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Post by webrunner on Jul 22, 2009 5:52:31 GMT -7
support is indeed waning because people see the holes in this promise for "change" Web, and because they realize that in order to maintain their credibility and stand behind these and other promises, politicians are willing and able to adopt the same (or similar) misleading spin in order to market "change" while they enact legislation that is still friendly to the idea of profit-centered care packages see, in order to maintain the illusion of fairness, you have to denigrate that evil "socialism" by employing the idea that we are all the "same". Nobody wants to be "the same" or "equal"....not here we want what we're entitled to and what we have "earned", right? I mean, you make a good living and have coverage, right? You have worked for that, you went to school and earned your degree. There is little that compares you to, say for example, a maid, whose education is limited. Granted, she works too, but really now, is that really enough for her to be considered "the same" with the likes of you, and mid-level managment, whose toilets she scrubs? That is not the way our capitalist and class-based society is structured. Now, with that off my chest: the notion is a very "capitalist" one, if you ask me. If you take away the hold that third party payers have on politics and the entire health care industry by providing alternatives, including a government model for reimbursment, making it competitive, forcing them to earn what they believe is their very own piece of the pie...they are not going to like this challenge it forces them to actually work to compete in an industry they have dominated for decades. It forces through the model of choice for consumers, some of whom would presumably "choose" to give their money to someone else. This means less money for that particular industry. How do we avoid this? Well, for starters, we ensure "stability" of the market by making sure politicians vote the way they "should". We ensure that whatever legislation they enact has a minimized negative effect on our hold in this market. I'm sure there are politicians out there that are less beholden to special interests, somewhere...but I suspect there aren't enough to ensure that real change takes place. Because nobody out there can stomach the notion that health care shouldn't be a commodity for sale. To do so would be un-American, a communist notion. And we are not Commies. Well I'm not, anyway. ;D Rosa, you make assumptions about the way I see folks that are inaccurate.
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rosa
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Post by rosa on Jul 22, 2009 5:53:59 GMT -7
I'll add one other thing: if you were to go to your practitioner and tell him or her that he she must learn to live on merit-based salaries, what do you think the response would be? Why, the mere notion of challenging the status of a doctor.....
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Post by webrunner on Jul 22, 2009 6:02:17 GMT -7
I'll add one other thing: if you were to go to your practitioner and tell him or her that he she must learn to live on merit-based salaries, what do you think the response would be? Why, the mere notion of challenging the status of a doctor..... How is it doctors' incomes are not merit based now? I don't visit doctors I hear bad things about or that I've had a bad experience with. You're just not a big fan of doctors or capitalists are you? Call me crazy.
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Post by Tim Collins on Jul 22, 2009 6:22:13 GMT -7
I'll add one other thing: if you were to go to your practitioner and tell him or her that he she must learn to live on merit-based salaries, what do you think the response would be? Why, the mere notion of challenging the status of a doctor..... How is it doctors' incomes are not merit based now? I don't visit doctors I hear bad things about or that I've had a bad experience with. You're just not a big fan of doctors or capitalists are you? Call me crazy. When it comes to reimbursements they are merit based. The smart ones figure out which procedures merit the biggest reimbursement, or a series of little treatments to add on to increase reimbursement - then they get more. See they know the merit of additional charges ;D
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rosa
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Post by rosa on Jul 22, 2009 6:24:42 GMT -7
