Dog Brothers Public Forum
Return To Homepage
Welcome, Guest. Please login or register.
September 03, 2014, 02:09:31 AM

Login with username, password and session length
Search:     Advanced search
Welcome to the Dog Brothers Public Forum.
82159 Posts in 2247 Topics by 1047 Members
Latest Member: MikeT
* Home Help Search Login Register
+  Dog Brothers Public Forum
|-+  Politics, Religion, Science, Culture and Humanities
| |-+  Politics & Religion
| | |-+  The Politics of Health Care
« previous next »
Pages: 1 2 [3] 4 5 ... 28 Print
Author Topic: The Politics of Health Care  (Read 164783 times)
JDN
Power User
***
Posts: 2004


« Reply #100 on: March 04, 2009, 12:20:57 PM »

If you go see a doctor tomorrow, pay attention the paperwork you sign.  One form in the stack will be an authorization to release medical records. 
Only if you pay cash and refuse to sign the form will you be exempt. 

Ergo the government/industry already has access to your medical records, insurance companies have access to your medical records, hospitals do,
other doctors do, etc.  Theoretically, this information cannot be disseminated or  "abused"; yet as you pointed out records are often improperly accessed
and abused.  Another data bank will not significantly change that. 
Logged
Body-by-Guinness
Power User
***
Posts: 2788


« Reply #101 on: March 04, 2009, 12:37:16 PM »

Horsepuckey. Currently the feds would have to do some pretty serious work to get a hold of my records and leave questionable fingerprints all over the place in doing so. I just transferred my files from one Dr. to another and am not particularly worried some clown in DC can get his hands on all those photocopies. That changes when there is a central repository for reasons I've already stated and that you failed to address.
Logged
Body-by-Guinness
Power User
***
Posts: 2788


« Reply #102 on: March 04, 2009, 09:00:00 PM »

Stealth Care
By INVESTOR'S BUSINESS DAILY | Posted Wednesday, March 04, 2009 4:20 PM PT
Spending: The stimulus provides for the creation of a federal health care bureaucracy not unlike Hillarycare. Decisions that should be made by doctors and patients will belong to bureaucrats deciding cost-effectiveness.
IBD Exclusive Series: Inside The Stimulus

The stimulus bill commits $19 billion to accelerate adoption of Health Information Technology (HIT) systems by doctors and hospitals. It involves the creation of electronic medical records to be stored in a central database. This is said to be for reducing treatment errors and increasing efficiency in the delivery of medical care.
It also authorizes the creation of the Office of the National Coordinator for Health Information Technology — and the appointment of a 15-member board of officials from federal agencies and others — charged with developing this nationwide health information database
It further creates an entity called the Federal Coordinating Council for Comparative Effectiveness Research, which will decide which treatments you should get, whether you should get them, and whether they should even be available. It is modeled after a British board which helps run the notoriously inefficient and bureaucratic National Health Service.
These agencies will monitor treatments to make sure your doctor is caring for you in a way the federal government deems appropriate and cost-effective. Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost-effectiveness standard that would lead to health care rationing. It would determine what medical care should be provided and who should get it.
The U.K. board approves or rejects treatments after dividing the cost of the treatment by the number of years the patient is expected to benefit. Such a formula is found on page 464 of the stimulus bill.
Under these formulas, younger patients likely get treatment for whatever ails them before granny can get her hip replacement. In 2005, the Orwellian-named British National Institute for Health and Clinical Excellence proposed that the National Health Service use age as a measurement of a patient's worthiness for treatment.
In 2006, for example, a U.K board decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other. After all, how many years would they be needing two good eyes?
The system that will store everyone's medical records electronically, which was supposed to make health care delivery more efficient, will make it more subservient to government whim by providing a system to monitor doctors' treatment.
Medical treatments should be determined by doctors and patients and not by a bureaucracy that will ration your health care, deciding whether you really need it and are really worth it.

http://www.ibdeditorials.com/IBDArticles.aspx?id=321064867290632
Logged
ccp
Power User
***
Posts: 4052


« Reply #103 on: March 05, 2009, 04:20:21 PM »

The them is us.  it is America as we knew it.  The you is BO and his true agenda.  America just voted the most liberal guy in the Senate to be our leader.  Why people now are so surprised by his leftist leanings I guess comes from the humanistic natural defense mechanism of denial.

Personally I have seen enough.  Lets not be taken by his deception.  This guy will go on to "being open to all ideas and options", and "everything is on the table" etc etc.

This guy's game is now obvious.  "Pretend you are one of them, then can change them."  Thanks to Mark Levin for opening my eyes pre election about what BO is really about and what he is up to.  As he says "it is pay back time".  This is reparations time.  Problem is we will all suffer far more because of this.

Folks, the *plan* for health care reform is already done.  Just like it is for Wall Street, Gas and coal companies, businesses, those at the higher end of the pay scale, Israel, and all the rest.   This is just a dog and pony show to snooker the gullible:

****Obama open to compromise on health care overhaul
         AP – President Barack Obama delivers remarks to the White House Forum on Health Reform, Thursday, March 5, … WASHINGTON – President Barack Obama said the consensus from the White House health care summit is that there is an immediate need for health care reform, and signaled that he's open to compromise on Thursday.

Obama told participants at the end of a health summit that although he offered a plan during last year's campaign, he isn't wedded to that proposal. He told Republicans and Democrats, doctors and insurers — "I just want to figure out what works."

The president said there are some elements that all sides can agree on such as electronic health records that will save lives and money. Other issues — such as his $634 billion down payment for expanded coverage — are certain to create deep divisions.

He said: "We have to keep an open mind."

Obama invited more than 120 people who hold a wide range of views on how to fix the system.

Obama entered the room with Sen. Edward Kennedy of Massachusetts, who is battling a brain tumor. After brief remarks summarizing the participants' observations, Obama called on Kennedy. The veteran Democratic senator said he looked forward to being a foot soldier in the push for health care reform and said: "this time we will not fail."

Kennedy, who recently turned 77, is battling brain cancer and has been in Florida continuing his treatment and physical rehabilitation. He chairs the Health, Education, Labor and Pensions Committee and was a strong Obama backer during the 2008 campaign.****


Logged
Body-by-Guinness
Power User
***
Posts: 2788


« Reply #104 on: March 06, 2009, 04:12:19 PM »

Some links that'll give you an idea what waitlists for surgery look like north of the border.

Waiting Lists For Surgery In Canada

British Columbia:

http://www.health.gov.bc.ca/waitlist/

Here's one for Cardiac surgery:

http://www.health.gov.bc.ca/waitlist/cardiac.html

Here's Ontario:

http://www.health.gov.on.ca/transformation/wait_times/wait_mn.html

Click in here, and click on "Wait Times In your Area". Then click on "Find By Map Location", and pick out an area at random. See how much time one has to wait for cancer surgery

http://www.health.gov.on.ca/transformation/wait_times/public/wt_public_mn.html

Here's a site that gives you the average wait times for whatever ails you in Alberta:

http://www.ahw.gov.ab.ca/waitlist/AccessGoalCharts.jsp
Logged
Body-by-Guinness
Power User
***
Posts: 2788


« Reply #105 on: March 06, 2009, 06:22:42 PM »

Interesting exchange about universal health care can be found here:

http://www.cato-at-liberty.org/2009/03/06/this-is-why-universal-coverage-is-a-religion-and-not-about-compassion-or-saving-lives/

Contains more formatting than I'd care to replicate and a lot of links.
Logged
G M
Power User
***
Posts: 12003


« Reply #106 on: March 06, 2009, 06:31:29 PM »

Why wait, let's get rid of free market supermarkets and have government run food centers instead! I'm sure that'll work just as well as Obamacare.
Logged
Chad
Power User
***
Posts: 103


« Reply #107 on: March 11, 2009, 10:33:16 PM »

Quote from: blackfive.net
WTF?!

On CNN's Political Tracker: http://politicalticker.blogs.cnn.com/2009/03/10/senator-warns-white-house-on-possible-vet-proposal/#more-43270

WASHINGTON (CNN) - Veterans Affairs Secretary Eric Shinseki confirmed Tuesday that the Obama administration is considering a controversial plan to make veterans pay for treatment of service-related injuries with private insurance, but was told by lawmakers that it would be "dead on arrival" if sent to Congress...

But it's still under consideration after several lawmakers tried to get ahead of the change:

...No official proposal to create such a program has been announced publicly, but veterans groups wrote a pre-emptive letter last week to President Obama opposing the idea after hearing the plan was under consideration. The groups also noticed an increase in “third-party collections” estimated in the 2010 budget proposal—something they said could only be achieved if the VA started billing for service-related injuries.

Asked about the proposal, Shinseki said it was under "consideration."

