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Bondsam, your dead wrong about defensive medicine. I'm saying this as an insider as a physician. We could save a few hundred million if we did not practice defensive medicine. I would venture to say that 50-75% of tests that are ordered in ER's and to a lesser extent in clinics are CYA tests due to fear of malpractice. Hell, even referrals to the ER by nurse care lines and Dr's clinics are CYA because they can't diagnose over the phone. We see about 5-10 patients a day sent in to us that do not need to be there.
If you don't think Dr's are scared about being sued, just look at states like Florida which has a shortage of OB-GYN Dr's because they are sue happy there and Malpractice insurance is over $100,000. They along with Nevada and Arizona also have trouble with emergency Neurosurgical Care because these Dr's have pulled out of those states due to high malpractice rates.
As far as lab goes, most lab is done by a hospital lab and hospital labs are owned by the hospital and usually run by the pathology group. Many hospitals do outpatient lab for physicans clinics. And a lot of lab is sent out to Specialty Hospitals like Mayo of John Hopkins where they do speacialty testing for certain diseases because the equipment is too technical and expensive for every day hospitals.
I won't dispute the fact that some Dr's may own shares of out of hospital private labs but it is generally illegal and there must be full disclosure. I have been in practice since 1986 and my brother has been in practice since 1980 and we have never run across your scenario. It is a drop in the bucket compared to the other factors that drive up the cost of medicine.
The majority of costs come from END OF LIFE CARE OR CARE IN THE LAST 6 MONTHS OF LIFE, new technology costs, product liability, drug costs and hospitals and Dr's clinics trying to recoup the losses of people not paying a dime for their care or receiving only 10 cents on the dollar reimbursement from state and federal health care.
Hospitals have 100's if not thousands of employees that need to pe paid. Dr's offices overhead typically run 50%. People forget that, but they sure don't forget to complain when they have to wait an hour in the clinic to see their overworked and underpaid family Dr.. Or complain when they have to wait 2 hours in the ER for a non emergent complaint. I guess we should hire double the employees and DR's and just double the cost!
But go a head and blame the DR's for everything. It's easy to make us the scape goats. Every one know's we only went into medicine to do 4yrs of college, 4 years of medical school 3-8yrs of residency training at minimum wage and come out $200,000 to 400,000 in debt with high interest loans at age 30-35 and then have to pay thousands of dollars of malpractice insurance and work 60hour work weeks. It just could not be that we want to do something as noble as taking care of the sick and injured. But honor and nobility has gone the way of the dinosaur in this country as evidenced by the high number of malpractice suits especially nuisance suits which are usually settled out of court.
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I am stunned that the house passed the health care reform bill yesterday, just shocked. After all the posturing and doubt, the Democrats actually work together to get the job done. The next step, the Senate!
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Well yes, that is the crux of the problem....
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Originally Posted by 3LB
I figured as much, but isn't that the crux of the matter, most people don't want to have to overpay so that others don't have to pay at all?
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Originally Posted by blackraven
EXACTLY, FINALLY SOME ONE BESIDES MYSELF SAID IT!!!!!!!!!!!
Maybe it's time we American realize that we actually should overpay so that others who can't pay don't have to. I know this is about as abhorrent to people as it sounds, but isn't that what society is about? Are we a society or a collection of individuals who only care about themselves? The fact is that if we don't care about others, it will mean more misery for us all and we as Americans just can't bring ourselves to realize that. Lack of adequate health care for all, opens us to greater risk from disease, slower response to care, overcrowded care facilities, higher costs, more people out of work longer because of illness, and if you're a true Darwinian, a necessary shrinking of communities as they consume more resources than the environment can sustain. And if you're a true capitalist, you'll also realize that in the long-run this is also bad for the growth of business and the corporation. IMO, that's why it just barely squeezed by in the house.
The way we've been doing things worked off-and-on while we were still fulfilling our manifest destiny in one way or another. But at some point, we need to realize that we have to live together and share our resources, all of them. As we crowd ourselves into bigger and denser metropolitan environments, the libertarian ideals that got us there, will not sustain us now that we've arrived with more an more people crowding in behind us. Maybe we need to look and see how other folks around the globe are dealing with that transition and learn from them. And guess what? They have better universal health care than what we are about to offer our own people.
