Fine for refusing health care?!?!?! - The Health care thread....

[srellim234]

Read it again, this time in context. You're assuming something that isn't there.

The reply was to a citizen of another country who didn't know what the term "death panel" meant in this debate. I explained the first (and continuing people) who coined the term and continue to exploit it ("They want to pull the plug on Grandma!) for their own personal gain.

The concept, implementation, etc. of such a program is a part of the debate and yes, people from all walks of life and all sides of the political spectrum have problems with the proposal. But "death panels" is a bogus term being used publicly for sensationalistic reasons. The term itself is so polarizing that it detracts from constructive discussion by demonstrating the closed minds of those who use it.

[telcoman]

Read it again, this time in context. You're assuming something that isn't there.

The reply was to a citizen of another country who didn't know what the term "death panel" meant in this debate. I explained the first (and continuing people) who coined the term and continue to exploit it ("They want to pull the plug on Grandma!) for their own personal gain.

The concept, implementation, etc. of such a program is a part of the debate and yes, people from all walks of life and all sides of the political spectrum have problems with the proposal. But "death panels" is a bogus term being used publicly for sensationalistic reasons. The term itself is so polarizing that it detracts from constructive discussion by demonstrating the closed minds of those who use it.

You cannot make any headway against those that believe what they hear & read from right wing news and print publications are facts.

The proposal on healthcare reform here allows for the federal insurance proposal to include counseling services and/or reimbursement for counseling services for people to establish directives should they become unable to communicate their wishes near the end of life. Basically, it helps people establish "living wills." The counseling can include everyone involved from the doctors to the insurance people, spelling out all the options available.

Some right wing people who are committed to opposing absolutely anything proposed by a Democrat (most notably Sarah Palin, Sen. Chuck Grassley and Rush Limbaugh) seized on the counseling sessions and the people who would be involved in the counseling as creating "death panels" who will be killing the elderly left and right, making decisions to pull the plug on people in order to save a buck.

Sensationalism to promote their incomes through viewership, readership or continued campaign contributions from those healthcare companies involved in fighting reform.

Notice they no longer mention the Terry Scheivo case.

They also fail to mention the outrageous salaries that are being paid to healthcare executives that deny payments to doctors, hospitals as well as those that do have healthcare.

http://sickforprofit.com/ceos/

Are we going to believe a few misguided wingnuts posting here or are we going to believe all the healthcare experts on both sides that President Obama called together in an attempt to come up with a viable plan?

Telcoman

[audtatious]

Read it again, this time in context. You're assuming something that isn't there.

The reply was to a citizen of another country who didn't know what the term "death panel" meant in this debate. I explained the first (and continuing people) who coined the term and continue to exploit it ("They want to pull the plug on Grandma!) for their own personal gain.

The concept, implementation, etc. of such a program is a part of the debate and yes, people from all walks of life and all sides of the political spectrum have problems with the proposal. But "death panels" is a bogus term being used publicly for sensationalistic reasons. The term itself is so polarizing that it detracts from constructive discussion by demonstrating the closed minds of those who use it.

No, my objection is the constant insistence that those against these policies or making "sensationalized" remarks are doing so to simply "promote their incomes through viewership, readership or continued campaign contributions from those health care companies involved in fighting reform." Sensationalized comments are coming from both sides of the table and have been for a while. Health care lobbyists are supporting the Obama plan, wonder why?....Yeah, they are going to be paid off well for it. Regardless of whether you agree or not there ARE valid concerns when you look past the titles being thrown out and as far as incomes come into play, look at which politicians (and X politicians) have the most buck and which party they are associated with.

[audtatious]

Notice they no longer mention the Terry Scheivo case.

Hey, old fool, it's because the majority of us ON THIS FORUM supported pulling the plug. Get over yourself.

[smockers83]

What a lot of people don't realize is that the current system is screwing the vast majority for the benefit of a minority (the guys in the boardroom). We have already abandoned a free market in favor of monopolies around the country.

http://news.yahoo.com/s/ap/200...ition

There is no insurance monopoly. The problem with increasing competition in the insurance market is that insurance is regulated at the state level, not the federal level (one of the things McCain was running on during the elections). If we want to say insurance companies have monopolies, then we can say cable companies, banks, utility companies, and the sorts have monopolies on a local basis as well. I don't have a Wells Fargo bank here, but TCF, Chase, and Nat City are all here because they dominate this local market. My cable company, by force, is Comcast which rapes you in the a** and is the most difficult company ever to get your dignity back.

[audtatious]

Dammit....I only have one water company to select from....MONOPOLY!!!!!

Good points.

[srellim234]

Sometimes there are "benevolent" monopolies that are somewhat necessary. Many of these, like water companies, electric companies, etc. come under the oversight of a public utilities commission and are generally not allowed to gouge the consumer.

The cable company monopolies were instituted by individual cities in order to provide one company that would be responsible for cable setup and maintenance. Bear in mind that just because Comcast may have the cable monopoly in your city, they do not have a monopoly on the television business. Satellite tv and internet tv are competitors, and in some major metropolitan areas broadcast tv is a competitor.

