September 6, 2009

"10 Things I Hate About Health-Care Reform."

By Arthur M. Feldman — "a cardiologist and the administrator of a large practice that includes general internists and specialists" — who agrees with the basic idea that reform is needed:
1. Private insurance companies escape real regulation....

2. We urgently need tort reform, but it's nowhere to be seen....

3. "Prevention" won't magically make costs go down....

4. Reform efforts don't address our critical shortage of health-care workers....

5. We need more primary-care physicians -- but we also need specialists....

6. We have to streamline drug development and shake up the Food and Drug Administration....

7. We can't fund health-care reform by cutting payments to doctors....

8. We can't forget about research....

9. Cutting reimbursements could shut some hospitals down....

10. We need to improve the quality of care....

110 comments:

rhhardin said...

In other words, take the Democrat plans and do the opposite.

Democrats believe systems work best when they run counter to human motivations.

Experience says go with human motivation.

PatCA said...

Makes sense.

Thus he will either be ignored or demonized.

The Drill SGT said...

While I agree with some of those, when I read it this morning, my second thought was that his list was pretty self-serving. Like a wish list from Doctors. I don't see any burden sharing from them in that list. e.g. get the lawyers and insurance companies off our backs, more payments, more grants, more research, more more...

CrankyProfessor said...

People in favor of Obama Reform MUST BOYCOTT THAT MEDICAL PRACTICE! Otherwise it would be like shopping at Whole Foods.

edutcher said...

Disagree with 1 and 6. Congress has already over-regulated the insurance companies, from what I get from the discussion, and I would rather see the FDA err on the side of caution (thalidomide, anyone?).

Sarge is right about 7 and, to a great extent, 2, although tort reform is probably needed as a matter of principle.

As for 10, my wife is an RN of 40 years' experience in many areas (oncology, rehab, med-surg, etc.) and her big complaint is that there is a gap in quality of care due to all that nurses are expected to do - including act as doctors' surrogates and backstops. This includes a great many menial tasks required of them which could be done by other (in many cases unionized) employees of whom hospitals won't demand as much. Add to this a general lack of respect by most doctors for people every bit as highly trained and many shifts are understaffed.

Ricardo said...

It seems to me, that you really can't get at this issue without taking the time to go deeper into the philosophic underpinnings. What exactly are "illness" and "health"? Is "illness" something to be economically exploited? Are sick people just "weak", and therefore is it alright to prey upon them as much as possible, from all sides? Or are we talking about a national security issue here, where a healthy citizenry is the backbone of our nation, and is an "asset" to be protected as much as possible? If this is more of a national security issue, shouldn't we be looking at it in those terms (as a "national" issue) rather than forcing 300 million people to flounder around on their own, figuring out solutions to basically insoluble problems?

Paco Wové said...

Good. Affordable. Universal.

(Pick any 2.)

Ricardo said...

Oops ... insolvable problems.

Michael Hasenstab said...

It all makes sense, the death knell for any gummint program.

William said...

Our health care system has suppurating sores underneath its fleshy folds and crud crusting over the gangrenous wounds that sicken the appendages that stick out of the cancerous growths. There are so many no brainer things that can be done to improve both quality and descrease cost. They can be written, as the Doctor has done, in brief understandable points. However, to match the monstrosity of our health care system, the Democrats have submitted a 1000 page thicket of restrictive clauses with qualifying conjunctions in a larger field of ambiguity. The incomprehensibility of the Democratic plan is the strongest argument against it.

t-man said...

Ricardo -

In other words, shouldn't those 300 million that are foundering around realize that they are part of a collective, and even if their own healthcare would be worse under the new plan, shouldn't they accept that the collective would be better off?

Big Mike said...

The incomprehensibility of the Democratic plan is the strongest argument against it.

That's 100% on point.

John Lynch said...

For me the health care debate is really easy.

Show me the money.

Insuring more people is going to cost a lot of money. Where's it going to come from?

Cuts or taxes. The only thing Democrats have cut in my lifetime is defense. We're in a war. Bad idea.

So that means taxes. We're in a recession, the worst of my life. Bad idea.

So, it's all a bad idea.

special agent said...

The complexities of health care reform make electric power regulatory debates seem like a walk in the park!

Robert Cook said...

As for point #1, this is why single payer, i.e., universal care, is necessary. It takes all the insurance companies OUT of the delivery of health care completely.

As long as they're involved in any way, health care in this country will become ever more expensive and out of reach for greater numbers of people. What cannot go on, won't. And our present system cannot go on.

t-man said...

"Single payer" does not, contrary to Robert Cook's, statement, mean universal coverage. (There could be plans that provide for universal coverage that do not require a "single payer" system.)

"Single payer" is a euphemism for "federal government" Anyone who uses the term "single payer" is trying to avoid the implications of that simple fact.

Chip Ahoy said...

Hmm, let me see, point #1, insurance companies escape real regulation (by the proposed health care reforms) therefore we must have single -payor, that is universal care, (that is 100% socialized medicine). Sounds logical to me. Let's do it!

LonewackoDotCom said...

While he briefly mentions it, what's off the establishment radar (except when they lie about it) is that illegal aliens will be part of the plan, one way or another.

For the backup of that from the CRS, do a find for "research" at that page. For examples of MSM sources and the like lying about this issue, see the other links on that page.

And, for something you can do about this, do a find for "this question" in the summary. I need you to contact local groups that go to townhalls and get them to have an experienced questioner (like a trial lawyer) really press a politician on those questions.

And, you might want to note that none of the tea party leaders have been encouraging people to go ask about that angle of UHC. In some cases that's because highlighting that angle would affect the bottom lines of their contributors, and in other cases it's because they're simply incompetent.

ricpic said...

"...suppurating sores underneath...fleshy folds and crud crusting over...gangrenous wounds..."

I'll have that, waiter, but hold the cancerous growths.


wv - eoreist: an egotistical eeyore.

Bender said...

Universal coverage is easy.

You simply make it illegal to not have insurance.

You are young, healthy, and haven't been to, or needed to go to, the doctor in years and, thus, neither need nor want insurance? Too bad, turn your head and cough up your money.

