On ‎5‎/‎28‎/‎2017 at 9:33 PM, Larry said:

I have to confess that I have severe doubts as to some of the proposals being made in here, to reduce health care costs.  

 

Many of them seem too simplistic, if not outright impossible.  "Just mandate that insurance companies must charge lower premiums, and pay a higher share of the costs, without reducing coverage."  

 

Now, I do have a feeling that there may be ways to reduce at least some costs.  but I feel like some of them will require huge attitude shifts.  on society as a whole.  

 

A decade or two ago, I head a report about a study somebody had dome.  I'm going strictly by memory, and have no link to any such study whatsoever.  So let's just call it a hypothetical, and pretend that I'm making it up.  Just assume that what I remember, is true.  

 

The study looked at four expensive but common medical procedures.  One of them was cardiac bypass surgery, I forget the other three.  They took all of the patients who's doctor recommended cardiac bypass surgery, and divided them into two groups:  Those who had the procedure, and those who chose not to have it.  

 

And they looked at their survival rates, which the study defined as "how many of the people, in each group, are still alive, five years later?"  

 

And in three of the four procedures they looked at, having the procedure did not increase the odds of the patient being alive, five years down the road.  Their odds of dying were the same, whether they had the procedure or not.  

 

So, let's just assume that what I remember is actually true.  Let's assume that cardiac bypass surgery does not actually improve the patient's odds of being alive, five years from now.  

 

Should we, as a society, at least consider the possibility that maybe we shouldn't have a system where other people pay for that procedure?  

 

I know, it's certainly easy to demonize a decision of "well, Uncle Joe needs cardiac bypass surgery, or else the odds are he may have another heart attack.  but this big entity (government or an insurance company) isn't going to pay for it.  And you can't.  So, you're not going to get it."  

 

What about the patient who's been in a nursing home for the last two years?  She can't speak a complete sentence.  (Although does sometimes appear to understand sentences.)  Can't stand.  Can't feed herself.  Has to be changed, every few hours.  

 

Does it really benefit society (or the individual, for that matter) to pay for her to live in a nursing home for five years, waiting for some medical condition to come along that will eventually end this?  What is anybody actually getting, for that money?  

 

But what's the alternative?  Kick her out and let her die in the street?  'Good morning, Mrs. Smith.  you've been here nine months, today.  The nurser will be in shortly with your ,mandatory euthanasia."?  

 

The current system, I feel like, isn't right.  But I'm not at all sure that I see a path to a better one.  How do you get to a better world?  (Especially when I'm not at all sure that I can even say what that better world is.)  

 

Part of me really wishes that we, as a society, would decide that maybe we need to relax some of the phobias we have against things like hospice, and I think things like suicide, and even physician-assisted euthanasia.  

 

Apologies for the probably morbid view.  

 

Funny thing is what you are suggesting is closer to what Tsongas and that Hillary lady were proposing in the 90's for which she is demonized to this day. He might have had a chance to be demonized as well, but he...well...he died.  They basically took an approach of we have x dollars which means we can afford to cover a,b, and c.  If you want D, we aren't saying it is no good.  We are simply saying covering it will not grant as many quality life years as a, b, or c.  So you can purchase insurance for D if you want.  It just won't be the insurance we believe all Americans are entitled to have.  The premise was basically greatest good for the greatest number possible using x dollars.

That failure became a starting point for the death panel misnomers that plagued the affordable care act decades later when they tried to cover doctors having end of life care discussions with patients.  Isn't it amazing how fear and slogans can slant a populations perspective for decades?  Sorry, I am feeling a bit jaded on the impact of politics on our healthcare, and yet it seems politics is a battlefield on which our fight must be carried.

As we cut social service programs because they are too expensive, I wonder how long it will be until we relearn the lessons of "Million Dollar Murray."

It doesn't matter if it is opioids (current epidemic), weed, crack or liquor.  The question to my mind is how serious are we about solving the problems?  One of my favorite quotes about what it takes for society to deal effectively with similar situations is "We can either be fair or effective, but we can't be both."  How do you tell the hard working single mom that society will provide a home and counselor to this troubled man while she struggles to pay rent and provide food?  Again, we can either be fair or effective.

As I watch so many safety nets taken down because they are too expensive for the tax payers, I find myself expecting we will pay far more in dollars and wasted lives traveling down our chosen path in the name of "fair."  There is a side of me left wondering if a problem that crosses racial and economic boundaries at will might finally bring the tragedies to enough light to re-inspire the side looking for solutions without preconceptions of morality beyond a desire to help those in dire need.

Poor guy. I might have more sympathy for thomas if I hadn't watched wall go through contact with out getting calls for years.

Whether it is popular on a sports message board with lots of testosterone or not, This Is Us is a fantastic show.  I don't think it is just our family's interracial adoptions that motivates me to think the show awesome.  It just hits on a lot of what it means to be a family with all the screw ups we all make and the emotions many of us experience with family.

Think how fitting the "bullets" name would have been for the goon image we see forming around our team.