As for healthcare lobbies for reform, a company would be remiss not to engage in moving healthcare reform forward in the areas where they stand to profit, while opposing those areas that may hurt them.

http://www.forbes.com/feeds/ap....html

http://www.medicalnewstoday.co...6.php

http://boston.indymedia.org/feature/display/208261

The last one is very liberally biased but there is a lot of good information in there that explains a lot.

[srellim234]

Here's some more on the VA booklet.

http://www.npr.org/blogs/healt....html

Question: Where did you actually get the term "death book" for that publication? It smacks of something a commentator from one side or the other would say.

[audtatious]

I think it was some WSJ op-ed....

[audtatious]

Very interesting perspective from Dr Alfred Bonati, head of the American Society of Medical Doctors and founder of the Bonati Institute:

http://www.washingtontimes.com...lines

"Perhaps this is why a nationwide, nonpartisan poll of physicians this month found that a full 70 percent oppose the health care reform proposals under consideration by Congress. Sixty-six percent feel that a government-run health insurance plan would restrict doctors' ability to give the best advice and offer the best care possible to their patients. Perhaps most importantly, 60 percent said they would not accept new patients covered by a government insurance plan. "

"I share the view of the 60 percent in the August poll -- those doctors who are planning to "just say no" if government-run health coverage is implemented. Many of us already do not accept patients who are on Medicare or Medicaid because of restrictions those programs put on our decisions as doctors. It pains us to turn away a patient in need, but the narrow rules of government reimbursement programs stymie our ability to follow our oath, so we simply opt out and work with patients who are also in need but have more flexible, private coverage. "

So, if doctors simply don't accept new patients or patients associated with the new UH plan, how are these people going to get treatment? Will the Fed Gov have to mandate it? Where are all the new GP doctors going to come from?

Just questioning......

[srellim234]

From the 40% that don't oppose it...

[srellim234]

Gov is doing a great job as usual.....

http://www.latimes.com/news/na...story

"Veterans Affairs mistakenly tells 1,200 they have Lou Gehrig's, a fatal neurological disease"

A coding error by a clerk in an office set that one off. Private companies aren't any better when it comes to entering data in a computer:

http://www.redtape.msnbc.com/

..."Eight out of 10 bills we see have some error," she said...

The entire article is worth reading. Besides pointing out that private companies make a lot of mistakes, too, it could save all of us a lot of money when dealing with our doctors and insurance companies.

[audtatious]

From the 40% that don't oppose it...

So....UH is passed. 40% of current doctors will treat those with the "public option", along with their current patients with private health care.....to the point they are going into debt in which the number shrinks from 40%. Businesses start to drop their private health care benefits programs and the number of those on the public option increases significantly.....who are they going to use for a doctor?

[audtatious]

A coding error by a clerk in an office set that one off. Private companies aren't any better when it comes to entering data in a computer:

http://www.redtape.msnbc.com/

..."Eight out of 10 bills we see have some error," she said...

The entire article is worth reading. Besides pointing out that private companies make a lot of mistakes, too, it could save all of us a lot of money when dealing with our doctors and insurance companies.

A billing error and notification that 1200 people have a life ending disease is quite a bit different, would you not agree?

[smockers83]

Sometimes there are "benevolent" monopolies that are somewhat necessary. Many of these, like water companies, electric companies, etc. come under the oversight of a public utilities commission and are generally not allowed to gouge the consumer.

The cable company monopolies were instituted by individual cities in order to provide one company that would be responsible for cable setup and maintenance. Bear in mind that just because Comcast may have the cable monopoly in your city, they do not have a monopoly on the television business. Satellite tv and internet tv are competitors, and in some major metropolitan areas broadcast tv is a competitor.

As for healthcare lobbies for reform, a company would be remiss not to engage in moving healthcare reform forward in the areas where they stand to profit, while opposing those areas that may hurt them.

http://www.forbes.com/feeds/ap....html

http://www.medicalnewstoday.co...6.php

http://boston.indymedia.org/feature/display/208261

The last one is very liberally biased but there is a lot of good information in there that explains a lot.

Yes, however true, my analogy still stands. You've proved it yourself in the quoted post. A company may have a monopoly on a local area but does not have a monopoly on the insurance industry, just as a cable company. There are many companies out there competing, there are just many barriers to competition at the state level.

If competition is what you want in the market, you have to get rid of the employer-based system as well. This "forces" employees to take the insurance provided by the company. However they can opt out, but realistically, how many do?

Another problem with introducing competition in insurance markets is that it takes vast amounts of capital (real and cash) to even start, which is a barrier to entry. One cannot enter the insurance market willy nilly anymore how these other companies started decades ago.

So, if doctors simply don't accept new patients or patients associated with the new UH plan, how are these people going to get treatment? Will the Fed Gov have to mandate it? Where are all the new GP doctors going to come from?

Surely not out of school, that's for sure. Family/general practitioners are becoming a rarity in medical schools as students go for the more lucrative and status-holding specialties and sub-specialties.