yeah, that must be it. I am anti-capitalist, and I don't want my doctor to bill me the hundreds of dollars he does for having spent less that 15 minutes with me, while reviewing my chart actually Web, I have always been a rather good "consumer" for my health care....my nurse practitioner at Planned Parenthood taught me how to do this so I do things to advocate for myself whenever I have to see my doctors, and even then, since I am no model of perfection, I forget things. But any doctor who has ever blown me off has never seen me again....and part of this is largely due to the expectation that he/she has had--one of having "earned" the hundreds later billed for that fifteen (or less) minutes of their valuable time see, I am one of those obnoxious people who considers my time to be of value as well how do many not earn the "merit" for which they are rewarded? I just illustrated one way. Not all doctors are created equal, some are good, others are great and others are pretty comparable to Frank Burns in the old M*A*S*H tv series. Whom would you rather end up seeing? I can gurantee you that those who have earned their higher pay aren't paid on salary, less so those in specialties, and that the insurance industry can facilitate the artificial inflaction in cost here, just as can other elements that are built into the way our health care system currently functions are you not one who is comfortable with the notion of paying for what you get? SO, comparably speaking, given the training, education and experience that a GP after say, five years of practice, what are YOU willing to pay for? Should that be merit-based? I can tell you what that doctor will argue and what in any of my arguments against worshipping doctors would lead you to the impression that I do not like them? I have doctors of my own, whom I happen to like, because I have seen to it that they have earned not only my trust but my business, such that when I was not insured, or if my plan didn't cover them, I saw them out of pocket prove I don't like doctors, or the idea of earning a living or a profit, Webrunner
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Post by rosa on Jul 22, 2009 6:26:00 GMT -7
How is it doctors' incomes are not merit based now? I don't visit doctors I hear bad things about or that I've had a bad experience with. You're just not a big fan of doctors or capitalists are you? Call me crazy. When it comes to reimbursements they are merit based. The smart ones figure out which procedures merit the biggest reimbursement, or a series of little treatments to add on to increase reimbursement - then they get more. See they know the merit of additional charges ;D when it comes to reimbursments, they can also be market-based; see? They know the merit of additional charges
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Post by webrunner on Jul 22, 2009 6:26:54 GMT -7
Webrunner, you are one for calling this administration on half-truths and outright lies, and you're to be commended for that. Now, my challenge is: take it all the way and show us where there is a model out there that suits itself to the needs of the growing numbers of un/underinsured Further, none of the proposed models that I have seen have any reliable degree of oversight which would hold the third party or government-based systems accountable to instances of mismanagement, waste or outright fraud. All this administration is doing is repackaging existing models in the hopes of selling the IDEA of change, rather than doing what it said it would. Even then, you would have to spoon-feed fiscal responsibility and equality to those who worship the bottom line. And even then, these are but mere notions, and there isn't one politician out there that doesn't already know this. Thanks for the commendation but the trouble with undertaking your challenge to me is that I'm not convinced, given what I've read and seen, that our health care system needs any kind of overhaul. Is it perfect? Heck no, no human run endeavor will ever be, but neither would a govt. run system be perfect. It would be worse for everyone. See, all those dire warnings we're getting from Canada and the UK (hell, Massachusetts for that matter) that you disregard, I cannot. I do agree with you though. Obama's trying to implement huge changes in small doses.
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Post by rosa on Jul 22, 2009 6:33:43 GMT -7
this is funny: I have a chronic condition for which a specialist comes highly recommended, by my insurer. Last year, I got pretty sick and finally follwed to the referral to the specialist, hoping something could be done
yep, something was done. He ordered various additional tests to r/o this or that, as my GP had done, he offered absolutely NO difference in range of services, delivery or time than had my GP, and, as I complained to my husband: he patronized me. THen he charged two and a half-times the rate my GP did, and confirmed the original diagnosis, after having spent approximately ten minutes with me, while simultaneously reviewing my very detailed chart and history
but he billed my insurer, who then highly recommended that I continue seeing him, recommending his specialized care over that of the attention and expertise (which he relied fully upon in order to confirm my original diagnosis;) ) over the more detailed treatment planning, attention and service delivery of my GP
tell me Web, who "earned" my time and the money? And guess whose hen-pecking I religiously avoid, once a month, along with the highly touted recommendations to see the specialist? Who are these individuals serving? Me?