Twa, did you read about trump's roll spreading the Russian disinformation in primary and general election that came out in senate today or just general skeptic of any non conforming info?

https://www.washingtonpost.com/powerpost/ryan-rubio-may-have-been-targets-of-damaging-russian-social-media-campaigns/2017/03/30/bdf5f4fa-154f-11e7-ada0-1489b735b3a3_story.html?hpid=hp_hp-top-table-main_ryan-rubio-3pm%3Ahomepage%2Fstory&utm_term=.b2d67b24d22d

The senate is taking it a bit more seriously since they have members who have been targeted. I note the roll trump played spreading the wildfire.  The question is how much was in knowingly furthering a foreign attempt to destabilise our democracy, the goal of the Russian disinformation tactics.

I still worry we are focusing on the wrong thing when we mention the areas with 1 or very few insurance providers. Is this area under served in terms of healthcare providers? Do the doctors and hospitals have market power to demand more regardless of what insurance says they will pay? I am not sure how a more free market for healthcare services solves the problem for these communities. I guess that is why i keep coming back to single payer as the optimal option for them. The irony is the places with the most healthcare choices seem to the only areas single payer is remotely popular. Those places it would help most dramatically wrap themselves in patriotism decrying single payer as a communist unamerican idea.  Nevertheless the rest of the world's free markets have moved to single payer. Could it be the only reason we do the have si for payer is government's intervention to keep us from a more natural economic state? Irony of just late night rambles?

Lombardi, I wasn't trying to pick on you.  I too am just trying to read and understand what they are planning in an effort to understand how they think this should unfold.  I am trying to understand what the goals are and how they are accomplished with this bill.

I get the tax relief as they repeal the ACA taxes and why many of their powerful constituents want that,

I sort of understand the reluctance over the insurance mandate, except we, the insured, end up covering the uninsured through increased medical bills and insurance premiums,  However, it requires a broader lens to see this because at first look someone else's decision to have or not have insurance shouldn't impact me, but it does.

I sort of understand the insurance across state lines, but is the issue with insurance or underserved markets for medical services.  The areas I heard where there was only one insurer seemed very rural.  If a geography has few medical providers, they can charge whatever they want.  This will drive up medical costs and consequently insurance costs.  However, if much of the population is poor then most won't be able to afford the insurance without government subsidies.  Look at where the insurance premiums rose the most.  How do these areas correlate with underserved medical markets and high costs for care?  We quickly assume the increase in costs is due to the ACA, but is it?  I ask, honestly not knowing the answer/rout cause,  I want to hope the Republicans crafting the bill are looking at causes not just snap shots of selected facts picked to tell a predetermined narrative.

Will medical bills and insurance premiums for the insured increase as the number of uninsured getting treatment (through the ER or other routes) they can not afford increases?  That was always explained to me as part of my hospital bill.

Will we see an increase in the number of medical bankruptcies (already number 1 cause of personal bankruptcies)?

If the government saves money by reducing Medicaid enrollment, how much of that will be spent covering ER visits by the uninsured and other costs? 

On ‎3‎/‎7‎/‎2017 at 10:59 AM, Riggo-toni said:

If all plans were required to use the very same universal forms for referrals, reimbursements, etc. you don't think think that would reduce the burden for Drs? 

Interesting note on this:  Over the summer, I was at a conference where various health professionals from doctors to med students to patients to healthcare systems administrators came together in an attempt to imagine ways healthcare could be improved.  On the first morning, I was off hiking with one of the founders of consumer reports and a few doctors, and I told them I thought the ACA had missed a huge opportunity to create a standard medical record and billing system.  I was told at that point there are 4 systems currently in popular usage in the U.S.

Of those four, three of them can read records from all but the one outlier. Think of Word being able to read a document from word perfect.  We are closer to a standard medical record than I appreciated from outside the system.

good graphical comparison btw Republican proprosal and ACA (Obamcare)

The only thing I think it missed was the reference to the tax breaks for insurance executives.

That continuous coverage requirement should worry those who remember insurance coverage for HIV patients in the 1990's. HIV patients were dropped from their insurance for any reason at all.  When I studied this in the late 90's over half of HIV positive patients lost their insurance within two years. I still remember the case of the patient dropped because their premium wasn't processed...As it sat in the po box for weeks.  

Does this combined w a race to the bottom as we allow insurance to be sold across state lines while be incorporated in the state w the most lax enforcement worry anyone?

The ACA is far from perfect, but we would due well to avoid the mistakes we made with previous health-care laws and systems.

deleted for going off topic due to frustration.

As a foster parent/adoptive parent, let me point out foster care, Medicaid and the ACA (A.K.A. Obamacare) are linked. 

This is even more true when we talk about medically fragile children.  FWIW, these are the kids with pre-existing conditions who used to run headlong into the troubles getting private healthcare to cover their conditions.  Then if they were lucky enough to get coverage, they had to worry about life time spending caps. 