"A final decision hasn't been made yet," he said...
Logged
DougMacG
Power User
***
Posts: 5875


« Reply #108 on: March 13, 2009, 06:17:10 PM »

Riot/protest video edited out of this topic per moderator directive. I stand by my observation that this unrest is now in Sweden because these people moved there, not for the weather, not for the jobs with 70% unemployed, but for the world's most lavish welfare benefits including universal healthcare. - Doug
« Last Edit: March 14, 2009, 09:03:05 AM by DougMacG » Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31053


« Reply #109 on: March 14, 2009, 12:16:29 AM »

Interesting footage, but the connection to the subject of this thread is ephemeral at best.  Please repost it in the Isalm in Europe thread.
=====================


http://www.americanthinker.com/2009/03/extinguishing_physician_consci.html
Extinguishing Physician Conscience
By Mary L. Davenport, MD
The largest generational cohort in American history, the Baby Boomers, will be the first Americans to be denied available effective life-saving treatments for reasons of cost. The seeds for this mass liquidation have already been planted.


Imagine that it is 2016, and you are a 65 year old boomer. You have been admitted to your local community hospital with malaise, fatigue, vomiting and cloudy mental status. You have had blood pressure problems and diabetes for a few years, and have just been diagnosed with renal failure. As you drift in and out of consciousness, you are vaguely aware your old family practice physician, who had taken care of you for 20 years, is not around. A religious man, he quietly retired from medical practice in 2014, after the full force of the Obama administration‘s removal of conscience protection for physicians in February, 2009, came into effect.


You feel vaguely uncomfortable as you are placed in a darkened room in the Comfort Care wing of the hospital. In moments of lucidity, you wonder if you shouldn't have some oxygen, an IV or SOMETHING! But the appropriate therapy, kidney dialysis, is not on the approved list of treatments for patients over 65, having been deemed too expensive. The new regulations from the Department of Health and Human Services were presented just last month to your hospital's Futile Care Committee. It was decided at the highest levels that for those over 65 years of age, renal dialysis would not be a beneficial treatment, that the alternatives of a kidney transplant were too expensive, and that your quality of life on chronic dialysis would be too diminished.

Your children wonder why you are not in an ICU. They are told that you will be placed on a morphine drip to make you more comfortable as you pass away, and that this is the highest standard of care for your diagnosis and age. It is called terminal sedation. You signed an advanced directive indicating that you did not want extraordinary care for a terminal condition, and under the new protocols renal failure, although treatable, qualifies as a terminal condition.


Your children frantically try to find their old family doctor. But your health plan replaced him with a large group of younger physicians, the hospital's Consortium for Health, a private-public foundation that was created to promote efficiency and reduce wasteful spending in medical care. By 2014 when he left, your family doctor was a dinosaur, having been trained in an earlier era. His medical school was one of the last to retain the original Hippocratic Oath.  It affirmed the covenantal relationship between the physician and patient, overseen by God, and that whatever the physician did would be for the patient's benefit.  You had felt safe entrusting your health to Dr. O'Brien's professional judgment.


Not only did the Hippocratic Oath your doctor took decades ago took specifically forbid physician assisted suicide and abortion, it also established patient confidentiality so that your secrets would never be disclosed. That is, until 2012, when physicians participating in the national healthcare system, which included ALL licensed physicians, were mandated to submit your visits to the unified electronic medical record system.  This data base was created in 2003 to coordinate medical care, detect emerging health threats, and exchange clinical information. Your doctor was very uncomfortable with this policy despite reassurances that HIPAA regulations would maintain your privacy.


But forces beyond any individual's control began to erode your relationship with your doctor long before he left the practice of medicine. The insurance companies stopped paying him in the late 1990's for hospital care, preferring to hire "hospitalists" or "intensivists" for greater efficiency in reducing hospital stays. Since office visits were reimbursed at lower and lower rates, your doctor had to see more and more patients in the office to just stay even. So although O'Brien knew you well and was trained to treat conditions such as renal failure or pneumonia, he stopped treating patients in the hospital.


Around 2007 both the hospital and office physicians began to be paid by a formula that rewarded them for saving money on medical care.  When your family doctor was forced to join the Consortium in 2012 because the health plans stopped contracting with individual physicians, a powerful new computer system tracked each doctor's prescribing habits, referrals to specialists, and utilization of expensive lab tests. But your doctor was an "outlier" in this new system, having been brought up in Hippocratic tradition of doing what was necessary for the individual patient, rather than the Greater Good, the newer communitarian ethic followed by the younger doctors. He was financially penalized for doing too much for his patients, since the formulas based 30% of physician income on "efficiency."


Your old doctor could tolerate the erosion of his income, but had trouble with the new regulations that insisted that he discuss and refer for "all legal procedures." Since by 2013 physician assisted suicide was legal in 21 of 50 states, the Consortium enumerated the conditions that mandated the "euthanasia talk", including multiple sclerosis, metastatic breast cancer, and many others. He could never actually bring himself to violate his original Hippocratic Oath that not only forbade assisting his patients in committing suicide but also prohibited even mentioning it. It was impossible to rid himself of the idea that a physician's role was to assist in healing and that medical killing was antithetical to his professional integrity.


Back in 2007, ACOG, the ob/gyn's professional organization, issued Ethics Committee Opinion 385, contending that ob/gyn doctors had the duty to either do abortions or have offices in close proximity to abortion doctors to whom they would refer patients. There was an outcry from professional organizations of pro-life ob/gyns, Catholic physicians,  and other Christian doctors. Especially troubling to many was the assertion in  Committee Opinion 385 that defined conscience as a sentiment, and measured its "authenticity" by the degree to which a provider would suffer "guilt, shame or loss of self esteem" if it were violated. Your doctor and many of his colleagues regarded medical killing as anathema, and were incensed by describing their integrity as a physicians as a "feeling". But by 2013 the protests had died down, and the ethics committee recommendation for ob/gyn's had evolved into a mandate for family practice doctors under new rules enforced by the Department of Health and Human Services.


The final blow came in early 2014. Back in 2008, in Benitez v North Coast Women's Care Medical Group, the California Supreme Court ruled against ob/gyn doctors who did not want to provide intrauterine insemination to a lesbian couple because of their religious beliefs. Although most European nations did not allow the buying or selling of eggs or sperm, and restricted fertility therapies to heterosexual married couples, the California courts not only permitted but required health care providers to cooperate in any reproductive therapies for any patient regardless of sexual orientation or marital status.


Although the birth of octuplets in 2009 with assisted reproductive technology to a single woman with six other children initially created a brief public uproar, ultimately no legislation was passed protecting physicians who did not want to participate in a patient's procreative endeavor. Your physician had a 68 year old bipolar single male patient who wanted to have an heir. The patient requested that your doctor appeal to the Consortium to provide him with a donated egg and surrogate mother for his desired offspring. Since your doctor did not want to be used as a tool in his patient's peculiar agenda and was legitimately afraid of an expensive lawsuit that would decimate his dwindling retirement funds if he refused, he decided at this point to quit medicine altogether and move to a sunny warm state.


Your family doctor had been inspired as a young man by study of the U.S. Constitution and other foundational documents that he thought would forever ensure his liberty. He had studied the same "Rules of Civility" that the young George Washington had encountered in 1747.  One of the most memorable of these maxims was "Labor to keep alive in your breast that little spark of celestial fire called conscience." It was clear to him that conscience here referred to man's innate understanding of moral right and wrong. When the American Founders would later declare independence from Great Britain in 1776, it was by virtue of this "spark of celestial fire" that they would establish the principles of human equality, unalienable rights, and government by consent as the foundations of American constitutional government.


Just before he left for his retirement home, your doctor was deeply disturbed to see the concept of conscience mocked in the New England Journal of Medicine by University of Wisconsin law professor R. Alta Charo in her article "The Celestial Fire of Conscience - Refusing to Provide Medical Care."  Charo's presentation did not acknowledge that many Americans do not believe that abortion, assisted suicide, and embryonic stem cell therapies are legitimate medical care in the first place. Her article also did not distinguish between emergency and elective care, and merely regards the health care provider as a tool for whatever ends the patient wants to achieve. Attorneys such as Ms. Charo claimed the right to take whatever cases they want, but seem deny the same basic right to physicians. Patients can always seek the care of other providers.


Your doctor (and many other Americans) believed that failure to protect physician conscience will destroy the trust and accountability that is essential to the physician patient relationship. If the physician and patient cannot freely collaborate, ultimately another agenda -- that of the health plan or state -- will replace it, to everyone's detriment.