You would rather spend your money on rent? Too bad, insurance comes first.

You would rather spend your money on food? Too bad, hand over your money.

You would rather put your money in savings or perhaps toward retirement? Too f***ing bad! PAY THE F***ING MONEY!

You don't want to pay an extra several hundred dollars a month for healthcare coverage that you are not going to use? You think that you have a right to your own money? Too f***ing bad! The government is simply going to take it. That car of yours -- gone. That house of yours -- confiscated. We'll slap a lien on every damn thing you own and seize it.

Yeah, universal coverage is easy. Simply eliminate freedom.

John Althouse Cohen said...

Notice that #8 is a call for more government involvement.

Diamondhead said...

Yeah, what gives with #7? Why do doctors have to make so much money? Surely helping people is a reward that more than makes up for the seven, eight, nine, ten, or eleven years of unpaid and low-paid training that doctors must undergo after college.

Jason (the commenter) said...

If no one can understand all the issues involved in healthcare, why would we let anyone be in charge of it?

Seems like an obvious reason not to let the government take control.

Jason (the commenter) said...

JAC: Notice that #8 is a call for more government involvement.

Possibly, I think one of the arguments against government control is that it would skimp on medical research. Our government is notoriously short term in its goals.

t-man said...

No 8. may be a call for more government involvement, but not necessarily. The majority if medical research is not funded by the government.

Deirdre Mundy said...

More access to preventative care won;'t save money---but it also won't make people healthier.

Look at all the boomers going diabetic--is it really because they haven't been to the doctor in years? Nope-they've been going to the doctor. They've had the bloodwork and the lectures. They've just chosen not to change their lifestyles.

It's sort of analogous to the problem of dental insurance. Our dental insurance is really cheap. The total cost per year (even with the employer cost) is LESS than the cost of 2 checkups a year for everyone in our family, yet preventative care is covered at 100%.

How can they do it? Most of the people who sign up for dental insurance DON'T GO FOR CHECKUPS. Even though they're free. Even though they can use 'sick' time to get off work for them. Even though the dentist sends them chipper postcards with pictures of beavers on them to remind everyone it's time for a checkup.

Preventative care won't PREVENT much unless we force people to go for checkups AND force them to obey the doctor!

Good luck with that.......

Obama, liberals and co. need to realize that not everyone values 'health' as much as they do. Some people prefer to spend their money on gym memberships and arugula. Others would prefer lavish vacations, or maybe cigars and nice food. Freedom means other people have the freedom to make atrocious choices.

I don't know why the same people who INSIST on the freedom to kill one's offspring are repulsed and disturbed by the freedom to spend all day eating twinkies and listening to Rush......

But the healthcare bills in the works are all about limiting choice and freedom.....

Ignorance is Bliss said...

Robert Cook Said

As for point #1, this is why single payer, i.e., universal care, is necessary.

Yes, and the hangnail is why the above the elbow amputation is necessary.

Here's an idea. Let's try an actual insurance plan, instead of a pay-for-every-cold-and-upset-tummy plan.

ricpic said...

The fact that no Democrat at no time will do nothing about trial lawyer gonuvim gives the game away.

Brad Templeman said...

It sounds like real reform is a lot more expensive than proponents are letting on.

Joe said...

#8 not only doesn't mean more government investment; it should mean less. The government distorts the entire market by picking and choosing areas of research which reflect the demands of a minority rather than responding to actual need. A simple examination of where government dollars are spent on medical research when compared to actual illness bears this out.

(And the heavy hand of the FDA also drives up costs and restricts research. Ambulance chasing lawyers drive up costs and even eliminate research in areas of great risk.)

ironrailsironweights said...

Health care reform that does not include significant restrictions on end-of-life care = rearranging the deck chairs on the Titanic.

Peter

rhhardin said...

The Democrats don't care what it does so long as the government controls it.

Taking a small cut of a vast flow of funds through Washington gives them everything they want.

Dysfunction and inefficiency is a deadweight loss, but not a loss to politicians.

blake said...

As Ace says, when people say they want "health care reform", what they mean is they want better service for less money.

The government can't deliver that, except by undoing the distortions it creates that inflate prices and cause legal concerns to override medical ones.

That's as unlikely as my wv: uncome

Maxine Weiss said...

I figure this must be the place to ask all those embarrassing questions that cannot be asked anywhere else.

__________________________


"Fleshlight Motion" is a trending topic on Twitter.

Nevermind how that happened, or what that says about users of Twitter.....

....can somebody please explain what "Fleshlight Motion" is ?

Or, is it one of those things....like a Bidet....that you really don't even wanna know....

I don't trust the Trending Topics. I think they are rigged.

Florida said...

Look ... let me be perfectly clear ... that the nation's cardiologists would rather amputate your heart than provide preventive heart care.

They get paid more when they crack your chest and cut your heart out, so you can't trust your doctors.

They're thieves.

Trust in Obama.

traditionalguy said...

The ethics of medicine stress excellent care that works to heal people. Raising the money is always a side struggle. Raising the money goes well when it is not snafued by a government interference. Nevertheless,the goal for the Pelossi/Obama government is to first grab all the money power connected to "Health", and to heck with all other ethics. To Obama his control over the money power IS the only real ethic. This innocent Doctor only wants to heal people, and therefore he is totally irrelevant to the Democrat's Washington DC powers that be.

Florida said...

Medicare payments audit for Dr. Feldman in ...

3

2

1

David said...

In the meantime, the Obama press aides are leaking the notion that on Wednesday Obama will come up with "his own legislation." In other words after eight months of saying that He, Obama, does not have a particular plan, he's going to come up with one in three or four days.

Just how good do you expect a that plan to be?

Obama and his advisors now seem to believe that they must pass something--anything. Just when you think it can't get any worse, it does.

David said...

Florida said...
"Look ... let me be perfectly clear ... that the nation's cardiologists would rather amputate your heart than provide preventive heart care."