At this point, I will return to my cynicism and say that whatever finally gets passed in the Senate will be so whittled down that it will not solve our health care problem. Obama needs a victory, any victory, and this bill will be just that: a political victory. It will be universal health care in name only and everybody will go home and move onto other thoughts. Kind of sad really, because in a few years when this universal health care becomes to expensive and unsustainable (like that's going to be a surprise!), it will be the right that will be saying: see we told you this wasn't going to work - when they were the ones who hobbled it in the first place (mostly Republicans and a few closet Republicans called Blue Dogs). It's even more ironic that most of them call themselves good Christians, too.
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Quote:
Originally Posted by nightflier
Maybe it's time we American realize that we actually should overpay so that others who can't pay don't have to.
We already do. If you are a physician, then you are in the top 10% of taxpayers who contribute 70% of the tax revenue. Nearly half of taxpayers contribute zilch.
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Originally Posted by nightflier
As we crowd ourselves into bigger and denser metropolitan environments, the libertarian ideals that got us there, will not sustain us now that we've arrived with more an more people crowding in behind us.
Speak for yourself. That's one of the reasons I live on an acre and a half in a small college town.
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Originally Posted by nightflier
... it will not solve our health care problem.
The current proposals will never address the systemic problems that constitute much of the problem - poor discretionary choices made by folks. The town hall meeting that ABC hosted with the President flashed some factoids about the issue. Fully half of our expenses relate to preventable conditions relating to smoking and obesity.
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Originally Posted by nightflier
It's even more ironic that most of them call themselves good Christians, too.
Good Christians care for folks by encouraging them to make good decisions and support them when they choose to help themselves. Good Christians don't encourage further dependence upon making poor life choices.
rw
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Quote:
Originally Posted by E-Stat
....
Good Christians care for folks by encouraging them to make good decisions and support them when they choose to help themselves. Good Christians don't encourage further dependence upon making poor life choices.
rw
Listen to yourself, 'Stat. Same stale, old, hypocritical, Pharisiac conservative crap about self-reliance and personal responsibility.
The "poor life choice" Americans are making is to live with healthcare system that is at best no better than that of most other developed nations and a lot more expensive.
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We could save hundreds of millions of dollars in health care money if people quit smoking and watched their diet and alcohol intake.
You can't believe how many people we see a day that have severe emphysema, asthma, heart disease, cerebrovascular disease, peripheral vascular disease, cancer and diabetes and still smoke, eat poorly and drink heavily. It has to be at least 20-30 patients a day.
I just love it when a person comes in with a severe asthma flare and they smoke. Or they have severe emphysema, cardiovascular disease and they continue to puff away. And its not just Americans, lets be realistic here. Its world wide. Look at the Europeans. They smoke like chimneys there.
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Quote:
Originally Posted by Feanor
Listen to yourself, 'Stat. Same stale, old, hypocritical, Pharisiac conservative crap about self-reliance and personal responsibility.
Please explain the hypocrisy of expecting others to make good choices that require precious little in the way of intelligence. Do you honestly think that smokers have not heard of emphysema and cancer? I ran a half-marathon last weekend.
Do you find good judgment to be a vice? Or do you think its ok to do just WTF you want without a single care as to the consequences? Are you serious?
rw
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Preventative medicine is all about people making the right choices for their health. And the government is betting big money on preventative medicine to help curb the cost of health care. They kidding themselves unless they heavily raise taxes on tobacco to force more people to quit.
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Quote:
Originally Posted by blackraven
Preventative medicine is all about people making the right choices for their health. .
No $hit. Does anyone here NOT understand that simple truth?
rw
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Doctors can help guide you to make the right choices and they can do yearly physicals and milestone tests but they can't make the choices for you.
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I won't spend much time villifying or condoning tobacco. I find it amazing that while so much hue and cry has been raised over these products, while other products, with ingredients and processes of manufactring applied to them, have managed to slip through with nary a fleeting glance. Let's face it, there's alot of sh*t on the shelves at your local grocery store. Even if one is wary and prudent, (he) risks ingesting something that is potentially harmful or detrimental to his health.
Cigarette smoking is quite risky, but what about the risks associated with breathing in the "clean air" outside? Sure, compared to smoking a cig, it is far more salubrious, but we all know that the air is replete of any possible toxin, carcinogen or organism imaginable.
And why are other ingestible toxic and habit-forming substances, like alcohol, not paraded out in the hall of shame? Why not sugar? Why not Red Dye No. 5? Is it because it's more PC to drink bourbon than to smoke? Is it because the alcohol lobby has deeeeper pockets? I don't know.
