The Goat Pen

BOJ needs to be careful at those soup kitchens.

sardis wrote:Just came from lunch with one of my contractor clients who has about 300 employees. He currently pays about $5K per employee in health insurance premiums. Will drop the benefit come 2014 and pay the $2K fine. He estimates it will save them about $500K a year.

Our firm will probably keep health insurance for our 100 employees because they are made up of high skilled professionals that will demand not being part of a government system.

You will see a two level system of healthcare in this country. The poor will be on gov't subsidized bare bones rationed care while upper middle and up will be able to continue their top of the line care that everyone gets now.

Maybe. Maybe not. The left will despise the tier you describe and demand that the tax be raised or call for an end to private health insurance which is what they want anyway.

Jungle Rat wrote:Why should you get better care than the average guy? Are you that more important?

Why should you have a better car? House? Microsoft fueled retirement account? Maybe cause you earned it?

And their is a huge difference between insurance and care. The left has succeeded in making then synonymous. This was about health ins not healthcare. 80 to 85% of the pop already had health insurance, so why fuck with that?

bluetick wrote:

sardis wrote:

You will see a two level system of healthcare in this country. The poor will be on gov't subsidized bare bones rationed care while upper middle and up will be able to continue their top of the line care that everyone gets now.

I've raised this scenerio since the cnnsi/worldcrossing days. A gov't/private sector hybrid that is basic coverage but is cost-effective and is centered on preventive care that utimately saves many billions. And the middle and uppers stay the course.

But opramacare doesn't allow for a basic or catastrophic type policy. Is a one size fits all where more and more items fall under the 100% covered, must cover, and no copay allowed.

All driving up cost.

bluetick wrote:Our healthcare system today is basically unchanged, except that children can stay on a polcy til age 26. The meat of opramacare doesn't begin kicking in til 2014.

Health insurance premiums have doubled every 7-8 years. We should just leave the system as is, right, with 55-60 mil uninsured wearing out ERs and hospitals while watching family annual premiums crest 30k/yr?

Is that your knuckleheaded plan? The No Plan?

So now it's 60 million? And it's not unchanged tick. All the crap that went into effect simply added costs. The " freebies" aren't free. All these tests that must be 100% covered with no copay aren't free. No lifetime max isn't free. Ins an adult on your policy isn't free.

Hence higher premiums and higher copays for the shit they can still charge.

And then there is the med dev tax on 2.3% of gross income. Not profit, but income. Way to spur innovation there. thousands of employees being let go due to this tax.

So far the net effect of opramacare is higher costs, thousands of companies including public universities forcing folks to less than 30 hours a week to avoid the cost, dropping insurance all together and paying the tax, companies NOT hiring to avoid the full time employee limit, and companies letting people go.

Nice work.

sardis - stfu and get my K1 ready.

On March 1, 2010, billionaire investor Warren Buffett said that the high costs paid by U.S. companies for their employees' health care put them at a competitive disadvantage. He compared the roughly 17% of GDP spent by the U.S. on health care with the 9% of GDP spent by much of the rest of the world, noted that the U.S. has fewer doctors and nurses per person, and said, "[t]hat kind of a cost, compared with the rest of the world, is like a tapeworm eating at our economic body."[52]
[edit]Allegations of waste
In December 2011, the outgoing Administrator of the Centers for Medicare & Medicaid Services, Dr. Donald Berwick, asserted that 20% to 30% of health care spending is waste. He listed five causes for the waste: (1) overtreatment of patients, (2) the failure to coordinate care, (3) the administrative complexity of the health care system, (4) burdensome rules and (5) fraud.[53]


that 17% gdp will go up to 19% by 2017

if you work in the health system you see the above especially 1thru 3 every day.

the health system is about making money for the health system. the patient is secondary--his ability to provide income is primary.

amazing how an old fart admitted into a hospital fopr one thing with good insuracne comes out of said hospital stay having seen 5 or more specialists, had 10 or more tests procedures or imaging done to him with very little relationship to whatever brought him into the hospital and comes out with 3-4 new meds for his 3 or 4 days stay on average.