Must be different where Florida lives. I've had a lot of traffic with cardiologists over the last 40 years. I have yet to encounter one who is rushing to perform surgery where it's not necessary. The emphasis has always been medication and lifestyle changes first, surgery as a last resort.

It's interesting how little respect the proponents of this "reform" have for people and institutions who have devoted life's effort to health care.

blake said...

David,

Check your sarcasm meter. It appears to be broken.

blake said...

last wv: rediag

You can't make this stuff up.

current wv: sludg

former law student said...

In other words after eight months of saying that He, Obama, does not have a particular plan, he's going to come up with one in three or four days.

Just how good do you expect a that plan to be?

Pretty good, if my hunch is right.

If Obama had given Congress a plan and told them to pass it, every single member would be resisting it more or less. So he set a deadline and told Congress to develop a plan to their own liking.

But now the deadline's passed, and few people like Congress's plan. Tired of wrangling, by now thoroughly familiar with all the difficulties, I bet Congress would embrace any well-thought out plan. I bet further that Obama's been working on one all this time.

The doc has a couple of good points: prevention will lead to longer lives and hence more medical care. But it would have cost the government less to have diagnosed and treated my dad's high blood pressure than to deal with his kidney failure (free care under Medicare, regardless of age), namely a failed transplant followed by a decade on dialysis.

Any argument regarding the physician shortage that doesn't point a finger at the AMA is beyond disingenuous. They are keenly aware of supply and demand. When demand goes up from universal healthcare, class sizes will grow and new medical schools will be created.

JAL said...

Nit Pick: Cardiologists don't do surgery. Cardiovascular surgeons do. Different creatures, different mindset, different skills. Both necessary.

I'd like to see tort reform (I know, I know -- it supposedly won't save *that* much --- but actually, NO ONE KNOWS. I know my daughter & son-in-law would save a chunk of change if their malpractice insurance would go down ....)

I also would like to see insurance companies opened up so there can be more competition across the country.

On the websites I looked at recently for insurance for college age daughter there was a claim that the rates were the same. ? Say What?

I did find some different rates ... but there were some bizarre quirks to the coverage. The same exact policy from the same exact company was more than twice as much (to the tune of >$1000) if her home residence state was different. Like 40 miles different ...)

Focus on fixing it for the 8 million who supposedy can't get insurance, not trashing the 80% who are okay.

Make CATASTROPHIC coverage available, not just policies which pay for every time you go in for a sore throat and strep test.

eshin
bionic shin replacement

Dogwood said...

I don't know why the same people who INSIST on the freedom to kill one's offspring are repulsed and disturbed by the freedom to spend all day eating twinkies and listening to Rush......

Because they really don't believe in individual freedom, just the collective good.

former law student said...

The same exact policy from the same exact company was more than twice as much (to the tune of >$1000) if her home residence state was different. Like 40 miles different ...)

Is the cheaper state more rural than the more expensive one? Does the cheaper state have pain and suffering limits? Anything obviously different between the two?

Zachary Paul Sire said...

I just scrolled through the comments on most of the posts here on the front page of Althouse, and this has turned into a truly ugly, hateful blog. The posts encourage/taunt the commenters, the commenters then encourage/taunt each other, and all you're left with are feelings of anger, bitterness, and cruelty.

Not a good experience.

Joe said...

Sorry we didn't provide an ass kissing, butt fucking Kumbaya experience for you Paul.

former law student said...

This includes a great many menial tasks required of them which could be done by other (in many cases unionized) employees of whom hospitals won't demand as much.

The tasks may be menial, but perhaps only a nurse would know (or think, or remember) to perform them with the requisite care.

Florida said...

"I just scrolled through the comments on most of the posts here on the front page of Althouse, and this has turned into a truly ugly, hateful blog."

That's the beauty of America. You can go elsewhere. Vote with your mouse. Leave.

Blogger has millions of alternative blogs you can go read.

david7134 said...

Florida,
As a caridologist with 40 years experience, I can assure you that my peers and I follow a code you clearly would not understand. Most of the time if they are rushing you to a surgeon or to angioplasy, they are doing so to save your heart muscle or life.

As to preventive care, guess what, it does not work. All that bunk on lowering cholesterol, is pure trash being propagated by the drug companies to sell statins and the AHA that is trying to justify its existance and get your money. Exercise helps a little. Medications are about as helpful as angioplasty except under certain circumstances that are spelled out in the American College of Cardiology guidlines.

I short you have little idea of which you speak.

david7134 said...

How to fix the system. First, is it truly broken? Much of the problem is the interference from the Federal government. Your bills are high because the Feds do not pay for Medicare or Medicaid patients.

What we need:
1. Get the government out except to set up a regulatory system over the insurance companies similar to that is the states. This would take care of several problems that seem to bother people.
2. Malpractice reform is not necessary. Only make it so that a doctor can sue in return. That will stop suits that don't have merrit.
3. Set up a tax on everyone. Not just the rich and with the proceeds issues chits that are redeemable for insurance at a base level. You shop the companies and pay extra if you want more. This system would only cover hospitalization and some doctor visit for important diagnosis.
4. Forget preventive care. It is expensive and studies show it does not work.
5. Make medicare and medicaid pay their share.
6. Make the politicians us the same system.
7. Again get the government out of the hospitals and doctors offices. Decriminalize medicare and medicaid mistakes.

To one responder, nurses are not well trained and not the equivalent of a physician. If your wife thinks this she needs to go the medical school.

Ignorance is Bliss said...

david7134-

Check your sarcasm meter. It appears to be broken.

Dogwood said...

But it would have cost the government less to have diagnosed and treated my dad's high blood pressure than to deal with his kidney failure

But doesn't that assume he would have made annual visits to a family physician, which would be necessary to diagnose the high blood pressure?

My dad didn't start going to a doctor for checkups until he was in his 60s. Healthy, non-smoker, normal weight, etc., etc., he still required emergency bypass surgery when he was 70.

Even if he had gone to the doctor every year for his entire life, those visits would not have prevented a very expensive surgery. Instead, they would have only added to his lifetime health care costs.

I'm 42 and I don't go to the doctor annually, nor would I under any kind of government health plan.

