Re-greetings spanners. Missed you folks.

Saw the motorized wheelchair commercial again yesterday, "If you're eligible for Medicare, we'll pre-qualify you and give you your chair FREE if we can't get the govt to pay" (or words to that effect).

If someone spends 65 years eating themselves to 300 pounds and now is too old to move that lard around, would you really want their family showing up with shotguns at your house to rob you to buy them a motorized wheelchair? Is it better for the government to carry the shotguns?

If someone spends their life eating bacon and cheese and washing it down with buttermilk, should your child's college fund by diverted to buy them cholesterol lowering pharmaceuticals. Or should the bill for those pills just be sent to your 5 year old grandchild - who can pay the interest when they finally are old enough to pay for the giveaways.

Medical decisions that have no personal cost are pretty easy... give me all you can, even if it lowers my chance of a disease from 5% to 4.5% - give it to me... it's my "right" to have anything ever invented, no matter the cost, no matter my personal choices.

Actually, I think the government makes equally bad decisions in the OPPOSITE direction too... very necessary care is withheld because of some bureaucrat's understanding of a 1,000 page set of regulations... or the care is delayed until it is too late to help. But that supports my contention that there is not nor should there be a "one size fits all" solution, nor should any solution be "free" to any but the most destitute and helpless.

Respectfully submitted,

cptrev
(I'm neither cpt nor rev any longer but the handle is SO easy for me to remember!)


Not wanting to get in the middle of a one liner festival of big fonted colorful put downs, I opened a new thread - if there's no interest, it'll die on the back pages.

Good point, cptrev.

You're no longer a "man of the cloth"? Interesting.

cptrev, that is going to be a core question for the upcoming healthcare debate. Is it OK for gubment to tell folks who have the money to pay for that next procedure that they cannot have it? Is it required that gubment provide the money to folks who really do need that next procedure but do not have the money themselves? This is going to be an interesting summer.

Great to see you back, cptrev.

You name came up just the other night and we were wondering where you were, and hoping for the best.

Those scooter deals are a particularly egregious example of the rip offs Congress has structured under the heading of durable medical equipment. Congress legislates prices (high) for those Medicare items, while keeping constant downward pressure on doctors fees.

Go figure.

I saw you around the other night and was quite sad you were gone before I could post to or PM you.

Medicare stuff drives me nuts. It's all so artificial. My dad HAD to take an ambulance to dialysis, though he could save hundreds having his friend take him or by staying in the hospital. Meanwhile folks in his county are spending big bucks getting pedicures every month. It's all too crazy.

I will make sure there are no big color put-downs on this thread, and Space can as well. Things are always a bit slow headed into spring and summer, but hopefully there will be some interest in this thread as well as the other Medicare/healthcare thread.

I have tennis and am running a bit late, but I'm happy to see you're OK. As usual people drift in and out around here. gret you could find your way back.

How about allowing us to buy our own medicine without the interference of a doctor every month or three? A hundred dollar doctor visit to get a piece of paper so I can buy $4 of medicine is putting a lot of money in somebody else's hands for what I might consider no benefit to me at all. Since there are going to be less and less doctors as the lawyers drive them out of business, how about letting us take up the slack on our own.

this is where AV tells you to go to Cuba

Pretty far-fetched claim right there, Bob K. I am not even sure there are fewer and fewer doctors (per capita) per se, even.

I've read more than once and have heard from doctors themselves that many are leaving the business. I heard just yesterday osteopath has cut down to one day a week, and he only does that because the hospital picks up his malpractice insurance. Otherwise he'd be out of business completely.


My point still stands, regardless of supply paying a doctor many times more than what the medicine costs is highly wasteful, regardless of who pays.

I am with you on the last point.

The AMA is as interested in their profit margin as they are in your health. Not that doctors don't have a right to try and keep their wages up, but those of us that pay the bill have a right to try and keep costs down. One way would be to give the patient more choice and control over their own care and treatment.

My prescriptions are written for 12 months but otherwise I agree that there should be significantly less gubment and gubment licensed practitioners standing in the way of medical. For instance, the statins should be OTC. Simvastatin OTC in Britain I believe...

I'm with you on that one.

That's like saying paying a carpenter many more times what nails and wood costs is highly wasteful.

More like saying once the carpenter builds you a fence you have to pay him every few months to tap back in the odd nail or tighten any loosening screws.

Why even have doctors at all? Just take whatever pills we think we need.