example of what drug companies can do

amioderone is a med used for irregular heartbeat. because of politics between drug companies and the CPR/ACLS people--every code that is run in this country usually includes amioderone because now it is the next choice after epinepherine for cardiac arrest. therefore every ER, clinic, nursing home etc has to stock this very expensive medication. Why? because one study showed it might have improved survivability getting to the hospital. never mind those pateints never make it out of the hospital.

same goes with with many of the statin drugs. one study out of many showed a reduction in cardiac issues compared to the non statin drugs. these arent exact numbers but gives you an example of drug company thinking. if you dont take statins you have a 4/100 chance of developing cholesterol containing lesions that form clots and cause heart attacks--if you take a stantin then it is 3/100 of those guys that have a heart attack. instead of telling you its a 1% reduction from 4% to 3% they tell you its a 25% reduction as they save 1 out of those 4 who had heart attacks. now mind you all the other studies didnt show this. but now we have standards that force you into giving these cholesterol drugs or face the conswequnces --ie peer review or malpractice etc if your patient was the one who had a MI and you didnt have him on a stantin with his cholesterol of 210

anyhoo we have medicare medicaid, the VA, Tricare and governement and childrens health insurance that account for about 50% of medical payments with private insurance basically providng the other 50% obama care will shift that equation. I see no way a govt run health care system saves the % of GDP from continuing to go up

one last stat for you. we rank first in percapita spending at about 8000 dollars a year per capita yet we rank 50th as a country in life expectancy. part of that reason is probably our homicide rate but dont forget the #9 cause pf death is the medical system itself with polypharmacy, needless and aggressive treatments due to the pressure of big money. we have to say no to people who have no business having certain treatments done to them because they are so high risk just because they have deep pockets

BigRedMan wrote:Couple of ways to cut costs:


Does every hospital in a 50 mile radius have to own a specialized machine like a MRI? What if local city hospitals took care of emergency stuff and basic surgery but for more specialized stuff, go to the hospitals that always advertise like #1 in heart care in central Indiana, etc... that have these special machines and doctors for that care.

Allow insurance companies to go between states and regions to allow more competition

Have a basic insurance plan that people can get that covers preventive and normal doctor visits like for a cold, twisted ankle, etc... and covers basic hospital stays for knee surgery, tonsil removal, etc..

Have another plan that you can opt-in for major health events like heart attack, major accident like car wrecks, or diagnosis of major health issues like cancer, diabetes, stuff like that.

Now how will that cut costs - Someone young starting out will most likely not opt in for a major health event plan because well, they are young. If the basic insurance does it job of providing cheaper and easier access to preventive measures, then major health issues should go down in the long term. Someone with a family in their 30-40 range will opt for both because of kids and just getting older. Now you can have plans where the major medical can be like 10k - 25k deductibles to help save money for both sides.

Couple of things:

1. Yes hospitals need their own imaging equpiment. This isn't 1957 where these are some wiz bang devices that people think are magic. These are standard pieces of equipment that hospitals and docs use to diagnose all kinds of injuries, diseases, stage treatment etc. One of the great things about being here is if you neet a ct, a petct, an mri you can get it and get it quickly. I posted a paper done by either Britain or Canada's own govt health body talking about this very thing. The USA has 5 to 7 times more ct and MRI machines per capita than uk and Canada. That is a primary reason that unless you are an emergency case from an accident or some other trauma, or MI you are going to be waiting in line to get a scan. Blown knee, bad back, etc you are waiting weeks or months to be seen. Having insurance and being able to access care when needed are two different things. Just in the last ten days mother in law has had a ultrasound, leading to gall bladder removed, a follow up ct looking at what we hoped are cysts on kidneys, to an MRI where there is a likely hood of malignancy and next steps are in the works. In the other countries we talk about that isn't all happening in ten days. More like months. States already have what is called a certificate of need for new scanners to be introduced. It basically let's hospitals, scanning centers, etc fight against or argue for more/newer scanners etc. seems like a cartel to me, but AA knows more about it.