I realize that this rant sounds like the froth-filled diatribes I am wont to post every now and then, but I do so to point to a fundamental and (maybe)ridiculous point: that health is a shared responsibility. As consumers (in every sense of the word), we ought to be aware that certain substances are quite dangerous to use. On the flip side, manufacturers should own up to the fact that many of their products are quite awful in terms of quality and provision of health and growth.
It's hard to say where, let alone when, the blade will fall, but increasing our awareness of these issues not only here, but bringing it to our loved ones, friends and acquaintances in frank, non-partisan, non-aggressive dialog should go a long way. In the meantime, we can go much further in making sure that our markets provide us with food that is not only life-sustaining but health-promoting. In turn, we can dig in and leave that extra drink alone and not buy that candy bar when our child starts having a tantrum.
And now, I would like a nice cigar....
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Quote:
Originally Posted by Auricauricle
I won't spend much time villifying or condoning tobacco. I find it amazing that while so much hue and cry has been raised over these products, while other products, with ingredients and processes of manufactring applied to them, have managed to slip through with nary a fleeting glance. Let's face it, there's alot of sh*t on the shelves at your local grocery store. Even if one is wary and prudent, (he) risks ingesting something that is potentially harmful or detrimental to his health.
Cigarette smoking is quite risky, but what about the risks associated with breathing in the "clean air" outside? Sure, compared to smoking a cig, it is far more salubrious, but we all know that the air is replete of any possible toxin, carcinogen or organism imaginable.
And why are other ingestible toxic and habit-forming substances, like alcohol, not paraded out in the hall of shame? Why not sugar? Why not Red Dye No. 5? Is it because it's more PC to drink bourbon than to smoke? Is it because the alcohol lobby has deeeeper pockets? I don't know.
I realize that this rant sounds like the froth-filled diatribes I am wont to post every now and then, but I do so to point to a fundamental and (maybe)ridiculous point: that health is a shared responsibility. As consumers (in every sense of the word), we ought to be aware that certain substances are quite dangerous to use. On the flip side, manufacturers should own up to the fact that many of their products are quite awful in terms of quality and provision of health and growth.
It's hard to say where, let alone when, the blade will fall, but increasing our awareness of these issues not only here, but bringing it to our loved ones, friends and acquaintances in frank, non-partisan, non-aggressive dialog should go a long way. In the meantime, we can go much further in making sure that our markets provide us with food that is not only life-sustaining but health-promoting. In turn, we can dig in and leave that extra drink alone and not buy that candy bar when our child starts having a tantrum.
And now, I would like a nice cigar....
I would go as far as to say we could really help ourselves get healthy if they just banned the use of high fructose corn syrup or any other fattening sweetener on the market. The amount of products with this ingredient is staggering. I had to give up some of my most favorite things like ketchup, and other turkey burger toppings because they are filled with it. Americans are just plain fat, and you can see it everywhere. You cannot even ride BART these days without having to sit all over each other. Airplanes rides are uncomfortable not just because they stuff more seats into a plane, but because our butts have gotten quite a bit larger over the years. The funny thing is, as we get bigger, we tend to gravitate towards foods that make us even bigger. One of the things that makes me cringe is when an overweight person is walking into a Wendy's or MacDonald's.
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We can debate all day about the toxic substances we take in every day, but the fact is that smoking is the number 1 killer world wide and costs us billions of dollars each year.
http://www.hsph.harvard.edu/news/pre...s09122003.html
http://www.vahealth.org/cdpc/TUCP/do...ginia_2008.pdf
http://drugwarfacts.org/cms/?q=node/30
Now don't forget that these numbers are just for deaths, not the total amount of people that are afflicted with co-morbid disease caused by tobacco. The numbers for these patients are staggering.
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Quote:
Originally Posted by blackraven
We could save hundreds of millions of dollars in health care money if people quit smoking and watched their diet and alcohol intake.
You can't believe how many people we see a day that have severe emphysema, asthma, heart disease, cerebrovascular disease, peripheral vascular disease, cancer and diabetes and still smoke, eat poorly and drink heavily. It has to be at least 20-30 patients a day.
I just love it when a person comes in with a severe asthma flare and they smoke. Or they have severe emphysema, cardiovascular disease and they continue to puff away. And its not just Americans, lets be realistic here. Its world wide. Look at the Europeans. They smoke like chimneys there.