Some countries work that way. I understand that some Latin American countries sell meds without a need for a doctor's scrip. They rely on pharmacists and their customers to figure out what they want to take.


This is particularly problematic for the over use of antibiotics.

chronic asthma from childhood, rx albuterol inhalor

the rx expires but not the asthma...

if you can't afford it, don't attempt to breathe

Anecdotally a valid claim for the good ones...can't wait to see second and third string docs entering the game.

I hadn't considered that.

When government funds health care, these questions MUST be asked. I believe government funding should be minimalized - probably to obvious cases of life saving treatment. Children born with asthma are a far cry from television shucksters who have mastered the byzantine paperwork to make a huge business of motorized wheelchairs.

I don't like government making those choices at all - drawing the line between needs and wants; rights and benevolence. I don't think government is capable of it, for one; more importantly, that those choices were ever granted to it by the Constitution. Where they ARE granted "promoting general welfare and providing for national defense"; they call for conservative choices by the nature of the design of our government.

Respectfully,

cptrev

Yep. If carpenters had been as successful at medical doctors in "closing" their activities off to non-medical doctors, then everytime you needed ANY carpentry work done, you'd have to hire a licensed and "board-certified" carpenter to, at the very least, supervise and sign off on it.

Like plumbers and electricians... well except you couldn't go down to Lowes or Home Depot and buy plumbing and electrical parts without a plumbers or electricians note either...

Yep.

So is it your opinion that we shouldn't need a doctor to prescribe medicine?

Not quite. OTOH, the fact that doctors get to charge for a complete office visit when all they do is repeat a prescription is a bit much. Somewhere between complete OTC and an over-priced office visit for everything is where I would like to be.

Make most medicines OTC, limit quantities for medicines that are extremely addictive or used to make extremely addictive drugs as they do now for some OTC cold medicines. Perhaps need a docs note to get larger quantities of the addictive medicines. For instance everyone should get access to statins and they can decide how often they want to get their liver functions checked or just wait for annual physical and be on the lookout for other statin side effects...

Makes sense. However, with my insurance I only pay a co-pay for the first visit relating to any problem. So when I go in to renew my script, I'm not charged another co-pay.

No such luck with my insurance. On the other hand, they do 'visits by e-mail', for such things as 'the common cold'. Cost us NOTHING.

I'd probably be better at doing doctor activity than carpentry. If we are willing to take the risk I don't see why we shouldn't be allowed to shop around for the discount.

If we shop around then the whole idea of their being professionals, offering a professional service, and not just people in 'business', peddling their services to the highest net bidder is going to become even more of a vague memory.

Isn't a professional one offering a service for money as opposed to just doing it for nothing?

All that aside, my argument is for professionalism to be decided on a basis of what is good for the consumer as opposed to what is best to keep the wage rate high. As far as I can tell much of what the AMA does is work to keep the doctor pool small and the pay scale high.

No, he/she isn't. I am talking about the technical definition of the term 'professional'.

An office manager is not a professional, even though he/she is not an amateur, and doesn't perform his/her duties for free.

A lawyer is a professional. A person who makes a living from offering astrological readings and advice, not so much.

Information and fairness would go FAR toward reducing costs.
Combined with REQUIRED co-payments - it would go FARTHER STILL.
Tort reform would go even FARTHER.

I have excellent insurance in that most things are covered 100%. I have TERRIBLE coverage in that most things are covered 100% so I normally don't go to valid preventative checkups because of the NUISANCE of a thousand runny noses running to the "free" doc for "free" anti-biotics.

I'd MUCH rather pay $20-$50 or even $100 to have a shorter line and available appointments.

And even THEN, I have no clue what labs charge for a blood test if I have a symptom I just can't shake with aspirin and orange juice... at least I don't until I get a BS bill for $800, that the insurance company has a "limit" for $140. Medicine isn't such a mystery that I couldn't shop around if prices were readily available and if I had the slightest reason to exercise such diligence. Flat co-payments and widely inflated "prices" compared to ridiculously discounted "coverage limits" agreed to by "participating doctors" are creating this mess.

Full payment, state mandated coverage, and other government intervention where they should butt out - and failure where they should regulate and standardize - have created this mess.

And that doesn't touch, for now, the ridiculous ambulance chasing shysters like John Edwards, candidate for president as well as husband of the year; and what they're doing to butcher the best health care on the planet in all of history.

Too many people get everything for free or little so they don't care what it costs, while others of us pay dearly for everything to make up the difference, and that's not counting the taxes.