Dr. Davenport is an obstetrician/gynecologist in private practice in El Sobrante, California.
Logged
Chad
Power User
***
Posts: 103


« Reply #110 on: March 15, 2009, 09:37:40 AM »

Proposal problematic for Obama as he denounced similar one in campaign

By Jackie Calmes and Robert Pear
The New York Times
updated 9:31 a.m. CT, Sun., March. 15, 2009
WASHINGTON - The Obama administration is signaling to Congress that the president could support taxing some employee health benefits, as several influential lawmakers and many economists favor, to help pay for overhauling the health care system.

The proposal is politically problematic for President Obama, however, since it is similar to one he denounced in the presidential campaign as “the largest middle-class tax increase in history.” Most Americans with insurance get it from their employers, and taxing workers for the benefit is opposed by union leaders and some businesses.

In television advertisements last fall, Mr. Obama criticized his Republican rival for the presidency, Senator John McCain of Arizona, for proposing to tax all employer-provided health benefits. The benefits have long been tax-free, regardless of how generous they are or how much an employee earns. The advertisements did not point out that Mr. McCain, in exchange, wanted to give all families a tax credit to subsidize the purchase of coverage.

At the time, even some Obama supporters said privately that he might come to regret his position if he won the election; in effect, they said, he was potentially giving up an important option to help finance his ambitious health care agenda to reduce medical costs and to expand coverage to the 46 million uninsured Americans. Now that Mr. Obama has begun the health debate, several advisers say that while he will not propose changing the tax-free status of employee health benefits, neither will he oppose it if Congress does so.

At a recent Congressional hearing, Senator Ron Wyden, an Oregon Democrat whose own health plan would make benefits taxable, asked Peter R. Orszag, the president’s budget director, about the issue. Mr. Orszag replied that it “most firmly should remain on the table.”

Mr. Orszag, an economist who has served as director of the Congressional Budget Office, has written favorably of taxing some employer-provided health benefits and using the revenue savings for other health-related incentives. So has another Obama adviser, Jason Furman, the deputy director of the White House National Economic Council.


They, like other proponents, cite evidence that tax-free benefits encourage what Mr. McCain called “gold-plated” policies, resulting in inefficient and costly demands for health care and pressure on employers to hold down workers’ pay as insurance expenses rise. And, they say, the policy discriminates against those — many of whom are low-income workers — who do not have employer-provided coverage.

When Senator Max Baucus, Democrat of Montana, advocated taxing benefits at a recent hearing of the Finance Committee, which he leads, Treasury Secretary Timothy F. Geithner assured him that the administration was open to all ideas from Congress. Mr. Geithner did, however, allude to the position that Mr. Obama had taken as a candidate.

The administration’s receptivity to the idea is owed partly to the advocacy of Mr. Baucus, whose committee has jurisdiction over tax policy and health programs, and to support from Republicans. There is less enthusiasm among Democrats in the House, though the health debate is at an early stage and no comprehensive plans are on the table.

Also, Mr. Obama’s own idea for raising revenues for health care — limiting the income tax deductions that the most affluent taxpayers claim — has run into opposition not only from Mr. Baucus but also from his counterpart in the House, Representative Charles B. Rangel, Democrat of New York, who is chairman of the Ways and Means Committee.

Mr. Obama’s proposed limit on deductions would raise an estimated $318 billion over 10 years, or half of his proposed “health care reserve fund.” That is a fraction of the revenues that could be raised from taxing employer-provided health benefits.

In the campaign, Mr. McCain estimated that taxing all health benefits would raise $3.6 trillion over a decade — “a multitrillion-dollar tax hike,” one Obama advertisement said.

The Congressional Budget Office says that including health benefits in taxable income could mean $246 billion in additional revenue for a single year. Stopping short of full taxation, as Mr. Baucus and others suggest, would mean less new revenue.

The latest government figures, for 2007, show that 70 percent of the 253 million people with health insurance received at least some of their coverage through employers. Employment-based insurance covers three-fifths of the population under 65.


Those who want to tax benefits in whole or in part make two main arguments. They say the tax exclusion is a generous subsidy that insulates employees from the true costs of health care, leading them to demand more of it and driving up overall costs. Critics also say the policy is unfair because it favors higher-income people. “It’s too regressive,” Mr. Baucus said. “It just skews the system.”

But in a blueprint for health legislation that he issued last November, Mr. Baucus said taking the exclusion on health benefits out of the tax code would go “too far” and “cause widespread disruption in employer-based health benefits.” Mr. Obama has also said he wants to preserve employer-provided coverage. Mr. Baucus, in his paper, cited other options, like taxing benefits above some value, taxing only wealthy employees or both.

However the proposal is devised, advocates will not have an easy time selling it.

Republicans, like Mr. McCain and former President George W. Bush before him, tend to favor taxing the benefits to finance other incentives for people to buy their own insurance. But given Mr. Obama’s use of the issue in his campaign, Republicans are unlikely to support a change unless the president himself proposes it, a senior adviser to Senate Republicans said.

Many Democrats, especially House liberals, are opposed. “It’s a dumb idea,” said Representative Pete Stark of California, chairman of the Ways and Means Subcommittee on Health. “We have to maintain as much as we can of the employer payments.”

Administration officials often say they will not repeat the mistakes of former President Bill Clinton, whose plan for universal health insurance collapsed in 1994. But Frank B. McArdle, a health policy expert at Hewitt Associates, a benefits consulting firm, said, “If President Obama agrees to cut back the tax break for employee health benefits, he will risk repeating one of Mr. Clinton’s errors by disrupting health insurance for people who have it and like it.”

Some big businesses consider nontaxable employment benefits a tool for recruiting and retaining workers. The United States Chamber of Commerce opposes eliminating the exclusion on health benefits, but James P. Gelfand, senior manager of health policy, said the group had not taken a position on limiting it.

Organized labor, a pillar of the Democratic Party base, considers the benefits among the union movement’s historic achievements for the middle class. But a split could be developing between the manufacturing unions, which have negotiated rich benefit packages, and the growing service employees unions, which include many low-wage workers without generous benefits.


Alan V. Reuther, legislative director of the United Automobile Workers, said: “These proposals would represent a tax increase on working families. They would undermine good health care coverage.”

But at the Service Employees International Union, which was an early supporter of Mr. Obama, Dennis Rivera, the coordinator of the union’s health care campaign, said that while his organization was “predisposed not to agree to the taxing of health benefits,” he would wait to pass judgment. The union, Mr. Rivera said, wants to see how any tax changes fit into the overall effort to revamp the health care system. “We need to see the total picture,” he said.

This story, Administration Is Open to Taxing Health Benefits, originally appeared in the New York Times.


Copyright © 2009 The New York Times
URL: http://www.msnbc.msn.com/id/29703278/



MSN Privacy . Legal
© 2009 MSNBC.com
Logged
Body-by-Guinness
Power User
***
Posts: 2788


« Reply #111 on: March 18, 2009, 02:56:45 PM »

More Reasons Not to Nationalize Health Care

Posted by Doug Bandow

Advocates of a government takeover of the health care system routinely offer up horror stories of American medicine, and no system yet has found a way around the problem of human imperfection, especially when operating in a system with such distorted incentives–most from ill-considered government policies.  Yet the horror stories in nationalized health care systems are manifold and tend to be more intractable since they result from government policy.

For instance, consider the quality of care delivered by hospitals in one region in Great Britain (with a hat-tip to Philip Klein of the American Spectator for finding this story).  According to the Daily Telegraph:

Sir Ian Kennedy, chairman of the Healthcare Commission, said the report is a ’shocking story’ and that there were failures at almost every stage of care of emergency patients. “There is no doubt that patients will have suffered and some of them will have died as a result,” he said.

The investigation of the trust now called the Mid-Staffordshire NHS Foundation Trust, found overstretched and poorly trained nurses who turned off equipment because they did not know how to work it, newly qualified doctors left to care for patients recovering from surgery at night, patients left for hours in soiled bedclothes, reception staff expected to judge how seriousness of patients arriving at A&E, patients left without food or drink, others who received the wrong medication or none at all, blood and faeces left on lavatories and floors, and doctors diverted away from seriously ill patients in order to treat minor ones who were in danger of breaching the four hour waiting time target.

When high mortality rates triggered questions, the trust board of directors ‘fobbed off’ investigators by saying the rates were a result of statistical errors but the Healthcare Commission found this was not that case.

The report said there was a ‘reluctance to acknowledge or even consider that the care of patients was poor’.

The trust was more concerned with hitting targets, gaining Foundation Trust status and marketing and had ‘lost sight’ of its responsibilities for patient care, the report said.

Sir Ian said: “The resulting report is a shocking story. Our report tells a story of appalling standards of care and chaotic systems for looking after patients.”