Maybe we need death panels empowered to deny treatment to these self-abusers. :smilewinkgrin:
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Quote:
Originally Posted by Feanor
Maybe we need death panels empowered to deny treatment to these self-abusers. :smilewinkgrin:
Maybe we could ask them to pay for their own healthcare.:devil:
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Quote:
Originally Posted by Sir Terrence the Terrible
I would go as far as to say we could really help ourselves get healthy if they just banned the use of high fructose corn syrup or any other fattening sweetener on the market. The amount of products with this ingredient is staggering. I had to give up some of my most favorite things like ketchup, and other turkey burger toppings because they are filled with it. Americans are just plain fat, and you can see it everywhere. You cannot even ride BART these days without having to sit all over each other. Airplanes rides are uncomfortable not just because they stuff more seats into a plane, but because our butts have gotten quite a bit larger over the years. The funny thing is, as we get bigger, we tend to gravitate towards foods that make us even bigger. One of the things that makes me cringe is when an overweight person is walking into a Wendy's or MacDonald's.
I wonder if the high-fructose-corn-syrup lobby is as powerful as the tobacco lobby or the health insurers lobby?
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Quote:
Originally Posted by GMichael
Maybe we could ask them to pay for their own healthcare.:devil:
It would be techically very easy to calculate the excess premium for smokers over non-smokers. The actuarial data exists and is already used by the insurance companies.
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Quote:
Originally Posted by E-Stat
Please explain the hypocrisy of expecting others to make good choices that require precious little in the way of intelligence. Do you honestly think that smokers have not heard of emphysema and cancer? I ran a half-marathon last weekend.
Do you find good judgment to be a vice? Or do you think its ok to do just WTF you want without a single care as to the consequences? Are you serious?
rw
Wow, I thought good Christians feed the hungry, welcome strangers, clothe the naked, and visit the sick and imprisoned. It's certainly easier to say "get a job" or "you did that to yourself" or stand on the sideline and either applaud or condemn the choices of others.
If you want to talk about sensible human behavior, that's one thing, but bringing up what "good Christians" do or don't do opens a different can of worms.
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Quote:
Originally Posted by Feanor
It would be techically very easy to calculate the excess premium for smokers over non-smokers. The actuarial data exists and is already used by the insurance companies.
Will the new health plan?
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Quote:
Originally Posted by dean_martin
Wow, I thought good Christians feed the hungry, welcome strangers, clothe the naked, and visit the sick and imprisoned. It's certainly easier to say "get a job" or "you did that to yourself" or stand on the sideline and either applaud or condemn the choices of others.
If you want to talk about sensible human behavior, that's one thing, but bringing up what "good Christians" do or don't do opens a different can of worms.
Christian do, but Pharisees don't. The just like the New Testiment Pharisees, so many Christian conservatives self-righteously proclaim, "Thank you God that I am not as other men". Jesus condemned the Pharisees as hypocrits; where he here today, he'd do the same for the Christian Right, (an oxymoron, by the way).
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Quote:
Originally Posted by E-Stat
Please explain the hypocrisy of expecting others to make good choices that require precious little in the way of intelligence. Do you honestly think that smokers have not heard of emphysema and cancer? I ran a half-marathon last weekend.
Do you find good judgment to be a vice? Or do you think its ok to do just WTF you want without a single care as to the consequences? Are you serious?
rw
Were it strictly up to me, even here in Canada, I would consider charging a premium to smokers and possibly others such as the obese, that would consist of difference in cost for them versus others who better life-style choices. Like I said to Bobsticks, (where is he?), I believe in equality of social responsibility. But the fact that there are so many self-abusers shouldn't be used road-block progress on the healthcare issues.
There is the other matter: equating self-reliance with Christian virtue; that is a spurious connection. Worse, suggesting that it is Christian to not help people because they lack self-reliance and personal responsibility is totally wrong. It is "Pharisaic", as I said, or anti-Christian if you'd rather put it that way.
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Can we leave out some of these remarks about religiosity, etc. when we get into these discussions?
BR, you are quite right: the number of deaths and co-morbid illnesses associated with smoking is quite alarming. Simultaneously, I subscribe to the notion that tobacco users are an easy target for the study of self-abusive behavior: it is observable, quantifiable (packs/cigarettes per day), and manageable. Anybody who has taken a course in research design and/or statistics can set up a program and submit it to any number of journals. In spite of this, I am concerned that Tobacco has become the whipping boy for those looking to target behaviors that endanger life and livelihood (and waste so much money that could/should have been spent elsewhere).