2. I don't see how you can have ins like you stated. You don't insure your house or car for dents and dings. You insure them in case of accident, fire, tornado, etc. For the major event not the minor. Same with healthcare. You aren't going to go bankrupt because of visits for strep. You will if you have a major medical stay due to accident , disease, etc. opramacare precludes someone from using an hsa and having a catastrophic plan with a high deductible. Why?

Crash,

Care to provide where you got that we are 50th in life expectancy?

Meanwhile back at the ranch....


The Voter Fraud That ‘Never Happens’ Keeps Coming Back

http://www.nationalreview.com/corner/34 ... -john-fund

Critics of voter ID and other laws cracking down on voter fraud claim they’re unnecessary because fraud is nonexistent. For instance, Brennan Center attorneys Michael Waldman and Justin Levitt claimed last year: “A person casting two votes risks jail time and a fine for minimal gain. Proven voter fraud, statistically, happens about as often as death by lightning strike.”

Well, lightning is suddenly all over Cincinnati, Ohio. The Hamilton County Board of Elections is investigating 19 possible cases of alleged voter fraud that occurred when Ohio was a focal point of the 2012 presidential election. A total of 19 voters and nine witnesses are part of the probe.

Democrat Melowese Richardson has been an official poll worker for the last quarter century and registered thousands of people to vote last year. She candidly admitted to Cincinnati’s Channel 9 this week that she voted twice in the last election.

This is how Channel 9′s website summarized the case:

According to county documents, Richardson’s absentee ballot was accepted on Nov. 1, 2012 along with her signature. On Nov. 11, she told an official she also voted at a precinct because she was afraid her absentee ballot would not be counted in time.

“There’s absolutely no intent on my part to commit voter fraud,” said Richardson. . . .

The board’s documents also state that Richardson was allegedly disruptive and hid things from other poll workers on Election Day after another female worker reported she was intimidated by Richardson. . . .

During the investigation it was also discovered that her granddaughter, India Richardson, who was a first time voter in the 2012 election, cast two ballots in November.

Richardson insists she has done nothing wrong and promises to contest the charges: “I’ll fight it for Mr. Obama and for Mr. Obama’s right to sit as president of the United States.”

puterbac wrote:Meanwhile back at the ranch....


The Voter Fraud That ‘Never Happens’ Keeps Coming Back

http://www.nationalreview.com/corner/34 ... -john-fund

. . .Well, lightning is suddenly all over Cincinnati, Ohio. The Hamilton County Board of Elections is investigating 19 possible cases of alleged voter fraud that occurred when Ohio was a focal point of the 2012 presidential election. A total of 19 voters and nine witnesses are part of the probe . . .

It started as 81 votes, now it's down to 19 . . . out of 420,000 . . . and none of it is people voting who didn't have the right to do so, but people who may have voted absentee and at the poll because they thought their absentee ballot wasn't counted.

Here's what they said when they thought it was 81:

The 81 double votes, while too large a number to dismiss as insignificant, represent an infinitesimally small percentage of the roughly 420,000 votes cast in Hamilton County that would not have changed any race’s outcome. http://news.cincinnati.com/article/2012 ... ots-twice-
\

So now that it's 19 - out of 420,000 (0.0045%). By the time they finish investigating, it'll be down to 6 or 7 at most (one one thousandth of a percent).

That fucking cheater Obongo, stealing one one thousandth of of a percent of the votes! Why, if he did that in every Ohio county, that's 175 votes! . . . in a state he won by 167,000 votes . . .

Still, those cocksuckers knew the law. fry the bastards.

puterbac wrote:Crash,

Care to provide where you got that we are 50th in life expectancy?

Puter, we are lower in life expectancy but that has alot to do with how the statistics are counted. We count premies as young as 26 or 28 weeks, others only count full term infants and some even older than that. That brings ours down. Then you have murder and the big one motor vehicle accidents. That hurts us as well.

But that's why our life expectancy is lower, it's not that it really is lower it's just a numbers thing based on how the data is collected just like the "infant mortality" rate.

10ac wrote:it seems to me that those who feed on the misery of others (lawyers, doctors, funeral directors), seem to make the most money. I guess I can now add CPAs to that list.