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Post by rosa on Jul 22, 2009 6:35:42 GMT -7
Webrunner, you are one for calling this administration on half-truths and outright lies, and you're to be commended for that. Now, my challenge is: take it all the way and show us where there is a model out there that suits itself to the needs of the growing numbers of un/underinsured Further, none of the proposed models that I have seen have any reliable degree of oversight which would hold the third party or government-based systems accountable to instances of mismanagement, waste or outright fraud. All this administration is doing is repackaging existing models in the hopes of selling the IDEA of change, rather than doing what it said it would. Even then, you would have to spoon-feed fiscal responsibility and equality to those who worship the bottom line. And even then, these are but mere notions, and there isn't one politician out there that doesn't already know this. Thanks for the commendation but the trouble with undertaking your challenge to me is that I'm not convinced, given what I've read and seen, that our health care system needs any kind of overhaul. Is it perfect? Heck no, no human run endeavor will ever be, but neither would a govt. run system be perfect. It would be worse for everyone. See, all those dire warnings we're getting from Canada and the UK (hell, Massachusetts for that matter) that you disregard, I cannot. I do agree with you though. Obama's trying to implement huge changes in small doses. I am not disregarding those dire warnings. I am not trying to convince you of anything, either. I am arguing that what we have now is as much a false bill of goods predicated on the notion of "earned" profit, which is to me, at many times, a lie and it's a lie I do not support
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Post by webrunner on Jul 22, 2009 6:50:38 GMT -7
yeah, that must be it. I am anti-capitalist, and I don't want my doctor to bill me the hundreds of dollars he does for having spent less that 15 minutes with me, while reviewing my chart actually Web, I have always been a rather good "consumer" for my health care....my nurse practitioner at Planned Parenthood taught me how to do this so I do things to advocate for myself whenever I have to see my doctors, and even then, since I am no model of perfection, I forget things. But any doctor who has ever blown me off has never seen me again....and part of this is largely due to the expectation that he/she has had--one of having "earned" the hundreds later billed for that fifteen (or less) minutes of their valuable time see, I am one of those obnoxious people who considers my time to be of value as well how do many not earn the "merit" for which they are rewarded? I just illustrated one way. Not all doctors are created equal, some are good, others are great and others are pretty comparable to Frank Burns in the old M*A*S*H tv series. Whom would you rather end up seeing? I can gurantee you that those who have earned their higher pay aren't paid on salary, less so those in specialties, and that the insurance industry can facilitate the artificial inflaction in cost here, just as can other elements that are built into the way our health care system currently functions are you not one who is comfortable with the notion of paying for what you get? SO, comparably speaking, given the training, education and experience that a GP after say, five years of practice, what are YOU willing to pay for? Should that be merit-based? I can tell you what that doctor will argue and what in any of my arguments against worshipping doctors would lead you to the impression that I do not like them? I have doctors of my own, whom I happen to like, because I have seen to it that they have earned not only my trust but my business, such that when I was not insured, or if my plan didn't cover them, I saw them out of pocket prove I don't like doctors, or the idea of earning a living or a profit, Webrunner Prove it? Sometimes things speak for themselves. I'm saying this in all sincerity and only as an attempt at an answer, but I have never seen you suggest that the notion of "profit", no matter the context, is anything other than, well...evil.
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Post by Tim Collins on Jul 22, 2009 6:50:56 GMT -7
www.nytimes.com/2009/07/22/business/economy/22leonhardt.html?_r=1July 22, 2009 Economic SceneChallenge to Health Bill: Selling Reform By DAVID LEONHARDT WASHINGTON — What’s in it for me? On the subject of health care reform, most Americans probably don’t have a good answer to the question. And that, obviously, is a problem for the White House and for Democratic leaders in Congress. Current bills would expand the number of insured — but 90 percent of voters already have insurance. Congressional leaders say the bills would cut costs. But experts are dubious. Instead, they point out that covering the uninsured would cost billions. So the typical person watching from afar is left to wonder: What will this project mean for me, besides possibly higher taxes? Barack Obama was able to rise from the Illinois State Senate to the presidency in large measure because of his ability to explain complex issues and then to make a persuasive argument. He now has a challenge worthy of his skills. Our health care system is engineered, deliberately or not, to resist change. The people who pay for it — you and I — often don’t realize that they’re paying for it. Money comes out of our paychecks, in withheld taxes and insurance premiums, before we ever see it. It then flows to doctors, hospitals and drug makers without our realizing that it was our money to begin with. The doctors, hospitals and drug makers use the money to treat us, and we of course do see those treatments. If anything, we want more of them. They are supposed to make us healthy, and they appear to be free. What’s not to like? The immediate task facing Mr. Obama — in his news conference on Wednesday night and beyond — is