Even with these big ticket items, I suppose there will always be somebody complaining about food stamps.  As an aside to bring it back around to the post saying to take the kids rather than let them starve without food stamps, this isn't as far fetched a worry as many of us privileged schmoes  would think.  NPR had a peace last year about Native American children taken from their parents for "neglect."  It turns out, many were taken simply because the Indians on the reservations were poor, and the state got federal funds to "treat" the kids equal to the funds granted for the care of medically fragile children.  So the "If they can't feed the children then we will take them" approach has been (and maybe still is being) used to explain some of our less savory treatment of the poor. Knowing some of the outlays for the foster care of medically fragile children, we can supply a lot of food stamps for far far les cost. 

You want to talk expensive?  "Take the kids"...as a foster parent, I can assure you the state dollars won't go nearly as far if we have to find homes for all the kids.  Of course, that assumes we could find homes for them.  We don't have enough homes for the ones in the systems now.

How are we really expecting sustained 3 percent growth in GDP with a declining work age population? Do people ever think what that would mean in their job or business? Imagine  being told you must make more this year and more again every year after...right after being told your hours are being cut...and your hours will be cut every year.  Maybe...If you can count on new tech to make your job easier, but the new tech better be exclusively yours or you will lose business to your competitors. Don't worry though because we are cutting education because new tech advancements don't come from studies.

We need more workers to at least offset some of the demographic losses we will see in coming years. 

I keep thinking demographics rules most macro economic models.  We have a baby boom generation approaching retirement.  It will hurt our economy as things stand now, but if one needs to feel better, it is a problem shared across all of the industrialized world save for one country,  The U.S. is lucky because the only country that is not facing an aging population issue happens to be directly to our south with a long history of sending workforce northward.

If you worry about the our economic output lowering our status in the world over the next generation, I would point out the areas most frequently thought to take over first place are in a worse spot than we are.  China is in much worse shape due to 30 years of a one child law.  India and Europe have  larger baby boomer problems than we do. 

At the end of the day, we need workers to produce the goods and services that make our economy productive.  If the thought is the immigrants don't have the skills we need, I would say that is on us.  We need to train them to the point where they can be a net positive in this generation or the next.  Assimilation is a tough problem, but I would maintain it is a better problem to have than the problem of a decline in the potential size of an economy's workforce.

I think of it as like having ants in your house.  It's annoying, but it beats having termites.  Since ants and termites don't peacefully coexist, having ants generally means not having termites.  Likewise, having an immigrant workforce beats not having workers.

I just don't understand why we didn't foul Lebron as soon as he got the ball before he could even go behind the three point line.  We should have fouled instantly and let him or anyone else take their 2 shots.. 

ABIM Statement: Travel Ban Threatens to Disrupt Patient Care

It is probably worth noting that the preventative care is the more expensive route in most cases.  Look at the likely possible outcomes: You get the cancer caught early by going for test number x that wasn't covered before.  You  go through the treatment and live because it was caught early.  This may be cheaper than having it caught later and spending a lot of money trying, unsuccessfully to cure you.  However under the first scenario, you lived to have y more tests, survive numerous more conditions and eventually succumb to some horribly expensive to treat disease.  The advantage to the "test often and catch early" medical system is you live, but nothing comes free. 

Last night was a reminder to me of how much like every other sport soccer is.  Like the other sports, it's all about time and space.  What I saw last night was a U.S. team unable to get good, clean first touches on the ball which lead to pressure leading to bad passes.  Argentina by contrast were clinical in their passing, needing little extra time or space.  Not that it mattered much, but the U.S. was for the most part content to try and play with numbers between the ball and their goal without consistent pressure on the ball.

Outside of the Messi goal (a thing of beauty), I didn't see much from Argentina besides good to great basic fundamentals.  Their passes and traps were clean, and their players maintained spacing to allow for relief when/if the U.S. tried to pressure them.  The U.S. seemed to have decided against applying pressure in the offensive zone, perhaps because there was too much space for them to defend?  Sadly, we did not mark well enough in the defensive half to apply pressure on that end to force Argentina to give the ball up for counter attacks.

Argentina played a beautiful game.  Sometimes, you have to just tip your hat to the team that played better in every aspect of the game.

I would be very surprised if the red is overturned.  Even with the evidence that no punch was landed, or for that matter intended, I just don't see FIFA overturning a call on the field.  For that matter, I think a good case can be made for the call as a good faith effort to regain control of a match that was rapidly getting dangerously out of control.  As a U.S. fan, I hate the call, but I can't say it was the wrong call.

I don't know who I think had the best game for us last night.  I think a good case can be made for Brooks or Wood, but it would be hard not to go with Dempsy after the goal and assist.  Still, the other 2 caused consistent problems for Ecuador all game long.

Outside of the cards, it was a great U.S. victory against a quality side.

Better than Affleck? You're joking, right?

Added - just watch it. By the end of episode two, you should be hooked. And then there is D'Onofrio, who takes it to a whole new level...the best comic villain depicted on film (better than any Joker portrayal, imo).

He was good, but I still like the most recent big screen Joker.  The boss was also awesome, and the two characters made Daredevil as much as finally having a script and plot for Daredevil himself.  As a side note, I have been watching Gotham, and I think the guy who plays Penguin does an incredible job.  I always thought of him as the weakest, weeniest of Gotham's villains, but his portrayal of him rocks enough to make me watch the series.