Doctors actually help people. Funeral directors don't make all that much. Lawyers screw people.

Advantage: Doctors. By a mile.

Professor Tiger wrote:

10ac wrote:it seems to me that those who feed on the misery of others (lawyers, doctors, funeral directors), seem to make the most money. I guess I can now add CPAs to that list.

Doctors actually help people. Funeral directors don't make all that much. Lawyers screw people.

Advantage: Doctors. By a mile.

Correction: Many doctors help people. The biggest myth in America is that all MDs are infallible. Incompetence among medical doctors occurs at a rate comparable to the rate in every other profession, yet MDs are often portrayed (and carry themselves) as incapable or poor judgement, bad diagnoses or inconsistent work ethic.

http://articles.latimes.com/2010/aug/02 ... e-20100802

Few doctors make it through their training without being involved in at least one case that goes awry. I was no exception.

As an intern, I was assisting in a routine hernia operation when the attending surgeon cut the vas deferens, the tube that transports sperm from the testicle. I expected to be grilled by my colleagues afterward on the details, pressed to explain how this largely avoidable mistake possibly could have been made. That didn't happen.

Everyone already suspected what had gone wrong and who was responsible — the attending surgeon was notorious for his careless surgical technique — and they were simply willing to let it pass.

The surgeon's technical error was the first of two mistakes made in this case. The surgeon's colleagues committed the second error post-operatively: They chose to overlook a pattern of seemingly suboptimal care.

As patients, we'd like to believe that every physician is well-qualified to practice medicine. It simply isn't so. Some doctors are impaired by substance abuse; others by medical conditions such as mental illness. And some simply lack the technical skills or knowledge to safely care for patients; they are, frankly, incompetent.

No one knows precisely how many such doctors are actively caring for patients. But, according to a study published in July in the Journal of the American Medical Assn., the numbers are likely substantial. Researchers at Massachusetts General Hospital surveyed thousands of physicians in a variety of medical specialties; 17% said they'd had direct, personal knowledge of an impaired or incompetent colleague in their hospital, group or practice in the last three years.

Weeding out physicians who threaten the quality of care is challenging. Hospitals must routinely undergo detailed reviews, but doctors are largely unmonitored. In large part, they are expected to police one another. "Physicians are really the first line of defense," says Catherine DesRoches, lead author of the JAMA study.

In many ways, this approach makes sense. After all, who better to judge the work of one professional than someone with the same training and skills? But without other methods of monitoring in place, many incompetent and impaired physicians are allowed to continue treating patients.

According to the American Medical Assn.'s Code of Ethics, individual physicians have an ethical responsibility to report colleagues who they suspect are unable to practice safely; in most states, including California, reporting is actually a legal requirement. Nevertheless, many doctors fail to follow through on concerns about fellow physicians. In the JAMA study, 1 in 3 doctors who had reason to report chose not to do so.

"Whether that's a good number or a bad number depends on where you sit," DesRoches says.

Two-thirds of doctors are acting responsibly, but patients naturally want that number to reach 100%.

Patients are destined to be disappointed. Some doctors simply don't believe that reporting is always the right thing to do. In fact, only 64% of physicians surveyed in the JAMA study completely agreed that they have a professional commitment to report a colleague who may be endangering patients or not adequately performing his or her job. Further, many doctors don't feel prepared to assume the role of overseer. For some, it's an issue of logistics; they don't know whom to contact or how the process works. Others simply don't feel qualified to determine whether or not someone should be reported.

"Sometimes determining who's competent and who's incompetent is difficult," says Dr. Matthew Wynia, director of the AMA's Institute for Ethics.

Not only can incompetence levels vary, but someone can be competent at one thing and incompetent at another. Then there's the issue of clinical opinion: Doctors frequently approach the same problem in different ways. Just because two doctors don't agree on the best way to care for a patient doesn't mean that either of them is wrong.

Sometimes doctors opt not to report because they worry about the potential repercussions — for both themselves and the physicians they're turning in. They fear that reporting one colleague will damage their own personal and professional relationships. If they're viewed as a "snitch," for example, other physicians may stop referring patients to them or avoid collaborating with them lest they be deemed incompetent too. In the JAMA study, 12% of physicians who failed to report a problematic colleague made that choice because they feared retribution.