Why would I? I'm healthy, not overweight, don't smoke, don't drink excessively, etc., etc., etc. I have no reason to go.

Early detection only works if people go to the physician on a regular basis and most people don't and won't because it is usually a waste of time and money.

Zachary Paul Sire said...

I don't know who at least half the people here are anyway, so whatever. "Joe"..."Florida"..."Alex"...? These are the new commenters Althouse attract with her incessant anti-Obama posts.

If Obama did something "good" and Althouse approved, would she blog about it? What would happen, in the comments?! The next time Althouse sees something she likes about Obama, I dare her to blog about it and face the mob of commenters. Can she stand the heat? Stay tuned!

david7134 said...

Other thoughts, why do we need the DEA and the War on Drugs. Legalize the stuff and let people treat thenselves or receive advice from the pharmacy. Other countries do this without problems. Why do you need to go to the doctor to get a percocet? If it is to moderate possible addiction then it is not working. As to preventing people from getting what are considered street drugs, this is only creating more hospitalization and a rising hep C and AIDS problem. Let people do what they desire and make it none of the governments business if they want to distroy themselves.

Also, if you want to make medical care cheaper consider fewer doctors, not more. Doctors will do more proceedures and other activity when there numbers are larger in order to maintain a certain income. They are less inclined to do so when the number of patients is high. Fewer doctors would institute a certain rationing, which the government is going to do anyway.

Paul Zrimsek said...

I'm pretty sure the ZPS who's on his high horse about our ugly hatefulness now is the same ZPS who treated us to these thoughtful and civil reflections then:

Obama will not carry a single southern state. The racists and religious nutjobs will be out in full force. And don't even get me started on all the blacks who'll be turned away from the polls due to some kind of registration "error."

Swell prediction, though!

Old Dad said...

ZPS posted:

"I don't know who at least half the people here are anyway, so whatever. "Joe"..."Florida"..."Alex"...?"

I'd be surprised if you knew any poster here--even remotely

Rich said...

edutcher said:

Congress has already over-regulated the insurance companies...

I agree with Dr. Feldman on this one. Thanks to ERISA the insurance companies have been getting away with murder for decades. Following is my WaPo comment to Dr. Feldman's piece:

Dr. Feldman is correct in my view, and indeed understates the case when he says "Private insurance companies escape real regulation." They've been escaping real regulation for decades, thanks to the Employee Retirement Income Security Act (ERISA). ERISA renders any employment-based coverage unduly difficult to enforce in court should that become necessary, which has a malignant effect on the behavior of insurance companies. Judge Judge Chalres W. Pickering, a Bush the Younger nominee to the Fifth Circuit, put it this way while he was a district court judge:

"There has not been a single case that has been filed before this Court by an employee coming into federal court saying, 'I want to protect my pension or my benefits under the broad terms of ERISA.' Every single case brought before this Court has involved insurance companies using ERISA as a shield to prevent employees from having the legal redress and remedies they would have had under long-standing state laws existing before the adoption of ERISA. It is indeed an anomaly that an act passed for the security of the employees should be used almost exclusively to defeat their security and leave them without remedies for fraud and overreaching conduct."

This assuredly needs to be changed, as it renders any employment-based coverage (with the exception of church plans or governmental plans) virtually unenforceable in court. For additional information those interested may wish to refer to my blog:

The Problem is ERISA

miller said...

a. we spend 2x $ as Europe does on health care
b. we are in a health care crisis
c. let's spend ONE TRILLION DOLLARS to fix the problem

So how does "C" follow from A & B?

WV: quisly, as in "Van Jones went all quisly on Obama"

Cedarford said...

The Drill SGT said...
Drill SGT - While I agree with some of those, when I read it this morning, my second thought was that his list was pretty self-serving. Like a wish list from Doctors. I don't see any burden sharing from them in that list. e.g. get the lawyers and insurance companies off our backs, more payments, more grants, more research, more more...

Agree. Asking doctors for their opinion on an "ideal heathcare system" and assigning them complete credibility is like asking a welfare momma or an insurance firm CEO what THEY see as an improved system, on the assumption that they will not also take whatever they can get. (Or trial lawyers).

1. The US heathcare system produces only 40% as many doctors and only 75% as many nurses as our Eurpean and Asian rivals do. As the AMA designed.
2. The European and Asian systems take 2-3 years off the time when they have a serving physician over the near-bankrupt US system. At 20-65% of the cost in real dollars. (Lower university labor costs, starting students in a medical curriculum as undergrads - with many opting out before med school to become nurses, med techs.
3. Advanced nations outside the US have regarded physicians as a critical skill the nation needs and which the State must ensure exist in large numbers. They subsidize med schools to later hold down medical costs. Fill critical niches where supply is less than demand.
4. Certain systems, like the Japanese and German, provide quality at or above the US level, but do it in systems where the doctor is the employee, not the owner...and are incentivized to hold down costs...with bonuses for innovations that maintain good quality or treatment for all, but achieve cost savings. Both systems cost roughly half the US system after vigorous national programs that foster quality and effeciency.
5. Euro and Asian systems do not follow the US system of 8-10 years of higher making doctors Generalists, then 1-3 years of specialty training that discards any use of the 8-10 years of generalist education and work needed to do anything the specialty demands. Specialists also have far lower costs there, and certain specialties "farm out" treatment to nurses, nurse-practitioners, even technicians that do minor surgery & other treatments. In Australia, skin cancer, quite common, is billed as doctor making diagnosis, then a surgical tech, licensed dermatologist tech removing or treating lesions at hourly clinic billing rate, then doctor's fee for followup. The US system is reimbursed piecework..only doctors permitted to do the tasks, wit assistance...and 400 to a few thousand billed for each lesion, with each lesion going to the lab.
Some insurance systems in the US involve the specialty doctor to "consult" on each post-surgery rehab, cardiac checkup, dialysis session, reissue a drug the patient has been taking for 20 years. This of course is from AMA-insurance company collusions.
Not done that way in many countries outside America, or at least not in certain specialties.
6. Outside the hospital and clinic settings most commonly discussed, people forget two huge components of healthcare are nursing homes and homecare costs. Nursing home care in America is immensely more expensive than in other advanced nations, with higher error, infection rates, and patient neglect problems. Homecare expenses foisted on the individual or taxpayer are far higher than in Europe or Asia - not just the premium-priced drugs, but the wheelchairs, porta-potties, oxygen bottle delivery, special needs childrens supplies and assistants, hover-rounds ("I didn't pay a penny out of pocket for upgrading out of a wheelchair" one ad says, "Medicare paid for it all." (3800 dollars)

Cedarford said...