While Britain tends to be near the bottom in terms of health care system in industrialized states, there are plenty of horror stories elsewhere.  Socialism doesn’t work, whether in health care or elsewhere.  As Investor’s Business Daily reminds us:

The Swedish government system is no better. It also refuses to provide some expensive medication and, inhumanely, refuses to let patients buy the drugs themselves. Why? According to a Journal of American Physicians and Surgeons article, bureaucrats believe doing so “would set a bad precedent and lead to unequal access to medicine.”

Like Canadians, Swedes are subjected to long waits. They also have denial-of-care problems that sometimes lead to death.

A reasonable person would see the record of repeated failures in government-run medicine as evidence that such a system is not sustainable. Yet every central planner thinks he or she — or his or her immediate group — is smart enough to correct the flaws of socialist programs and therefore has the moral authority to force others to participate in his experiments. It is the same thinking that will move a person to say we are the ones we’ve been waiting for.

The Obama administration seems determined to waste a lot of money “stimulating” the economy.  We can replace money lost.  But if the administration succeeds in nationalizing the medical system directly or indirectly, the damage may prove irreversible–and deadly.

http://www.cato-at-liberty.org/2009/03/18/more-reasons-not-to-nationalize-health-care/
Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31053


« Reply #112 on: March 26, 2009, 11:39:14 PM »

Praise Mitt Romney. Three years ago, the former Massachusetts Governor had the inadvertent good sense to create the "universal" health-care program that the White House and Congress now want to inflict on the entire country. It is proving to be instructive, as Mr. Romney's foresight previews what President Obama, Max Baucus, Ted Kennedy and Pete Stark are cooking up for everyone else.

 
AP
Mitt Romney.
In Massachusetts's latest crisis, Governor Deval Patrick and his Democratic colleagues are starting to move down the path that government health plans always follow when spending collides with reality -- i.e., price controls. As costs continue to rise, the inevitable results are coverage restrictions and waiting periods. It was only a matter of time.

They're trying to manage the huge costs of the subsidized middle-class insurance program that is gradually swallowing the state budget. The program provides low- or no-cost coverage to about 165,000 residents, or three-fifths of the newly insured, and is budgeted at $880 million for 2010, a 7.3% single-year increase that is likely to be optimistic. The state's overall costs on health programs have increased by 42% (!) since 2006.

Like gamblers doubling down on their losses, Democrats have already hiked the fines for people who don't obtain insurance under the "individual mandate," already increased business penalties, taxed insurers and hospitals, raised premiums, and pumped up the state tobacco levy. That's still not enough money.

So earlier this year, Mr. Patrick appointed a state commission to figure out how to control costs and preserve "this grand experiment." One objective is to change the incentives for preventative care and treatments for chronic disease, but everyone says that. It sometimes results in better health but always more spending. So-called "pay for performance" financing models, on the other hand, would do away with fee for service -- but they also tend to reward process, not the better results implied.

What are the alternatives? If health planners won't accept the prices set by the marketplace -- thus putting themselves out of work -- the only other choice is limiting care via politics, much as Canada and most of Europe do today. The Patrick panel is considering one option to "exclude coverage of services of low priority/low value." Another would "limit coverage to services that produce the highest value when considering both clinical effectiveness and cost." (Guess who would determine what is high or low value? Not patients or doctors.) Yet another is "a limitation on the total amount of money available for health care services," i.e., an overall spending cap.

The Institute for America's Future -- which is providing the intellectual horsepower (we use the term loosely) for reforms like those in Massachusetts -- argues that the cost overruns prove the state must cap how much insurers are allowed to charge consumers and regulate their profits. If Mr. Patrick doesn't get there first, that is. He reportedly told insurers and hospitals at a closed meeting this month that if they didn't take steps to hold down the rate of medical inflation, he would.

Even the single-payer cheerleaders at the New York Times have caught on to this rolling catastrophe. In a page-one story this month, the paper reported on the "expedient choice" that Mr. Romney and Democrats made to defer "until another day any serious effort to control the state's runaway health costs. . . . Those who led the 2006 effort said it would not have been feasible to enact universal coverage if the legislation had required heavy cost controls. The very stakeholders who were coaxed into the tent -- doctors, hospitals, insurers and consumer groups -- would probably have been driven into opposition by efforts to reduce their revenues and constrain their medical practices, they said."

Now they tell us. What really whipped along RomneyCare were claims that health care would be less expensive if everyone were covered. But reducing costs while increasing access are irreconcilable issues. Mr. Romney should have known better before signing on to this not-so-grand experiment, especially since the state's "free market" reforms that he boasts about have proven to be irrelevant when not fictional. Only 21,000 people have used the "connector" that was supposed to link individuals to private insurers.

Which brings us to Washington, where Mr. Obama and Congressional Democrats are about to try their own Bay State bait and switch: First create vast new entitlements that can never be repealed, then later take the less popular step of rationing care when it's their last hope to save the federal fisc.

The consequences of that deception will be far worse than those in Massachusetts, however, given that prior to 2006 the state already had a far smaller percentage of its population uninsured than the national average. The real lesson of Massachusetts is that reform proponents won't tell Americans the truth about what "universal" coverage really means: Runaway costs followed by price controls and bureaucratic rationing.

 
Logged
ccp
Power User
***
Posts: 4052


« Reply #113 on: March 27, 2009, 08:17:19 AM »

Well for those people who for whatever reason have no health coverage now, rationed care is better than no care.  They will be quite pleased to have someone else pay for their health care - rationed or not.
For the rest of us who will have to foot the bill - we are screwed.
Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31053


« Reply #114 on: March 27, 2009, 08:20:31 AM »

Ummm , , , has "no care" actually been the case?
Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31053


« Reply #115 on: March 27, 2009, 08:33:23 AM »

second post

How U.S. Health Care Really Stacks Up
By INVESTOR'S BUSINESS DAILY | Posted Thursday, March 26, 2009 4:20 PM PT

Facts: A movie has been made solely to criticize it. The left treats it as if it's an invader that must be repelled. Most Americans, however, are satisfied with this object of so much hate — America's health care industry.


--------------------------------------------------------------------------------

Read More: Health Care


--------------------------------------------------------------------------------


Manipulative filmmaker Michael Moore says "we have the worst health care in the Western world" and has offered up Cuba as a paradigm for the U.S. to follow.

Former South Dakota Sen. Tom Daschle, who was nearly named the administration's health and human services secretary, says the "flaws in our health care system are pervasive and corrosive."

Rep. Dennis Kucinich, a former Democratic presidential candidate, called the current health care market "predatory capitalism." Some Democrats go so far as to say the system is racist.

The kindest thing most Democrats will say about health care in the U.S. is that it's broken. Their talking points to back up the claim revolve around costs, America's low position (37th) in World Health Organization rankings and the number of uninsured.

The last is a useless measure, since only a small portion of the uninsured are chronically without coverage. So are the WHO rankings, which can't be trusted because of disparities in how countries compile statistics, demographic and cultural differences, and the WHO's leftist bias.

Which leaves us with the issue of costs.

Yes, with $2.5 trillion expected to be spent this year, health care in the U.S. is more expensive than in any other country, including Great Britain and Canada, whose nationalized, universal care systems are held up as models .

But what we spend isn't thrown down a rathole. The National Center for Policy Analysis has published a study, "10 Surprising Facts About American Health Care," that shows how Americans get something for the extra dollars they lay out. To wit:

• "Americans have better survival rates than Europeans for common cancers." Breast cancer mortality: 52% higher in Germany and 88% higher in the United Kingdom than in the U.S. Prostate cancer mortality: 604% higher in the U.K., 457% higher in Norway. Colo-rectal cancer mortality: 40% higher among Britons.

• "Americans have lower cancer mortality rates than Canadians." Rates for breast cancer (9%), prostate cancer (184%) and colon cancer among men (10%) are higher than in the U.S.

• "Americans have better access to treatment of chronic diseases than patients in other developed countries." Roughly 56% of Americans who could benefit are taking statin drugs. Only 36% of the Dutch, 29% of the Swiss, 26% of Germans, 23% of Britons and 17% of Italians who could benefit receive them.

• "Americans have better access to preventive cancer screenings than Canadians." Nine of 10 middle-aged American women have had a mammogram; 72% of Canadian women have. Almost every American woman (96%) has had a pap smear; fewer than 90% of Canadian women have. Roughly 54% of American men have had a prostate cancer test; fewer than one in six Canadian men have. Almost a third of Americans (30%) have had a colonoscopy; only 5% of Canadians have had the procedure.

• "Lower-income Americans are in better health than comparable Canadians." Nearly 12% of U.S. seniors with below-median incomes self-report being in "excellent" health, while 5.8% of Canadian seniors say the same thing.

