that these external
stressors are not uniformly distributed across
all disadvantaged communities, and therein
might lie the source of the observed variability.
Although vulnerability might result from
chronic economic deprivation, the range of
adverse health outcomes will depend on the
degree to which each community experiences
stressors and the distribution within communities
of counteracting protective factors.
Variability in biological systems is increasingly
seen as a marker for stresses to systems
in homeostasis. Applying this insight to communities
and health, we postulate that economic
deprivation produces vulnerability to
stressors whose nonuniform distribution
across populations manifests as variability in
health outcomes. One possible implication of
this model is that interventions to improve
public health might exert the greatest effect
not by targeting particular stressors, but
rather by focusing on improving general social
and economic well-being, thus reducing
populations' overall vulnerability.

My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?

• Quote

[jenfly00 0]

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Canada has your dream plan, you should move there.

Never mind the story about the guy with brain cancer that had to come to the States and pay out of pocket for an MRI, since the state decided it wasn't an urgent requirement.

Nevermind the millions of senior Americans who can, using their own money, buy their prescription drugs cheaper in Canada than they can get through Medicare here in the states.

http://seniorliving.about.com/od/manageyourmoney/a/canadavsmedicar.htm


All systems have their pros and cons.

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"O brave new world that has such people in it".

[Lindsey 0]

Nevermind the millions of senior Americans who can, using their own money, buy their prescription drugs cheaper in Canada than they can get through Medicare here in the states.

Or they can buy them cheaper ($4 per prescription) at wal-mart

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A conservative is just a liberal who's been mugged. A liberal is just a conservative who's been to jail

[Zipp0 1]

Don't misunderstand me. (it's hard because there are so many issues addressed here).

I would never punish a doctor criminally for the 'shit happens' issues, or small oversights. What I am proposing is ending the cash cow of malpractice lawsuits and the associated costs to doctors and patients.

With that protection gone, there would need to be additional protections. There would need to be better and more serious looks by review boards at careless mistakes that result in serious suffering. The way things stand now, those boards rarely take action. Criminal liability would be the last resort, and saved for the very worst cases. This would save good doctors and their patients lots of money.

Your case of the improvised chest tube would not even get a second look. the result speaks for itself.

When I fixed avionics on fighter jets in the gulf war, we were sometimes forced to improvise with non-standard parts to get the plane into the fight. None of our aircraft were grounded, and none got shot down. We didn't get punished - they gave us medals.

On my comments about curing disease, I was referring to the business of drug reseaech, marketing, and sales, not doctors.

I have nothing against doctors. Seriously. I'm just searching for answers to very difficult questions.

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Chuck Norris doesn't do push-ups, he pushes the Earth down.

[Lindsey 0]

I'm just searching for answers to very difficult questions.

And they are difficult problems.... I think we're starting to make some headway, and I do believe the problems are solvable without becoming like Canada. I think that it is possible for people to become more healthy, but sometimes it takes hitting a wall to shift the tide. We're the unhealthiest we've been in a long time. I recently read in some journal or other than our children will be the first generation whose life expectancy will be shorter than their parents. Trying to keep up with that is expensive. I hope that we will be turning the corner soon....

linz

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A conservative is just a liberal who's been mugged. A liberal is just a conservative who's been to jail