There is lots of reform needed. The Free Market has failed in healthcare. In no small part due to cabals of doctors, Big Pharma, lawyers, educrats, insurers all trying to limit competition and only looking out for their own people's self interest, not the overall interest of The People and the Public Health. We have a 37 trillion unfunded mandate in Medicare alone.
Private health insurance is becoming unaffordable, and business is crippled by trying to be globally competitive when costs of heathcare is built into their otherwise exportable products. Their only current solution, absent reform, is drastically cutting back benefits, setting caps, forcing larger and larger assessment of bills on the private funds of individuals.

Change is desperately needed.

The longer we wait, the more fiscally endangered, even bankrupt we are as a nation, the worse the necessary transition to a national healthcare system will be. And it isn't just "socialists" that see it as essential. Business owners, economists, privately insured individuals, those who wish to maintain Free Trade - see the writing on the Wall.

Maguro said...

I just scrolled through the comments on most of the posts here on the front page of Althouse, and this has turned into a truly ugly, hateful blog.

Shocking, isn't it, to see intemperate arguments in blog comments saection, of all places.

Maybe you were expecting David Gergen and Ellen Goodman to be here discussing Obama in hushed, reverential tones?

By the way, your little "Sorry you all can't control your your birthers and your racists" rant from the last thread was kinda unfriendly too, so you might want to think twice before casting that stone.

Ignorance is Bliss said...

ZPS said

I just scrolled through the comments on most of the posts here on the front page of Althouse, and this has turned into a truly ugly, hateful blog. The posts encourage/taunt the commenters, the commenters then encourage/taunt each other, and all you're left with are feelings of anger, bitterness, and cruelty.


Well, I'm glad to see you take such a strong, consistant stand against taunting those with different views from your own.

david7134 said...

Many of the people making comments seem to be ignorant of some aspects of physicians thoughts and their politcal spectrum.

The AMA represents only about 30% of American physicians. Of that 30%, the majority do not support most of the ideas or goals of the AMA. For instance, the AMA has been pushing the concept of socialized medicine for about 100 years. I know a number of politician who favor the ideas presented by physicians. None of these have received money from the AMA. Most politicians received donations from individuals doctors or their local medical societies. There really is not a good organization that supports the political agenda of doctors as a whole. When we get socialized medicine, that will be one thing that will change and a union will likely be created, then you have trouble.

Despite the fact that doctors seem to bring in a good yearly income, their individual payments have been under attack for about 20 years and payments are actually about 40% of what they were in the 80's. This varies according to speciality. When the union is fromed this will change and thus the cost of medicine will go higher. One of the reasons for the higher incomes is the fact that doctors generally work 24/7. This results in higher incomes despite the lower reimbursment.

I do know first hand that the politicians respond to money in forming policy. I know that it cost about $10,000 per representative here in Louisiana to get a favorable knod on a bill. Unfortunately our politicians do not stay bought and the price can go up. The point is that in the end it is the one with the most political dollars that will win this debate. I socialized medicine comes into being then it will be important to maintain these contributions to improve ones reimbursment. That is the nature of our system and why I feel it best to get the government out.

miller said...

I of course favor the federal government getting the power to set doctors' reimbursements and salaries, and find it especially delicious that doctors will get more tightly regulated in their reimbursements and decisions, but their exposure to lawsuits will not in any way be reduced.

Those doctors, thinking they were so smart and going into a lucrative practice. Don't they know they're just chumps--the government is the boss, and it's about time these lowlife scum who charge money for services get to understand this.

I sure hope those in med school don't wise up too fast--we'll need lots of doctors who pay big bucks for schooling so they can live by government restrictions.

WV: stingle, as in "Those Mets make a stingle go up my leg -- Chrissy Matthews."

former law student said...

Those doctors, thinking they were so smart and going into a lucrative practice. Don't they know they're just chumps--the government is the boss, and it's about time these lowlife scum who charge money for services get to understand this.

Lucrative practice? Haven't the comments been about how malpractice insurance takes all the profit out of practice, not to mention inadequate reimbursement by Medicare and other government agencies?

Moreover, right now your physicians' reimbursements are set by insurance company functionaries whose bonus and promotions come from their ability to make money for their employer. I've mentioned my friend's girlfriend the RN, whose job is to reject treatment plans. After being the humble maidservant of MDs for so long, she loves to stick it in the eye of some bill-padding doctor.

david7134 said...

Cedaford,
Some of your points are good, expecially with respect to home health services and old folks homes. But you miss the point on education. I have known several doctors that went almost straight into a six year medical school out of high school. They are some of the worst. None of them seem to have matured and they have little fullness to their education and life. The 3 to 4 years of college is a vetting process and really is necessary. In addition, all doctors need education as a generalist first. That is because we check each others work and do offer critical analysis. Patient's have a bad tendency to have numberous problems and the diagnosis is rarely straight forward and often crosses several specialities.

Comparing the US system to Europe and Asia is poor. When we get these doctors here, it is necessary to almost retrain them.

Big Mike said...

After being the humble maidservant of MDs for so long, she loves to stick it in the eye of some bill-padding doctor.

So your friend's girlfriend lets patients die so that she can "get even" with MDs?

former law student said...

lets patients die

Make a note that Big Mike is estopped from arguing that doctors perform unnecessary tests and procedures.

Comparing the US system to Europe and Asia is poor. When we get these doctors here, it is necessary to almost retrain them.

To what purpose? Do American bodies work differently from Asian and European ones? Hint: if European countries deliver health care more effectively than we do, maybe we should send our candidates overseas for training.

blake said...

lol @ fls

Maguro said...