At the same time, there are other behaviors and products that should share some of the scrutiny. Sir T's remarks about obesity addresses one of America's (and rapidly become the world's--ask the Japanese) most intransigent issues. While some awareness has been paid to this problem, companies like MacDonald's continue to pump out insanely large, cholesterol-filled burgers that are consumed by the millions every day.
I mentioned earlier the sense I have that while tobacco has its associated risks, there are other exposures we are subject to that are, at least, potentially as dangerous. Manufacturers of plastics and solvents know the hazards of producing these products, but we continue to be exposed to them, if passively.
In short, I want to point out that if we think that laying the brunt of attacks on Big Tobacco will solve our problems, there are many more exposures that will continue to endanger us. While cigarettes, etc. are a direct means of ingestion and not as insidious or passive as smog inhalation, I submit that the ingestion of any substance bears some risk.
So what is the solution? For starters, I would like to see manufacturers of these products held more accountable for their wares. While industries have been waylaid for the production of Greenhouse Gases, they should also be held to account for the production of toxic/harmful products/by-products. Likewise, I would like to see industries like the fastfood vendors and high-fructose "food" vendors take some responsibility for their products. No one forces people to consume many of these products, but for many people who don't have the means to shop at the local market, let alone buy Organic Products, junk food fills a hungry tummy and doesn't break the bank. Vendors who cater to these people full-well know the demographics of their customer base, and continue to pump the sh*t out. Like drug-pushers, they should share some of the responsibility and accountability.
Consumers should likewise pay some of the price for their behavior (as Feanor suggests). If obesity and cigarette smoking (or whatever) has been detected, certainly people who participate in certain behaviors should be urged to lose weight, stop smoking, or whatever, or pay the price for doing so. An argument may be made that such a policy attacks certain people, while others, who continue to be exposed to and use certain products, walk away scot free. This is a red-herring argument and should be quashed for the nonsense it is.
Responsibility is the key, and these I think are a few ways we can approach these issues reasonably and efficiently for the benefit of all of us....
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Quote:
Originally Posted by dean_martin
Wow, I thought good Christians feed the hungry, welcome strangers, clothe the naked, and visit the sick and imprisoned. It's certainly easier to say "get a job" or "you did that to yourself" or stand on the sideline and either applaud or condemn the choices of others.
Wherever did you get that? The topic on which I commented is smoking and obesity. Don't spend your money on tobacco. Don't overeat. Take a walk. Exercise. What does any of that have to do with getting a job?
Quote:
Originally Posted by dean_martin
If you want to talk about sensible human behavior, that's one thing, but bringing up what "good Christians" do or don't do opens a different can of worms.
Look again at post 404 to find the source of who brought up Christians.
rw
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Quote:
Originally Posted by Feanor
Worse, suggesting that it is Christian to not help people because they lack self-reliance and personal responsibility is totally wrong. It is "Pharisaic", as I said, or anti-Christian if you'd rather put it that way.
You missed the context of my comment. Nightflier says that objections to the completely whacked, impractical, expensive non-solution to our problem is "even more ironic that most of them call themselves good Christians, too. "
It has nothing to do with being a bad Christian. Christians help folks today without endorsing such a cluster of a plan.
rw
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Quote:
Originally Posted by E-Stat
Wherever did you get that? The topic on which I commented is smoking and obesity. Don't spend your money on tobacco. Don't overeat. Take a walk. Exercise. What does any of that have to do with getting a job?
Look again at post 404 to find the source of who brought up Christians.
rw
I know who brought it up but didn't you say this: "Good Christians care for folks by encouraging them to make good decisions and support them when they choose to help themselves. Good Christians don't encourage further dependence upon making poor life choices.
rw"
Here's what I said: " Wow, I thought good Christians feed the hungry, welcome strangers, clothe the naked, and visit the sick and imprisoned. It's certainly easier to say "get a job" or "you did that to yourself" or stand on the sideline and either applaud or condemn the choices of others.
If you want to talk about sensible human behavior, that's one thing, but bringing up what "good Christians" do or don't do opens a different can of worms."
I'll retract the "get a job" language from my original post, but the rest is a direct response taken from Jesus's "least of these" directive which isn't qualified by how the sick became sick. Your list of dos and don'ts is a good one but it's neither Christian nor non-Christian.
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