Screw the lawyers, let me at the very least get BP medicine without wasting my money and a doctor's time every few months just to get the same prescription I already have.



You can do your own medical research better than most doctors, who won't spend but ten minutes on your case at a time anyway.

Gods in White Coats Hold Key to Health Care

Bloomberg,
by Margaret Carlson


6/20/2009 5:28:27 AM

Give me your arm, make a fist, relax. This isn’t going to hurt. It always does but that just makes doctor and patient even. What really, really hurts, physicians say, are medical malpractice suits -- those humongous awards ladled out by gullible juries are more painful than a thousand hypodermic needles. If only President Barack Obama would fix that, the American Medical Association says, it would be more open to his reforms.

So now y'all apply the label "god" to the pro-health care program people?

Do you realize how transparent you are? But the really sad thing is the idiot faith-based will eat it up.

My dad was butchered by a bad doctor. He never recovered. It ruined his life. I heard the bastard did the same to others.

Fixin up health care must, if it is at all an honest effort, include some plan to reduce liability costs for bad outcomes.

What kind of hospital was he in, VA, private or local - did you do a follow up on the surgeon later? I don't know how large the area is where you live. It's true some surgeons are not as good as others and then some situations don't get the results desired. My surgery for the Sciatica pain is, I don't think, working - next week will be two months and I still have to take pain pills - but the surgeon told me he would try to help - no guarantees - - I was the one who ask him to do the surgery - I have so much arthritis in the area - I think that is a hindrance to correcting the situation.

My brother in law has serious back issues as well. What I understand is that there are very few fully successful back surgeries for some pain problems.

Nevertheless, even after having the outcomes fully disclosed, some patients opt to go ahead because any hope of improvement beats the misery of their current condition. My brother in law's surgery was semi-successful - diminished pain symptoms, but no cure.

I hope yours works out for you LP.

Thanks, yes, I have observed a change in the patterns and some are probably not as severe - but I still hope for some gradual relief - I know one thing, atmospheric changes do affect, i.e., exagerate the negative!

Especially bad outcomes that aren't caused by negligence. Sometimes bad things just happen.

When the docs tell us that the mortality rate for a certain operation is only 2% we all are hoping that we will be in the 98%. But there will be two deaths for every hundred.

Even with good doctors, and if we weed out every doctor who has a bad outcome even the best will be gone after 50 surgeries.

I have two thoughts for you.

I think, for me, the core question is: Why is no one calling this socialized medicine, when that is what this is?

What I see is that the "gubmint" takes in taxes-thats private money, then through the magic of ownership, those tax dollars are transmuted into public money. Once the transmutation process is complete, the money will be spent to provide health care to those who otherwise could not afford it.

Yeah, that's socialized medicine. Tax money out of my pocket, and spend it on someone who is not me.

The second thought is: How did we get here?
How is a historically proven failure going to make us all healthier and save us money in the process?

Plenty of folks are calling it that already, even though the plan has yet to be announced.

Having been in the individual health insurance market for more than a decade I can say there is more than enough blame to go around for how we got here... Health Insurance and Medical Care providers have developed and tolerate this financing scheme that has zero rationality in it... Doctors refuse to police themselves... Insurance Companies refuse to police themselves... Gubment plans Medicare, Medicaid, VA are a mess for both financing and covered care... Personally I would be OK with simple as possible. Only individual policies with absolute transparency in coverage, billing, procedures, and premium support for low income and EVERYONE in the same system, no Medicare, no Medicaid, no VA, no FEHB, no State boundaries for insurance/risk pools, no billing for twice what you know you are going to get paid, loser pays malpractice lawsuits...

The discussion still revolves around insurance and not care. What except the government and lobbies prevents us from throwing open the doors to the medicine cabinet and letting people take responsibility for their own decisions? Let doctors write prescriptions for a whole year for scheduled drugs and make most other drugs OTC. That would free up a lot of doctor time to be used in diagnosing illness and treating patients instead of makework doctor visits. Make people pay full price for unnecessary visits instead of allowing folks to see the doctor for free just because they're lonely or bored.

I don't even mind the government being the charity of last resort, but I hate the idea that it pays everything for some people and absolutely nothing for others, while helping to keep medical costs up with it's own intervention.

I think we are not that much apart Art, the care is pretty good and to the extent it is screwed up it is largely because of the finance issues driving it. I think catastrophic insurance is fine including for healthcare. I don't think that a regional health insurance cooperative would be allowed under current rules for instance which to me says we need to get rid of a lot of the existing rules even more than we need more rules...