to explain that the health care system doesn’t really work the way it seems to. He won’t be able to put it in such blunt terms. But he will need to explain how a typical household, one that has insurance and thinks it always will, is being harmed. The United States now devotes one-sixth of its economy to medicine. Divvy that up, and health care will cost the typical household roughly $15,000 this year, including the often-invisible contributions by employers. That is almost twice as much as two decades ago (adjusting for inflation). It’s about $6,500 more than in other rich countries, on average. We may not be aware of this stealth $6,500 health care tax, but if you take a moment to think, it makes sense. Over the last 20 years, health costs have soared, and incomes have grown painfully slowly. The two trends are directly connected: employers had to spend more money on benefits, leaving less for raises. In exchange for the $6,500 tax, we receive many things. We get cutting-edge research and heroic surgeries. But we also get fabulous amounts of waste — bureaucratic and medical. One thing we don’t get is better health than other rich countries, whether it’s Canada, France, Japan or many others. In some categories, like emergency room care, this country seems to do better. In others, like chronic-disease care, it seems to do worse. “The fact that we spend all this money and don’t have better outcomes than other countries is a sign of how poorly we’re doing,” says Dr. Alan Garber of Stanford University. “We should be doing way better.” So far, no one has grabbed the mantle as the defender of the typical household — the opponent of spending that creates profits for drug companies and hospitals at no benefit to people’s health and at significant cost to their finances. Republicans have actually come out against doing research into which procedures improve health. Blue Dog Democrats oppose wasteful spending but until recently have not been specific. Liberals rely on the wishful idea — yet to be supported by evidence — that more preventive care will reduce spending. The American Medical Association, not surprisingly, endorses this notion of doing more care in the name of less care. Mr. Obama says many of the right things. Yet the White House has not yet shown that it’s willing to fight the necessary fights. Remember: the $6,500 tax benefits someone. And that someone has a lobbyist. The lobbyist even has an argument about how he is acting in your interest. These lobbyists, who include big names like Dick Armey and Richard Gephardt, have succeeded in persuading Congress to write bills with a rather clever feature. They include some of the ideas that would cut costs — but defang them. One proposal would pay doctors based on the quality of care, rather than quantity, but it’s a pilot project. Doctors who already provide good care may well opt in; doctors providing wasteful but lucrative care surely will not. The bills would also finance research on which treatments are effective. But Medicare officials would not be prevented from continuing to spend taxpayer money on ineffective treatments. In reaction, some people who should be natural supporters of reform have become critics. The Mayo Clinic — one of Mr. Obama’s favorite models of care — says the legislation fails to “help create higher-quality, more affordable health care.” On Thursday, Mr. Obama will visit another example he likes to cite, the Cleveland Clinic. Its successes capture what real reform would look like. Like Mayo, the Cleveland Clinic pays its doctors a salary, rather than piecemeal, and delivers excellent results for relatively little money. “I came here 30-some years ago,” Delos Cosgrove, a heart surgeon who is the clinic’s chief executive, told me. “And I have never received any additional pay for anything I did. It never made a difference if I did five heart operations or four — I got paid the same amount of money. So I had no incentive to do any extra tests or anything.” This is the crux of the issue, economists say: the current fee-for-service system needs to be remade. The administration has made some progress, by proposing a powerful new Medicare overseer who could force the program to pay for good results and stop paying for bad ones. But even a strong Medicare plan won’t be enough. Reform will need to attack the piecemeal system in numerous ways. Among the most promising, which Mr. Obama has resisted, is a limit on tax subsidies for the costliest health insurance plans. This limit would give households and employers a reason to become smarter shoppers. Above all, reform can’t revolve around politely asking the rest of the medical system to become more like the Cleveland Clinic. In recent weeks, polls have shown that a solid majority of Americans support the stated goals of health reform. Most want the uninsured to be covered and want the option of a government-run insurance plan. Yet the polls also show that people are worried about the package emerging from Congress. Maybe they have a point.
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Post by webrunner on Jul 22, 2009 6:57:17 GMT -7
Thanks for the commendation but the trouble with undertaking your challenge to me is that I'm not convinced, given what I've read and seen, that our health care system needs any kind of overhaul. Is it perfect? Heck no, no human run endeavor will ever be, but neither would a govt. run system be perfect. It would be worse for everyone. See, all those dire warnings we're getting from Canada and the UK (hell, Massachusetts for that matter) that you disregard, I cannot. I do agree with you though. Obama's trying to implement huge changes in small doses. I am not disregarding those dire warnings. I am not trying to convince you of anything, either. I am arguing that what we have now is as much a false bill of goods predicated on the notion of "earned" profit, which is to me, at many times, a lie and it's a lie I do not support "Earned profit" is a lie? In all business or only when referencing doctors?