[bigbadberry3]

I am still in college and a lot of my friends and peers in my classes are premed/medically orientated and despise this plan, not on grounds that they can't help people, but only on the grounds that they won't be paid enough for their services which is more of a straightforward answer than Dr. Alfred Bonati.

[audtatious]

Surely not out of school, that's for sure. Family/general practitioners are becoming a rarity in medical schools as students go for the more lucrative and status-holding specialties and sub-specialties.

Yep. GP's work their butts off for somewhat "minimal" pay, as compared to other "specialist" salaries....

[audtatious]

I am still in college and a lot of my friends and peers in my classes are premed/medically orientated and despise this plan, not on grounds that they can't help people, but only on the grounds that they won't be paid enough for their services which is more of a straightforward answer than Dr. Alfred Bonati.

Without solving other issues within the medical industry, pay will be a big issue. So, with UH either the Gov will have to mandate more GP's to fill a void that is already there, subsidize GP's salaries so more will go into the field or make it a requirement for medical students to spend "X" years as a GP before entering some specialty field. I'm not sure of any other options around the problem....

[srellim234]

aud- legitimate question since I truly don't know the answer-

How much of the load on a GP can realistically be taken off by using nurse practitioners? I realize they can't do the heavy things but pharmacy has really benefited from the use of pharmacy techs to do the basics.

[audtatious]

You are looking at 6 years of so of training + patient time to become a NP and by 2015 will need a Masters on top of a ASN and BSN to become certified. NP's are required to have malpractice insurance, just like a doctor as well. In their field they are usually specialty-driven so that limits a NP's viability to support a wide range of patients. NP's are generally paid as much as GP's and in some cases more.

Now, I understand your point and I don't disagree. But in the real world the majority of those who are considering up to 8 years training for a NP are also considering 8-11 years to become a real doctor, which opens the door to more income possibilities and more recognition. In 2004 there were an estimated 141,209 NP's in the US as compared to 800k-1.5 million physician/specialty-level positions (depending on who is reporting the number). The number of NP's is probably so low in contrast because those who go into the nursing field are usually happy with a RN-level.

[srellim234]

Thanks for clearing that up for me. I honestly didn't know that. If the NP is getting as much as the GP then that is really not an option.

[audtatious]

It's always an option...In general, per WIKI, they can:

* Diagnosing, treating, evaluating and managing acute and chronic illness and disease (e.g. diabetes, high blood pressure) * Obtaining medical histories and conducting physical examinations * Ordering, performing, and interpreting diagnostic studies (e.g., routine lab tests, bone x-rays, EKGs) * Prescribing physical therapy and other rehabilitation treatments * Prescribing pharmacologic treatments and therapies for acute and chronic illness (extent of prescriptive authority varies by state regulations) * Providing prenatal care and family planning services * Providing well-child care, including screening and immunizations * Providing primary and specialty care services, health-maintenance care for adults, including annual physicals * Providing care for patients in acute and critical care settings * Performing minor surgeries and procedures (with additional training and usually under supervision) (e.g., dermatological biopsies, suturing, casting) * Counseling and educating patients on health behaviors, self-care skills, and treatment options * Not formally trained for surgical assisting

With the above, their role is similar to a GP. I just don't know why someone would go into nursing simply for NP. I see it more as advancement capabilities when you are a RN. Now, it may be viable for the Gov to offer an easier path for existing RN's to become NP's to fill the gap but it's going to be difficult, even if the Gov did a reimbursement program, for them to fill a void left by doctors not accepting patients.

[smockers83]

A NP is essentially a doctor without the doctor status/pay. They can have their own practice and such.

[srellim234]

I know you want to approach this thing from a cost reduction basis, which should almost always be a major goal, but from your perspective, how do we provide proper, reasonable healthcare for all American citizens in need of it?

I'm a believer that basic healthcare is both a right AND a privilege. Everyone should have access to it for a reasonable price based on their ability to pay, but they in turn have a responsibility to use it wisely and not abuse it.

How would you get us there from where we are now?

[smockers83]

If we went on an ability-to-pay system, the consumers would decide the price and the doctors would be price takers. A market can't/won't work that way. Once it does, it can disappear altogether. The reason people can't get healthcare is because they're priced out of the market. Lower the costs through different pay structures, such as the Cleveland Clinic, take a stab at care on the front end (preventative) instead of cleaning up the back end (always, always costs more no matter what it is). We can have the best health technology and care in the world, but if we don't keep ourselves healthy and rely on the system to keep us healthy, costs will continue to rise. Two thirds of Americans are either overweight or obese. That's a health issue leading to many things such as cardiovascular disease to sleep apnea. I know America is getting fatter because it gets harder and harder to find my size in pants as stores move to bigger and bigger sizes. A gym membership is much more manageable than a hospital bill.

Is that my outright and thorough proposal, no, but that's all I have time for at the moment. Another aspect is increasing the number of spots open in med schools, allowing an increase in the supply of healthcare in order to reduce the price.