To what purpose? Do American bodies work differently from Asian and European ones? Hint: if European countries deliver health care more effectively than we do, maybe we should send our candidates overseas for training.

Hint: Europeans and Asians live healthier lifestyles than Americans. Therefore we don't know if "European countries deliver health care more effectively than we do".

Paddy O. said...

ZPS, I'm not sure the tone has changed that much. Althouse has never been entirely consistent, and like SNL has its good seasons and worse seasons of commenters.

The trouble is, I think, there was the recent exodus of a number of particularly unique commenters who added different contributions to the usual topics.

But there still are people who comment with interesting expertise, and who make for interesting conversation. Some people, I think, haven't quite yet found the tone Althouse comments represent--and a number of the former "tutors" have wandered away.

Plus, some of the new names aren't necessarily new people. Script changes and character re-assigning has taken place. Though I'm not quite sure who is who.

Pogo said...

Government control of health care, whether by the current plan or the Hail Mary Obama is supposed to throw, depends entirely on price controls for it's "success" in reducing health casre costs. That is, the government sets the fees for everything it can.

But this neglects the fact that price controls inevitably fail.

1. Price controls cause shortages.

2. The government cannot control the prices of land, rents, mortgages, energy, staff, food, legal input, and equipment that a health system uses (unless it becomes totalitarian), and these costs must be paid. How?

3. Quality is reduced, by reduced time with the doctor, reduced training for those seeing you, reduced building and equipmwent maintenance and upgrades, and requiring multiple visits to solve one problem.

4. Queues will arise. The waits in the UK and Canada are enormous. get used to it.

5. Some hospitals and clinics will go out of business. File that under shortages, but also file it under 'reduced quality of life', when some people must now travel greater distances to see a doctor.

6. Because excellent care and 5-star service is paid at the same rate as crappy care and rude service, why provide excellent care? Why provide service that goes the extra mile? ask yourself: If otel room fees were fixed by the feds at $60 a night to make hotel rooms "more affordable", what kind of rooms do you think would be available in 5 or 10 years? Think Thrifty Scot motels, everywhere and only.

7. One major consequence of price controls is that in Canada and other countries employing them, they do not create nearly as many of the new life-saving pharmaceutical drugs as the United States.

Thomas Sowell said, "Costs don't go away because you refuse to pay them", and price controls are an attempt to refuse.

There is a 40 century history of attempts at price controls and their repeated failures. Among these historical consequences are national decline and economic collapse. Most people who advocate price controls are as unaware of this economic law of gravity, and we are thus fated to relearn its nasty consequences once again.

Old Dad said...

The Definitive Argument Against the Public Option:

Human beings tend to selfishness and laziness, except in their own interest.

vw: tonicsi--a gin drink south of the border.

david7134 said...

law student,
All human bodies work the same, but doctors in different countries don't. I don't know where other countries come up with the stats regarding there health care but I can assure you the most of the doctors from other countries are as dumb as dirt. That is what you get when you have people working at the pay scale of other countries. There is an old saying. You get what you pay for. About the only physicians that are half way decent are Indians, but that depends on the region they come from and the schools they attend. It varies considerably.

As to the necessity for a fix. I don't understand what the big rush is about. The cost to you is the result of the government not paying for medicare and medicaid and the price being passed on. Whether you know it or not the government has been preventing doctors and hospitals from increasing prices. This coupled with insurance pratices facilitated by government policy has resulted in a significant decrease in payments to physicians and hospitals.

The result is that if you go to the hospital without insurance and spend a week with a major operation, look to pay out of your pocket about $70,000 to $100,000. I know because that happened to me. But I had an insurance with a contract with the hospital and I paid $1000 and the insurance company paid $15,000 and that was it. I did not owe anything else.If I had been under medicare, they would have paid $5000 at best. So if you don't have insurance then you might have a problem. But remember this, in the entire 40 years I have spent in medicine I have never seen a doctor or hospital take someone to court over a charge. If they go broke (as our country is doing now), it is because they can't earn a living and did not put money back for emergencies which is 90% of the people in the US.

knox said...

Zach's just not used to being on the defensive against a lot of unhappy people.

Zach, that's the price you pay when your guy won. And I still don't understand how you can be so disgusted, with full knowledge of the horrendous things you used to say about Palin. Your outrage rings false.

Just Lurking said...

Let's watch as the left attempts to redefine political opposition to Obama, as hate speech. Exhibit one:

"I just scrolled through the comments on most of the posts here on the front page of Althouse, and this has turned into a truly ugly, hateful blog. The posts encourage/taunt the commenters, the commenters then encourage/taunt each other, and all you're left with are feelings of anger, bitterness, and cruelty."

Imagine- a blog fostering dissent! How unpleasant. In Obama nation dissent is verbotin because it makes people sad.

"Not a good experience."

You guys won, remember? The opposition gets to throw the shoes now.

Get used to ducking.

Big Mike said...

Make a note that Big Mike is estopped from arguing that doctors perform unnecessary tests and procedures.

Actually, FLS, the doctors always perform tests that are necessary. The question is whether the tests are medically necessary or necessary merely to stave off potential lawsuits from ambulance-chasing shysters such as John Edwards, and no doubt yourself.

As for your friend's girlfriend, perhaps she's the person who gives my doctor so much grief over his prescription of Diovan for my blood pressure instead of the preferred medicine -- the mere fact that I have an allergic reaction to the preferred medicine notwithstanding.

At any rate, the argument over whether your friend's girlfriend is qualified to substitute her judgment for my internist's judgment is orthogonal to the question of whether tests are necessary or not. Can we stipulate that she is a worthless POS and press onwards?

Alex said...

The elephant in the room that Republicans don't want to deal with are people who go bankrupt due to a medical bill. Until that issue is fully engaged by the GOP, the voters will not put them back in power.

Pogo said...

Alex/Titus, that 'fact' has been proven to be complete bullshit.

AJ Lynch said...

ZPS said:

"If Obama did something "good"...."

Stop it Zach, that made me laugh so hard, I almost fell off my chair!