• "Americans spend less time waiting for care than patients in Canada and the United Kingdom." Canadians and Britons wait about twice as long, sometimes more than a year, to see a specialist, have elective surgery or get radiation treatment.

• "People in countries with more government control of health care are highly dissatisfied and believe reform is needed." More than seven in 10 Germans, Canadians, Australians, New Zealanders and Britons say their health systems need either "fundamental change" or "complete rebuilding."

• "Americans are more satisfied with the care they receive than Canadians." More than half (51.3%) of Americans are very satisfied with their health care services, while 41.5% of Canadians hold the same view of their system.

• "Americans have much better access to important new technologies like medical imaging than patients in Canada or the U.K." There are 34 CT scanners per million Americans. There are 12 per million in Canada and eight per million in Britain. The U.S. has nearly 27 MRI machines per million. Britain and Canada have 6 per million.

• "Americans are responsible for the vast majority of all health care innovations." The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other single developed nation; the most important recent medical innovations were developed here.

Can the nationalized, universal systems in Britain, Canada or anywhere else improve on this? No, but we can ruin our health care by following the policies of countries where medical treatment is far below the American standard.

Logged
ccp
Power User
***
Posts: 4052


« Reply #116 on: March 27, 2009, 10:03:02 AM »

I agree with the post but,
I am afraid that one can find statistics that buttresses both sides of the argument. For or against national or single payer care.
I am not for big government care.  But at this point the free market's answer appears unsustainable with regards to costs.
The electronic medical  records may or may not decrease costs - the jury is out - as is the concept that preventative care reduces costs (evidence suggests it increases costs in many cases). 
There is simply no way to insure another 40 mill people and not ration care.
That said we will need to ration care anyway at some point.

People are living longer and the result is more health care needs.  As well of course the baby boom thing.

The best hope in my opinion still comes ironically from the pharmaceutical industry.

For example it is becoming apparent that diabetes 2 is possibly an intestinal disease and bariatric surgery which was used for weight loss results in reversal of diabetes far more than expected for any degree of weight loss.  This seems to have been discovered by accident.  It is also clear that some people who are NOT overweight still will have diabetes reversed by this surgery.
Thus a treatment with goal of cure for this is surgery.  At this time it costs several thousand dollars.  Yet in the long run thses procedures may reduce costs.

If the drug industry can find a real cure or better treaments for obesity and other conditions than costs may actually decrease.

It is all too complicated.  I could work towards a Phd thesis and still not know the answers though I would have a better handle on the problems.
Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31053


« Reply #117 on: March 27, 2009, 10:39:34 AM »

"That said we will need to ration care anyway at some point."

The proper mechanism is called "price". grin
Logged
ccp
Power User
***
Posts: 4052


« Reply #118 on: March 27, 2009, 10:54:55 AM »

The proper mechanism is called "price".

I don't follow you. huh
Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31053


« Reply #119 on: March 27, 2009, 12:36:05 PM »

Sorry for my failed effort at laconic wit  smiley

In a free market, who gets something is determined by price.
Logged
ccp
Power User
***
Posts: 4052


« Reply #120 on: March 27, 2009, 01:42:41 PM »

Well now you are getting to the question:  is health care a right or a privilege that is earned?

I just tried to look up if there are any polls conducted on the opinions of people on this issue.  I do not find much.
Clearly BO feels it is a right and in conjuction, a responsibility for those who can and do pay to do so for those who can't or won't.
I don't know where the majority of Americans are on this issue.  I suspect most feel it is a right but I could be wrong. 
What do I feel?  Well of course as a doctor I am expected to be kind, thoughtful, and a true humanitarian and philanthropist, and alive and working only for the public good. 
All the while my wife and I are getting stalked and robbed. 
And everyone and their sister has an opinion about how much doctors should or shoudn't make.
So is it a right or a privilege?  Personally I am tired of philosophy and I frankly don't even give a darn.
My thoughts don't mean anything anyway. 

I suspect one reason BO is so popular is because most agree with him.
Logged
JDN
Power User
***
Posts: 2004


« Reply #121 on: April 08, 2009, 10:37:03 AM »

When it comes to healthcare, the U.S., Britain and Canada are hurting
Healthcare in all three countries has the same problem. They just feel it in different places.
By Ezra Klein

April 7, 2009

When asked by the New England Journal of Medicine to detail his healthcare vision during the campaign, John McCain concluded with a rousing denunciation of "new government bureaucracies that will translate into higher taxes, reduced provider payments and long waiting lines."

Long lines come up frequently in the American healthcare discussion, the symbol of all that is to be feared about a government-run system. And it's true that in Canada and Britain, the two countries most often cited in discussions of what nationalized healthcare might mean, some patients report having to wait months for some elective treatments. Sometimes.

But we've got waiting lines too -- along with 50 million uninsured and a system that costs more than twice as much per person as that of any other country. We've just managed to hide our lines through clever statistical gimmickry.

Britain and Canada control costs in a very specific fashion: The government sets a budget for how much will be spent on healthcare that year, and the system figures out how to spend that much and no more. One of the ways the British and Canadians save money is to punt elective surgeries to a lower priority level. A 2001 survey by the policy journal "Health Affairs" found that 38% of Britons and 27% of Canadians reported waiting four months or more for elective surgery. Among Americans, that number was only 5%. Score one of us!

Well, sort of. American healthcare controls costs in another way. Rather than deciding as a society how much will be spent in the coming year and then figuring out how best to spend it, we abdicate collective responsibility and let individuals fend for themselves. So although Britain and Canada have decided that no one will go without, even if some must occasionally wait, the U.S. has decided that most of those who can't afford care simply won't get it.

When that very same survey also looked at cost problems among residents of different countries, 24% of Americans reported that they did not get medical care because of cost. Twenty-six percent said they didn't fill a prescription. And 22% said they didn't get a test or treatment. Those latter numbers are probably artificially small: If you can't afford to see a doctor, you never know that you can't afford the treatment she would recommend. In Britain and Canada, only about 6% of respondents reported that costs had limited their access to care.

Moreover, surveys conducted by the Organization for Economic Cooperation and Development have found that most countries don't have waiting lines or the uninsured. Not Germany or France or Japan or Sweden, all of which have more of a mix of public and private options. But Canada is next door, and Britain speaks our language, so we tend to spend a lot of time comparing our system with these systems and not a lot of time thinking through the full range of options.

In light of the "Health Affairs" data, smugness about our speedy access to care seems a bit peculiar. If someone can't afford care, we record their waiting time as zero. You don't wait for what you can't have. But a more accurate accounting would record that wait as infinite, or it would record when the patient eventually ends up in the emergency room because the original ailment went untreated. Research like this raises a simple question: Would you rather wait four months for a surgery or be unable to get it altogether?



Just last week, House Republicans expressed their preference for the latter. Their long-awaited budget document was admirably specific about changes to Medicare. They call for "a new Medicare program" in which enrollees are given a check "equal to 100% of the Medicare benefit," which they can then take to the private market to purchase their own care.

This proposal has a purpose beyond dismantling a popular government entitlement program. Currently, Medicare does not abide by a budget. It is not run like the Canadian or British healthcare systems. Instead, it pays whatever is deemed "reasonable and necessary." Because of that, costs are shooting through the roof: The Congressional Budget Office estimates that Medicare spending will more than triple by 2050.

The Republican plan gives Medicare a budget. Costs grow only as fast as the check grows. And because the check grows more slowly than health spending does, the program saves money. But this is, in effect, almost precisely the strategy of Britain and Canada: It is the government imposing an arbitrary budget on its healthcare spending.

The difference is that the British and Canadian governments try to apportion that health spending so that the whole population gets care. That can mean, alongside other cost-saving measures, longer waits for services. The Republican budget simply would give individuals a fixed check. That will mean that patients who exceed that sum and don't have money of their own go without needed care.

So Americans will continue to brag that no one waits, and Canadians and Britons will continue to brag that no one goes without. And somewhere, the French and the Germans and the Japanese and the Swiss and many others will wonder why we insist on choosing between such awful extremes.
Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31053


« Reply #122 on: April 08, 2009, 10:52:49 AM »

"Rather than deciding as a society how much will be spent in the coming year and then figuring out how best to spend it, we abdicate collective responsibility and let individuals fend for themselves."

Wow , , ,  rolleyes
Logged
G M
Power User
***
Posts: 12003


« Reply #123 on: April 08, 2009, 11:06:10 AM »

Who thinks that this should be done with food? It's only "fair".....
Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31053


« Reply #124 on: April 08, 2009, 05:05:51 PM »

The coming clusterfcuk gathers momentum:

By JEROME GROOPMAN and PAMELA HARTZBAND
The Obama administration is working with Congress to mandate that all Medicare payments be tied to "quality metrics." But an analysis of this drive for better health care reveals a fundamental flaw in how quality is defined and metrics applied. In too many cases, the quality measures have been hastily adopted, only to be proven wrong and even potentially dangerous to patients.