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Post by webrunner on Jul 22, 2009 7:50:28 GMT -7
How is it doctors' incomes are not merit based now? I don't visit doctors I hear bad things about or that I've had a bad experience with. You're just not a big fan of doctors or capitalists are you? Call me crazy. When it comes to reimbursements they are merit based. The smart ones figure out which procedures merit the biggest reimbursement, or a series of little treatments to add on to increase reimbursement - then they get more. See they know the merit of additional charges ;D BTW who asked for your input anyway, Snil? ;D
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rosa
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Post by rosa on Jul 22, 2009 7:55:25 GMT -7
I am not disregarding those dire warnings. I am not trying to convince you of anything, either. I am arguing that what we have now is as much a false bill of goods predicated on the notion of "earned" profit, which is to me, at many times, a lie and it's a lie I do not support "Earned profit" is a lie? In all business or only when referencing doctors? sorry, not biting I understand that you are comfortable with the benefits and deficits of our health care system, Web if you ever lose your insurance coverage but you keep your job as costs continue to rise (God forbid) and we are forced to bear the brunt of a tanking economy....and you develop cancer (again, God forbid) which you can't afford to take care of because costs keep rising and access to care is out of reach you being gainfully employed, but nonetheless suddenly thrust into that microscopically tiny percentage of Americans who aren't covered at all, as cited by that poll (....commissioned by whom, by the way? Oh, never mind....) I'm sure you will continue to enjoy the fruits of your labor as actualized by your non-existent "right" to treatment, let alone a cure, or palliative or end-of-life care Or, perhaps being the malcontent that I am, I'll develop cancer or some other catastrophic illness, and I'll lose my coverage or have it denied as has happened in the past.....and I'll lose my 'right' to health care, even though I have worked longer (I am older) and as hard as you have, albeit in a different profession but in either case, I know I'll support being "forced" to pay for your care, or mine, or anyone else's.....being taxed for that. Because I am nothing but a capitalist-hating socialist. And in either case, I know that people like Paris Hilton or the idle rich who arguably "work" on the golf course, will enjoy the "right" to access, care and treatment, because after all, I am anti-profit, and "pro-entitlement", so.....should I bit*ch while the nurse who tends to the sick on set earnings that are profitable, but she didn't invest well, and over the course of her lifetime, her earnings won't cover the cost of her kid's treatment for Leukemia--after her kid gets dumped from insurance coverage because his treatment costs too much, or the treatment is considered to be "experimental"....? after all, those inequities are part of life, and nobody said life was fair. And in a capitalist society, we need the rich to bear the higher cost of things, right? They know their importance in terms of class and income-based earnings To suggest that any of this is unfair or not right, or needs improvment (each of these examples being real-aside from those including you and me, but for the sake of this discussion, let's argue they are spun from whole cloth as a means to arguing to an extreme because this stuff never happens, and most Americans are happy with our current health care system)....this smacks of instantaneous, treasonous "socialism", and to suggest that we change the debt load or eliminate third party payer and challenge artificial costs and marketing so that a three-day stay for an elderly gentleman who's hospitalization to rule out colon cancer doesn't cost any more than the 400k it cost last year, billed to you and me through medicare (already in the red) because of artificial spikes in costs well, this clearly means that I in fact, support anti-capitalist agendas. I will agree, that in spite of it all, we still have the most envied system of health care delivery in the world, and as evidenced by this example, I clearly know nothing about government-based waste and potential fraud. In fact, as is clearly evidenced by my implicit support of all things "socialist", I support and endorse wasteful spending and fraud that occurs under socialized models of inherently inferior care
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Post by rosa on Jul 22, 2009 8:13:12 GMT -7
Oh here's another two, that are more closely related to "fairness", "entitlements" and "rights" in your respective profession, Web. Check out the new benefits structure for EPISD officials, I know you work elsewhere in education, but I hear that structure is really making everyone quite happy--access is irrelevant because anyone adversely affected, is clearly and by design, "undeserving" in our relatively healthy, minimally profitable existing structure and the head of a testing/education facility who recently received treatment for a serious ailment that cost in excess of 800k for minimally invasive work and a brief hospital stay has nothing to complain about, even though his carrier initially hedged on covering the procedure after all, he makes good money, but in a lifetime of earning what he has to date, he wouldn't be able to afford that treatment, the hospital stay or the follow-up care on his fairly substantial salary. But see, as "undeserving" as I think he is, given my propensity to stereotype negatively across all higher earning brackets (as anti-capitalist as I am, you know?), I really don't think he has a clue as to the inequities he faces while currently struggling with decisions on how to continue funding his program and keep insurance coverage for his employees. See? I'm clueless and unsympathetic, and only target the well-to-do with my ire. And, in the grand sum of things, perhaps I'll hold him, (not unchecked costs and concurrent greed of third party systemic abuse) responsible when he ultimately decides between cutting staff, coverage or salaries---that often supplement the costs his program's restructuring can no longer finance across the board maybe you're right--we have the most enviable, systemically healthy and marketed health care that a dirty capitalist society can boast of. And I'm nothing but one of those malcontents who is incapable of seeing the good in anything, or appreciating the benefits that come from living in a free and democratic society
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