AJ Lynch said...

Yeah, one of Obama's czars, Elizabeth Warren and a colleague hasve put out several msleading "studies" that falsely claim medical bills cause half of all bankruptcies.

That is total bullshit but it suits Warren's worldview that businesses are big bad wolves. It then feeds the Dems incorrect talking points health care reform.

Alex said...

Pogo - why are you implying I'm a Titus duplicate account? You've seen me posting at the same time as Titus before so it's an impossibility.

On to medical bankruptcies, an awful lots of websites seem to think it's a real problem. How much of a political problem, I'm not sure. But it's so easy for a liberal to simply bring it up and conservatives never have an answer. It's a debate killer.

Alex said...

It matters little about what actual % of medical bankrupties there are. Even if it's far less then the lefty blogs are pushing, enough other people will feel that something has to be done about it in the name of compassion. Then the Democrats roll out the compassion-card and what is the GOP left with? Nothing.

AJ Lynch said...

Alex, read this link:
http://meganmcardle.theatlantic.com/archives/2009/06/elizabeth_warren_and_the_terri.php

Now you have an argument for all those Koolaid drinking Dems you debate. If they don't beleve it, tell the dumb bastards to fuck off.

Zachary Paul Sire said...

And I still don't understand how you can be so disgusted, with full knowledge of the horrendous things you used to say about Palin.


I don't know of anything horrendous I said. If I did, remind me, and I'll own up to it. I have joked about her and vehemently called her out for being a liar, so if that's "horrendous," you win.

I'd be happy if one of the raging Obama haters here would admit that they are acting just as insane as the Bush haters did on this very same blog, and elsewhere. I haven't seen anyone do that nor have I seen any of the old school, rational commenters here call these people out, not that it's anyone's job. Still, the hypocrisy is outrageous, if not amusing.

Pogo said...

Jeebus, Zach, you have no shame (or memory), do you?

Dr Weevil said...

david7134 begins a comment "As a caridologist with 40 years experience". That's a cool profession. I didn't realize that there are people who make a living studying shrimp and prawns, and that there's a properly-formed neo-Greek word for it.

WV: parmic, what ignorant people say when they mean Parmesan, 'of or pertaining to the city of Parma'.

JAL said...

former law student said...
The same exact policy from the same exact company was more than twice as much (to the tune of >$1000) if her home residence state was different. Like 40 miles different ...)
Is the cheaper state more rural than the more expensive one? Does the cheaper state have pain and suffering limits? Anything obviously different between the two?
============
TN & NC
Don't know about p & s limits. The questions just wanted to know state she would be in school and state where she resided.

If she was in school in TN and her state of residence was TN it would cost >$1000 than if she was in school in TN and her legal residence was NC.

Maybe because of TennCare? I have no idea.

wv = sumell
This sure sumells funny.

Alex said...

Of course Zachary is shameless liar. Like all lefties.

Alex said...

AJ - from that same link many comments seem to dismiss McArdle's claim that the study is flawed. Read the comments.

Cedarford said...

David7134 - I have known several doctors that went almost straight into a six year medical school out of high school. They are some of the worst... The 3 to 4 years of college is a vetting process and really is necessary. In addition, all doctors need education as a generalist first.

David, I am not a physician, but in several other industries I have been involved in, and the military - I have seen processes that look like they require a good less training and quals than their present workforce participants claim it requires. Generally, in transformation after transformation, that process generally goes with the "less qualified" as long as skills and knowledge previously residing in one individual are made collective. Easier now with near-instantaneous data transmission....with higher qualified people kept in reserve for the "more difficult challenges" by face-to-face or long distance consultation.

Always, the present workforce is against "lowering standards" even though the general effect is lowered costs, no more mistakes, no dimunition in capacity after transformation.

Why are some "medical MD specialities" done just as well in other nations by a 4-year college grad? Or replaced by a nurse anethesiologist or practitioner?

Think of helicopter pilots. At one time the core of helo pilots insisted that only 4 year college grads with engineering degrees could even THINK about ever flying such a craft. Then the military had a pilot shortage. All of a sudden, you had the military "magically" finding a way to pare out all the superfluous crap of what was a 6-year program down to an 18-month process.

Why do we have gastroenteroligists banging out 9-11 colonoscopies a day when such a common procedure could be done by a nurse and a surgical assistant that calls the G-I guy in when it spins out of the routine?
Why are urologists consulted on PSA when the protocols for treatment are now computerized standards?
Why do internists have to see a wino with a headache and send them to an MRI after an RN is assigned to see if they continue to insist on seeing "dat real doctor..??"

ANS: Loans and bills to pay, revenue to keep confortable...And not letting just anyone into lucrative practice...And with winos, knowing that Medicare will cover an MRI to verify the wino is just hung over.
Heathcare can also benefit from a complete re-evaluation of what is needed to do the job, and from a subsidized educational system that starts critical persons off with little or no college debt to pay off, rather than 100s of thousands. that help drive high fees and doctor's insistance that they are involved in low-skill processes for a "cut" of each.

I know what you are saying about having the ability to know as an individual 1,000 different patient complications in any specialty...and how can a doctor review another with 12 years of generalist and specialty training when they only have 5-6 years..

But....other countries manage this.

And technology is making it even easier to differentiate the healthcare workforce into people that can do 100 tasks that are 90% of the procedures a hospital or ER deals with, or 95% of what a specialty clinic sees. You have ability to send data to a real expert for unusual complications, sort out drug interaction risk with certain patients, and spit out 8 symptoms that have to be closely watched for, while a doctor who remembers only 80% of what he or she was taught may be looking for 5 of those symptoms off the top of their head.

Much of what people HAVE to learn in a curriculum is vestigal.
One rationale for once requiring military helo pilots to be eng graduates was that the older models might need manual navigation, ability to use a sliderule, do calc formulae to assist in attack profiles to fire "dumb" ordnance.

Penny said...

Years ago, I served on an ad hoc task force that brought together business leaders, hospital administrators and state health officials to see what could be done to help reduce health care costs.