 
Martin KozlowskiHealth-policy planners define quality as clinical practice that conforms to consensus guidelines written by experts. The guidelines present specific metrics for physicians to meet, thus "quality metrics." Since 2003, the federal government has piloted Medicare projects at more than 260 hospitals to reward physicians and institutions that meet quality metrics. The program is called "pay-for-performance." Many private insurers are following suit with similar incentive programs.

In Massachusetts, there are not only carrots but also sticks; physicians who fail to comply with quality guidelines from certain state-based insurers are publicly discredited and their patients required to pay up to three times as much out of pocket to see them. Unfortunately, many states are considering the Massachusetts model for their local insurance.

How did we get here? Initially, the quality improvement initiatives focused on patient safety and public-health measures. The hospital was seen as a large factory where systems needed to be standardized to prevent avoidable errors. A shocking degree of sloppiness existed with respect to hand washing, for example, and this largely has been remedied with implementation of standardized protocols. Similarly, the risk of infection when inserting an intravenous catheter has fallen sharply since doctors and nurses now abide by guidelines. Buoyed by these successes, governmental and private insurance regulators now have overreached. They've turned clinical guidelines for complex diseases into iron-clad rules, to deleterious effect.

One key quality measure in the ICU became the level of blood sugar in critically ill patients. Expert panels reviewed data on whether ICU patients should have insulin therapy adjusted to tightly control their blood sugar, keeping it within the normal range, or whether a more flexible approach, allowing some elevation of sugar, was permissible. Expert consensus endorsed tight control, and this approach was embedded in guidelines from the American Diabetes Association. The Joint Commission on Accreditation of Healthcare Organizations, which generates report cards on hospitals, and governmental and private insurers that pay for care, adopted as a suggested quality metric this tight control of blood sugar.

A colleague who works in an ICU in a medical center in our state told us how his care of the critically ill is closely monitored. If his patients have blood sugars that rise above the metric, he must attend what he calls "re-education sessions" where he is pointedly lectured on the need to adhere to the rule. If he does not strictly comply, his hospital will be downgraded on its quality rating and risks financial loss. His status on the faculty is also at risk should he be seen as delivering low-quality care.

But this coercive approach was turned on its head last month when the New England Journal of Medicine published a randomized study, by the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Canadian Critical Care Trials Group, of more than 6,000 critically ill patients in the ICU. Half of the patients received insulin to tightly maintain their sugar in the normal range, and the other half were on a more flexible protocol, allowing higher sugar levels. More patients died in the tightly regulated group than those cared for with the flexible protocol.

Similarly, maintaining normal blood sugar in ambulatory diabetics with vascular problems has been a key quality metric in assessing physician performance. Yet largely due to two extensive studies published in the June 2008 issue of the New England Journal of Medicine, this is now in serious doubt. Indeed, in one study of more than 10,000 ambulatory diabetics with cardiovascular diseases conducted by a group of Canadian and American researchers (the "ACCORD" study) so many diabetics died in the group where sugar was tightly regulated that the researchers discontinued the trial 17 months before its scheduled end.

And just last month, another clinical trial contradicted the expert consensus guidelines that patients with kidney failure on dialysis should be given statin drugs to prevent heart attack and stroke.

These and other recent examples show why rigid and punitive rules to broadly standardize care for all patients often break down. Human beings are not uniform in their biology. A disease with many effects on multiple organs, like diabetes, acts differently in different people. Medicine is an imperfect science, and its study is also imperfect. Information evolves and changes. Rather than rigidity, flexibility is appropriate in applying evidence from clinical trials. To that end, a good doctor exercises sound clinical judgment by consulting expert guidelines and assessing ongoing research, but then decides what is quality care for the individual patient. And what is best sometimes deviates from the norms.

Yet too often quality metrics coerce doctors into rigid and ill-advised procedures. Orwell could have written about how the word "quality" became zealously defined by regulators, and then redefined with each change in consensus guidelines. And Kafka could detail the recent experience of a pediatrician featured in Vital Signs, the member publication of the Massachusetts Medical Society. Out of the blue, according to the article, Dr. Ann T. Nutt received a letter in February from the Massachusetts Group Insurance Commission on Clinical Performance Improvement informing her that she was no longer ranked as Tier 1 but had fallen to Tier 3. (Massachusetts and some private insurers use a three-tier ranking system to incentivize high-quality care.) She contacted the regulators and insisted that she be given details to explain her fall in rating.

After much effort, she discovered that in 127 opportunities to comply with quality metrics, she had met the standards 115 times. But the regulators refused to provide the names of patients who allegedly had received low quality care, so she had no way to assess their judgment for herself. The pediatrician fought back and ultimately learned which guidelines she had failed to follow. Despite her cogent rebuttal, the regulator denied the appeal and the doctor is still ranked as Tier 3. She continues to battle the state.

Doubts about the relevance of quality metrics to clinical reality are even emerging from the federal pilot programs launched in 2003. An analysis of Medicare pay-for-performance for hip and knee replacement by orthopedic surgeons at 260 hospitals in 38 states published in the most recent March/April issue of Health Affairs showed that conforming to or deviating from expert quality metrics had no relationship to the actual complications or clinical outcomes of the patients. Similarly, a study led by UCLA researchers of over 5,000 patients at 91 hospitals published in 2007 in the Journal of the American Medical Association found that the application of most federal quality process measures did not change mortality from heart failure.

State pay-for-performance programs also provide disturbing data on the unintended consequences of coercive regulation. Another report in the most recent Health Affairs evaluating some 35,000 physicians caring for 6.2 million patients in California revealed that doctors dropped noncompliant patients, or refused to treat people with complicated illnesses involving many organs, since their outcomes would make their statistics look bad. And research by the Brigham and Women's Hospital published last month in the Journal of the American College of Cardiology indicates that report cards may be pushing Massachusetts cardiologists to deny lifesaving procedures on very sick heart patients out of fear of receiving a low grade if the outcome is poor.

Dr. David Sackett, a pioneer of "evidence-based medicine," where results from clinical trials rather than anecdotes are used to guide physician practice, famously said, "Half of what you'll learn in medical school will be shown to be either dead wrong or out of date within five years of your graduation; the trouble is that nobody can tell you which half -- so the most important thing to learn is how to learn on your own." Science depends upon such a sentiment, and honors the doubter and iconoclast who overturns false paradigms.

Before a surgeon begins an operation, he must stop and call a "time-out" to verify that he has all the correct information and instruments to safely proceed. We need a national time-out in the rush to mandate what policy makers term quality care to prevent doing more harm than good.

Dr. Groopman, a staff writer for the New Yorker, and Dr. Hartzband are on the staff of Beth Israel Deaconess Medical Center in Boston and on the faculty of Harvard Medical School.

 
Logged
ccp
Power User
***
Posts: 4052


« Reply #125 on: April 10, 2009, 01:12:16 PM »

If one doesn't think the NEJM is a liberal rag this is from the same issue:

Conscientious Objection Gone Awry — Restoring Selfless Professionalism in Medicine

Julie D. Cantor, M.D., J.D.
 
 A new rule from the Department of Health and Human Services (DHHS) has emerged as the latest battleground in the health care conscience wars. Promulgated during the waning months of the Bush administration, the rule became effective in January. Heralded as a "provider conscience regulation" by its supporters and derided as a "midnight regulation" by its detractors, the rule could alter the landscape of federal conscience law.

The regulation, as explained in its text (see the Supplementary Appendix, available with the full text of this article at NEJM.org), aims to raise awareness of and ensure compliance with federal health care conscience protection statutes. Existing laws, which are tied to the receipt of federal funds, address moral or religious objections to sterilization and abortion. They protect physicians, other health care personnel, hospitals, and insurance plans from discrimination for failing to provide, offer training for, fund, participate in, or refer patients for abortions. Among other things, the laws ensure that these persons cannot be required to participate in sterilizations or abortions and that entities cannot be required to make facilities or personnel available for them. And they note that decisions on admissions and accreditation must be divorced from beliefs and behaviors related to abortion. On their face, these laws are quite broad.