Doctors also worry that their colleagues will be punished excessively. Even the suggestion of a problem can irreparably damage a physician's reputation within the medical community. And, if a physician's license is revoked, his or her career is over.

"We need to recognize that doctors are human beings," Wynia says. Like anyone else, they have difficulty being the whistle-blower and have trouble turning in their friends.

"It's not the only method we should use to monitor professional behavior," says Wynia. "There are other mechanisms for quality assurance that are equally, if not more, important." For example, physicians should be required to pass rigorous recertification exams. "You should have to not only maintain your competence to practice over time, you should have to prove it."

There are plenty of details about my internship I can't remember; the hernia surgery, however, remains vividly clear. None of my colleagues wanted to hear what had happened in the operating room that day; it would have put them in the awkward situation of having to do something about it. Because the error had been corrected and the patient was doing fine, everyone could rationalize that it was a case of no harm, no foul.

I was distressed by the response but, being new on the job, figured it wasn't my place to accuse anyone of practicing bad medicine. I also thought that ultimately someone with more authority would address the problem. As far as I'm aware, nobody ever did.

Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. The M.D. appears once a month.

And don't forget, they are all a bunch of horn dogs. We pay more at Walgreens while sawbones plays grab-ass with some pharma sultry siren.

Couple of things:

1. Yes hospitals need their own imaging equpiment. This isn't 1957 where these are some wiz bang devices that people think are magic. These are standard pieces of equipment that hospitals and docs use to diagnose all kinds of injuries, diseases, stage treatment etc. One of the great things about being here is if you neet a ct, a petct, an mri you can get it and get it quickly. I posted a paper done by either Britain or Canada's own govt health body talking about this very thing. The USA has 5 to 7 times more ct and MRI machines per capita than uk and Canada. That is a primary reason that unless you are an emergency case from an accident or some other trauma, or MI you are going to be waiting in line to get a scan. Blown knee, bad back, etc you are waiting weeks or months to be seen. Having insurance and being able to access care when needed are two different things. Just in the last ten days mother in law has had a ultrasound, leading to gall bladder removed, a follow up ct looking at what we hoped are cysts on kidneys, to an MRI where there is a likely hood of malignancy and next steps are in the works. In the other countries we talk about that isn't all happening in ten days. More like months. States already have what is called a certificate of need for new scanners to be introduced. It basically let's hospitals, scanning centers, etc fight against or argue for more/newer scanners etc. seems like a cartel to me, but AA knows more about it.

2. I don't see how you can have ins like you stated. You don't insure your house or car for dents and dings. You insure them in case of accident, fire, tornado, etc. For the major event not the minor. Same with healthcare. You aren't going to go bankrupt because of visits for strep. You will if you have a major medical stay due to accident , disease, etc. opramacare precludes someone from using an hsa and having a catastrophic plan with a high deductible. Why?

I am not saying that you should have to drive 8 hours to have a simple MRI but you have to agree that some of these devices are close to a million dollars in cost just for the purchase price. Not including setup in the hospital, maintenance, and training. Would it really be so bad if someone had to drive a couple of hours at most and wait a couple of more hours to get the MRI done? I really don't think so.

You absolutely can insure your car for dents and dings. It is called property and liability. All you need is the state min coverage. Plain and simple. People who want to totally protect their vehicle do the full coverage.

Agreed you won't go bankrupt for doctor visits for strep, that part of the insurance should be inexpensive. Having a 10,000 deductible on a major medical stay policy isn't going to bankrupt anyone per say. I guess I look at it this way - What is worse, being uninsured and having a heart attack then coming home with a 100k bill OR having some sort of insurance like I described and coming home with a 10k bill? At least with the 10k bill, you have some options to work out payment plans and such. 100K and you are filing bankruptcy as soon as you get home.

puter

https://www.cia.gov/library/publication ... 2rank.html

I didn't mean that doctors were the cause of other peoples miserie, but that they made big bucks off peoples miseries. As do lawyers, funeral directors, CPAs...