The most stunning takeaway for those of us representing business was the total lack of metrics and basic business sense on the part of administrators.

I'll just give one example. Nursing shortages were a pressing problem. The administrators didn't know their nursing turnover rates, attendance rates or where nurses were going when they left, or why they were leaving. There was no thought given to job redesign, so that lower level duties could be given to less skilled workers. No one had thought to partner with local education providers to pump up the pipeline. Literally, they were doing only one thing - dramatically pumping up the wages, and passing that cost along.

Jumping forward in time, think about imposed Medicare payment limits. The answer was to do what has always been done - pass along the costs to private insurers who in turn pass it along to us.

And now they think the answer is universal healthcare, because that broadens the pool for passing along the costs. This is just plain bull crap. WE NEED MORE COMPETITION. If you can't manage creatively, then somebody else can.

Pogo said...

Alex, the study has been refuted a number of times. You and other leftists don't give a damn whether it's true or not, but it fits your narrative and it's useful even if entirely false. You are after power, and that's the entirety of it

Alex said...

Pogo - I'm not a leftist, just a political realist. I know the Democrat are going to make a full court press with the medical bankruptcy issue this fall.

chickenlittle said...

The simplest "big government" healthcare solution would be to subsidize tuition for doctors and nurses ala post Sputnik funding of science education. This would lead, as it did for science, to a glut of very good talented practitioners, who would work just as hard.

In the long run, the thing to watch would be a good people leaving the eventual glut (as they did science careers). Also, such a scheme would have to be coupled with tort reform--as if that will ever happen.

Joe said...

Wow, I'm a new commentator. Funny math since I've been commenting here for about four times longer than the fellow making that declaration. Then again, his memory doesn't go back for more than six months, so I guess everything is new to him. Must be fun.

AJ Lynch said...

Alex:

Well, do you own research if it is so important to you.

And don't tell me to read the comments... I am certain they are Axelrod's astroturfers posting bullshit.

Pogo said...

" a full court press with the medical bankruptcy issue this fall."

So what?
You're telling me Obama and the Democrats will get up and lie to the public.
Shock!
Surprise!

And people will believe it??!?
Yup.

The MSM will push a bullshit meme and sway the public, you say?
Hell, it got a President elected, why the hell not?

People are chumps, generally.

daubiere said...

Here you can read all of the nice things zachary paul sire has had to say here on althouse haha

link

"Someone on my blog commented that the next names in the Palin family should be "Trailer" and "Trash."

"It will be fun to watch Palin get dragged through the mud and humiliated all over again, and then lose all over again, for a second time. I say this only because she obviously and willfully is putting herself in this position. Have fun, lady."

"Sarah's experience lobbying for $420,000 to put in a new shit tank in Wasilla, now the meth capital of Alaska, is definitely the change that Washington needs."

and lots more!!

Florida said...

Zachary Paul Sire,

And friend.

http://2.bp.blogspot.com/_zZHT_alTccg/SlqUooYTDyI/AAAAAAAACM8/mQ-wHhcnzcQ/s400/julie.jpg

bagoh20 said...

I believe the most improvement in all areas would come from simply increasing the supply. More doctors, more nurses, more insurance companies, more hospitals, more competition.

To get there you cut the things that prevent this: taxes, regulation, litigation. Well targeted incentives and regulation primarily designed to guarantee increased competition would do nearly all of what's needed while creating a miracle machine from a free market unleashed on saving lives. A captive market (life on earth) and a guaranteed demand for an endless variety of medicines, machines and methods along with the people to deliver them. This would not cost much except political capital.

kentuckyliz said...

Medical BK is
not a problem! It's a compassionate solution.

Why? Health insurance doesn't keep you healthy, it prevents against financial losses. Those who go without health insurance have nothing to lose or are gambling.

So if you lose that bet, get the health care you need, then declare BK.

There is no medical BK without actual health care provided! Get it? They got their care!

The solution is to help people recognize when they DO have something to lose--and let them get at least a catastrophic care policy for covering just the devastating big price tag stuff. Health insurance gets expensive when state legislators start mandating specific coverages like chiropractic and boner drugs and tattoo removal, out of a misguided sense of compassion.

I think 125 plans should be able to carry forward and accumulate balances like HSAs can. It's like the gummint doesn't actually want us to accumulate the resources to pay for the expensive bumps in the road that life brings.

If end of life care is the problem, there should be an IRA product with lifelong investment growth to pay for it.

Duh.

Mark said...

#6."We have to streamline drug development and shake up the Food and Drug Administration". But do you know the Food and Drug Administration has issued two new rules, "first clarifying how patients can receive drugs in development outside of a clinical trial, and secondly setting standards for when drug companies or researchers can charge for the treatments."

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OhioAnne said...

Whether you like or dislike his suggestions, there has been more debate on the merits of these suggestions than I have seen in Congress on the health care option they wanted to pass.

badrita73 said...

Face it, people! The griping coming from the GOP about Obama's haelthcare plan is its lack of TORT REFORM.
I have been on both sides of the bed, as a Floor Nurse, Paralegal Nurse Consultant,and as a three-time transplant recipient.I recall how, in the mid-70's, the Ohio General Assembly, run by the GOP, attempted to place monetary caps on malpractice awards when injuries were caused by medical malpractice and product liability. States like FLA already have a $100.00.00 cap; what will that take care of? Certainly not enough $$ to take care of housing renovations, therapy, & doctors' visits.
If everyone involved in healthcare decisions did their jobs more conscientiously & communicated more efficiently, we would have no need for a punitive legal system.
I believe the reformed healthcare system should provide a database that would allow health consumers to be more knowledgable about the medical professionals taking care of them, such as professional affiliations, continuing education, & previous disciplinary actions. Ohio has that database that applies to nurses, but physicians' databases open to the public are non-existent. We should also be able to access information on the insurance companies that will provide a "public option," such as salaries & $$$ spent on their communities in which they do business.

Thomas said...

Whatever happened to the 10th Amendment?
I guess it must have expired.
But don't tell Arizona, they are proposing a state amendment to nullify Washington's attempt to impose Healthcare on them.

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