But the Bush administration's rule is broader still. It restates existing laws and exploits ambiguities in them. For example, one statute says, "No individual shall be required to perform or assist in the performance of any part of a health service program or research activity funded" by DHHS if it "would be contrary to his religious beliefs or moral convictions."1 Here the rule sidesteps courts, which interpret statutory ambiguities and discern congressional intent, and offers sweeping definitions. It defines "individual" as physicians, other health care providers, hospitals, laboratories, and insurance companies, as well as "employees, volunteers, trainees, contractors, and other persons" who work for an entity that receives DHHS funds. It defines "assist in the performance" as "any activity with a reasonable connection" to a procedure or health service, including counseling and making "other arrangements" for the activity. Although the rule states that patients' ability to obtain health care services is unchanged, its expansive definitions suggest otherwise. Now everyone connected to health care may opt out of a wide range of activities, from discussions about birth control to referrals for vaccinations. As the rule explains, "an employee whose task it is to clean the instruments used in a particular procedure would also be considered to assist in the performance of the particular procedure" and would therefore be protected. Taken to its logical extreme, the rule could cause health care to grind to a halt.

It also raises other concerns. In terms of employment law, Title VII of the Civil Rights Act, which applies to organizations with 15 or more employees, requires balancing reasonable accommodations for employees who have religious, ethical, or moral objections to certain aspects of their jobs with undue hardship for employers. But the new rule suggests that if an employee objects, for example, to being a scrub nurse during operative treatment for an ectopic pregnancy, subsequently reassigning that employee to a different department may constitute unlawful discrimination — a characterization that may be at odds with Title VII jurisprudence.2 As officials of the Equal Employment Opportunity Commission remarked when it was proposed, the rule could "throw this entire body of law into question."3

Furthermore, although the rule purports to address intolerance toward "individual objections to abortion or other individual religious beliefs or moral convictions," it cites no evidence of such intolerance — nor would it directly address such intolerance if it existed. Constitutional concerns about the rule, including violations of state autonomy and rights to contraception, also lurk. And the stated goals of the rule — to foster a "more inclusive, tolerant environment" and promote DHHS's "mission of expanding patient access to necessary health services" — conflict with the reality of extensive objection rights. Protection for the silence of providers who object to care is at odds with the rule's call for "open communication" between patients and physicians. Moreover, there is no emergency exception for patient care. In states that require health care workers to provide rape victims with information about emergency contraception, the rule may allow them to refuse to do so.

Recently, the DHHS, now answering to President Barack Obama, took steps to rescind the rule (see the Supplementary Appendix). March 10 marked the beginning of a 30-day period for public comment on the need for the rule and its potential effects. Analysis of the comments (www.regulations.gov) and subsequent action could take some months. If remnants of the rule remain, litigation will follow. Lawsuits have already been filed in federal court, and Connecticut Attorney General Richard Blumenthal, who led one of the cases, has vowed to continue the fight until the regulation is "finally and safely stopped."4

This state of flux presents an opportunity to reconsider the scope of conscience in health care. When broadly defined, conscience is a poor touchstone; it can result in a rule that knows no bounds. Indeed, it seems that our problem is not insufficient tolerance, but too much. We have created a state of "conscience creep" in which all behavior becomes acceptable — like that of judges who, despite having promised to uphold all laws, recuse themselves from cases in which minors seek a judicial bypass for an abortion in states requiring parental consent.5

The debate is not really about moral or religious freedom writ large. If it were, then the medical profession would allow a broad range of beliefs to hinder patient care. Would we tolerate a surgeon who holds moral objections to transfusions and refuses to order them? An internist who refuses to discuss treatment for diabetes in overweight patients because of moral opposition to gluttony? If the overriding consideration were individual conscience, then these objections should be valid. They are not (although they might well be permitted under the new rule). We allow the current conscience-based exceptions because abortion remains controversial in the United States. As is often the case with laws touching on reproductive freedom, the debate is polarized and shrill. But there comes a point at which tolerance breaches the standard of care.

Medicine needs to embrace a brand of professionalism that demands less self-interest, not more. Conscientious objection makes sense with conscription, but it is worrisome when professionals who freely chose their field parse care and withhold information that patients need. As the gatekeepers to medicine, physicians and other health care providers have an obligation to choose specialties that are not moral minefields for them. Qualms about abortion, sterilization, and birth control? Do not practice women's health. Believe that the human body should be buried intact? Do not become a transplant surgeon. Morally opposed to pain medication because your religious beliefs demand suffering at the end of life? Do not train to be an intensivist. Conscience is a burden that belongs to the individual professional; patients should not have to shoulder it.

Patients need information, referrals, and treatment. They need all legal choices presented to them in a way that is true to the evidence, not the randomness of individual morality. They need predictability. Conscientious objections may vary from person to person, place to place, and procedure to procedure. Patients need assurance that the standard of care is unwavering. They need to know that the decision to consent to care is theirs and that they will not be presented with half-truths and shades of gray when life and health are in the balance.

Patients rely on health care professionals for their expertise; they should be able expect those professionals to be neutral arbiters of medical care. Although some scholars advocate discussing conflicting values before problems arise, realistically, the power dynamics between patients and providers are so skewed, and the time pressure often so great, that there is little opportunity to negotiate. And there is little recourse when care is obstructed — patients have no notice, no process, and no advocate to whom they can turn.

Health care providers already enjoy broad rights — perhaps too broad — to follow their guiding moral or religious tenets when it comes to sterilization and abortion. An expansion of those rights is unwarranted. Instead, patients deserve a law that limits objections and puts their interests first. Physicians should support an ethic that allows for all legal options, even those they would not choose. Federal laws may make room for the rights of conscience, but health care providers — and all those whose jobs affect patient care — should cast off the cloak of conscience when patients' needs demand it. Because the Bush administration's rule moves us in the opposite direction, it should be rescinded.

Dr. Cantor reports representing an affiliate of Planned Parenthood in a legal matter unrelated to conscientious objection. No other potential conflict of interest relevant to this article was reported.
Dr. Cantor is an adjunct professor at the UCLA School of Law, Los Angeles.

This article (10.1056/NEJMp0902019) was published at NEJM.org on March 25, 2009.

References

42 U.S.C.A.  300a-7(d).
Shelton v. Univ. of Medicine & Dentistry of New Jersey, 223 F.3d 220 (3d Cir. 2000).
Pear R. Protests over a rule to protect health providers. New York Times. November 17, 2008:A14.
Press release of the State of Connecticut Attorney General's Office, Hartford, February 27, 2009. (Accessed March 20, 2009, at http://www.ct.gov/ag/cwp/view.asp?A=3673&Q=434882.)
Liptak A. On moral grounds, some judges are opting out of abortion cases. New York Times. September 4, 2005.

Logged
ccp
Power User
***
Posts: 4052


« Reply #126 on: April 11, 2009, 09:42:40 AM »

Dear Mr. Ricardo Alonso-zaldivar,

They may not be a "lobbying" group but they certainly do have and use a voice - its called voting.  The same for those who pay no income taxes.  They express their "voice" with their votes!  And I don't need a poll to tell me which party they overwhelmingly vote for:

****Associated Press Writer Ricardo Alonso-zaldivar, Associated Press Writer – 1 hr 19 mins ago
WASHINGTON – If the uninsured were a political lobbying group, they'd have more members than AARP. The National Mall couldn't hold them if they decided to march on Washington.

But going without health insurance is still seen as a personal issue, a misfortune for many and a choice for some. People who lose coverage often struggle alone instead of turning their frustration into political action.

Illegal immigrants rallied in Washington during past immigration debates, but the uninsured linger in the background as Congress struggles with a health care overhaul that seems to have the best odds in years of passing.

That isolation could have profound repercussions.

Lawmakers already face tough choices to come up with the hundreds of billions it would cost to guarantee coverage for all. The lack of a vocal constituency won't help. Congress might decide to cover the uninsured slowly, in stages.

The uninsured "do not provide political benefit for the aid you give them," said Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health. "That's one of the dilemmas in getting all this money. If I'm in Congress, and I help out farmers, they'll help me out politically. But if I help out the uninsured, they are not likely to help members of Congress get re-elected."

The number of uninsured has grown to an estimated 50 million people because of the recession. Even so, advocates in the halls of Congress are rarely the uninsured themselves. The most visible are groups that represent people who have insurance, usually union members and older people. In the last election, only 10 percent of registered voters said they were uninsured.

The grass-roots group Health Care for America Now plans to bring as many as 15,000 people to Washington this year to lobby Congress for guaranteed coverage. Campaign director Richard Kirsch expects most to have health insurance.

"We would never want to organize the uninsured by themselves because Americans see the problem as affordability, and that is the key thing," he said.

Besides, added Kirsch, the uninsured are too busy scrambling to make ends meet. Many are self-employed; others are holding two or three part-time jobs. "They may not have a lot of time to be activists," he said.

Vicki and Lyle White of Summerfield, Fla., know about such predicaments. They lost their health insurance because Lyle had to retire early after a heart attack left him unable to do his job as a custodian at Disney World. Vicki, 60, sells real estate. Her income has plunged due to the housing collapse.

"We didn't realize that after he had the heart attack no one would want to insure him," said Vicki. The one bright spot is that Lyle, 64, has qualified for Medicare disability benefits and expects to be getting his card in July.

But for now, the Whites have to pay out of pocket for Lyle's visits to the cardiologist and his medications. The bills came to about $5,000 last year. That put a strain on their limited budget because they are still making payments on their house and car.

"I never thought when we got to this age that we would be in such a mess," said Vicki, who has been married to Lyle for 43 years. "We didn't think we would have a heart attack and it would change our life forever."

While her own health is "pretty good," Vicki said she suffers chronic sinus infections and hasn't had a checkup since 2007. "I have just learned to live with it," she said.

The Whites' example shows how the lack of guaranteed health care access undermines middle-class families and puts them at risk, but that many of the uninsured eventually do find coverage. Lyle White has qualified for Medicare, even if the couple must still find a plan for Vicki.

Research shows that nearly half of those who lose coverage find other health insurance in four months or less. That may be another reason the uninsured have not organized an advocacy group. At least until this recession, many have been able to fix the situation themselves.

"The uninsured are a moving target," said Cathy Schoen, a vice president of the Commonwealth Fund, a research group that studies the problems of health care costs and coverage.

But even if gaps in coverage are only temporary, they can be dangerous. "Whenever you are uninsured, you are at risk," said Schoen. "People don't plan very well when they are going to get sick or injured."

Indeed, the Institute of Medicine, which provides scientific advice to the government, has found that a lack of health insurance increases the chances of bad outcomes for people with a range of common ailments, from diabetes and high blood pressure to cancer and stroke. Uninsured patients don't get needed follow-up care, skip taking prescription medicines and put off seeking help when they develop new symptoms.

Such evidence strengthens the case for getting everybody covered right away, Schoen said. But she acknowledges the politics may get tough. "It certainly has been a concern out of our history that unorganized voices aren't heard," she said.****

___

Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31053


« Reply #127 on: April 13, 2009, 11:28:34 AM »

Above every other health-care goal, Democrats this year want to institute a "public option" -- an insurance program financed by taxpayers, managed by government and open to everyone, much like Medicare. This new middle-class entitlement is the most important debate in Congress this year, because it really is the last stand for anything resembling private health insurance.

This public option will supposedly "compete" with private alternatives. As President Obama likes to put it, those who are happy with the insurance they have now can keep it -- and if they happen to prefer the government offering, well, gee whiz, that's the free market at work. The reality is far different. Not only will the new program become the default coverage for the uninsured, but Democrats intend to game the system to precipitate -- or if need be, coerce -- an exodus to government from private insurance. Soon enough, that will be the only "option" left.

A public program won't compete in a way that any normal business would recognize. As an entitlement, Congress's creation will enjoy potentially unlimited access to the Treasury, without incurring the risks or hedging against losses that private carriers do. As people gravitate to "free" or heavily subsidized care, the inevitably explosive costs will be covered in part with increased outlays to keep premiums artificially low or even offer extra benefits. Lacking such taxpayer cash, private insurance rates will escalate.

Much like Medicare, overall spending in the public option will be controlled over time by paying less for medical services, drugs and technology. With its monopsony purchasing power, below-market fees will be dictated on a take-it-or-leave-it basis -- an offer hospitals and physicians won't be able to refuse. Medicare's current reimbursement policies pay hospitals only 71% of private rates, and doctors 81%, according to the Lewin Group.

 In a recent analysis, Lewin estimates that enrollment in the public option will reach 131 million people if it is open to everyone and pays Medicare rates. Fully 119 million people will shift out of -- or lose -- private coverage. Everything depends on the payment levels that Congress adopts, as well as the size of the eligible pool. But even if a public option available to all takes the highly improbable step of paying at some midpoint between private and Medicare rates, nearly 68 million people will still be crowded out of private insurance. The nearby table summarizes Lewin's eye-popping findings.

This public option would be the most radical change in the way American health care is financed -- and thus provided -- in at least 44 years, and maybe ever. About 170 million people currently have private insurance, which is already pressured by the price controls of Medicare and Medicaid. A significant share of government underpayments are simply transferred to the private sector, adding tens of billions of dollars every year to consumer health bills.

A 2006 study in the journal Health Affairs concludes that around 17 cents of every dollar in relative reductions in Medicare payments to private hospitals are shifted onto private patients -- and that such cost-shifting accounts for fully 12.3% of the total increase in private payer prices between 1997 and 2001.

This share would be far higher were government payment rates not limited to the elderly and the poor but imposed over the entire system. This will only hasten the flight to government. Meanwhile, employers small and large will have every incentive to dump their plans and transfer their workers to the public rolls. The result will inevitably be a cascade of failures or withdrawals from the market by commercial insurers, with the public option as the only option for the diaspora.

Congress will finish the job with regulatory changes. Under the aegis of a level playing field, all private plans will be forced to offer benefit packages similar to those in the public option. They will also be required to accept all comers, regardless of pre-existing conditions, and also be forced to offer similar rates to all enrollees, ending the ability to manage risk through underwriting. Any private plan will essentially become a public utility where government decides what products it must offer and how much it can charge.

Democrats couldn't be clearer on this point. House baron Pete Stark -- who thought HillaryCare was too moderate and has long favored Medicare for all -- said at a recent hearing that currently "We have no mechanism to directly push the private sector to do delivery system reform and address rising costs." But the public option, he added, would force private insurers to "modernize," which seems to be his term for industrial policy.

Under this model, the annual political warfare over Medicare payment policies would be imported to what is left of the private sector. Once government takes over the majority of U.S. health-care liabilities, it can either provide every service at huge and growing cost, or it can ration services. People who need an MRI or hip replacement or whatever will face waiting lines. Medical innovation will be at the mercy of the price controls hashed out in Washington.

Proponents of a public option point to the Federal Employees Health Benefits Program to dismiss such criticism, but that program is offered only to a discrete population. Mr. Obama's proposal would be open to everyone and necessitate a huge permanent increase in government spending as a share of the economy. Medicare and Medicaid alone account for 4% of GDP today and will rise to 9% by 2035, according to the Congressional Budget Office. CBO estimates that individual and corporate income tax rates would have to rise by about 90% to finance the projected increase in spending through 2050 -- without the new middle-class entitlement.

Proponents will say we are exaggerating, but the consequences we describe are inevitable when government bulldozes into a market. Democrats want to sell their "public option" as a modest and affordable reform that won't affect anyone's private insurance. It isn't true. Republicans, especially those in the Senate who want to cut a deal on health care, should understand that a public option is the beginning of the end of private health insurance.

Please add your comments to the Opinion Journal forum.
Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31053


« Reply #128 on: April 17, 2009, 12:01:20 AM »

WSJ
by MARC SIEGEL

Here's something that has gotten lost in the drive to institute universal health insurance: Health insurance doesn't automatically lead to health care. And with more and more doctors dropping out of one insurance plan or another, especially government plans, there is no guarantee that you will be able to see a physician no matter what coverage you have.

Consider that the Medicare Payment Advisory Commission reported in 2008 that 28% of Medicare beneficiaries looking for a primary care physician had trouble finding one, up from 24% the year before. The reasons are clear: A 2008 survey by the Texas Medical Association, for example, found that only 38% of primary-care doctors in Texas took new Medicare patients. The statistics are similar in New York state, where I practice medicine.

More and more of my fellow doctors are turning away Medicare patients because of the diminished reimbursements and the growing delay in payments. I've had several new Medicare patients come to my office in the last few months with multiple diseases and long lists of medications simply because their longtime provider -- who they liked -- abruptly stopped taking Medicare. One of the top mammographers in New York City works in my office building, but she no longer accepts Medicare and charges patients more than $300 cash for each procedure. I continue to send my elderly women patients downstairs for the test because she is so good, but no one is happy about paying.

The problem is even worse with Medicaid. A 2005 Community Tracking Physician survey showed that only 50% of physicians accept this insurance. I am now one of the ones who doesn't take it. I realized a few years ago that it wasn't worth the money to file the paperwork for the $25 or less that I received for an office visit. HMOs are problematic as well. Recent surveys from New York show a 10% yearly dropout rate from the state's largest HMO, the Health Insurance Plan of New York (HIP), and a 14% drop-out rate from Health Net of New York, another big HMO.

The dropout rate is less at major medical centers such as New York University's Langone Medical Center where I work, or Mount Sinai Medical Center, because larger physician networks have more leverage when choosing health plans. Still, I am frequently hamstrung as I try to find a good surgeon or specialist to refer one of my patients to.

Overall, 11% of the doctors at NYU Langone don't participate in at least two insurance plans -- Aetna or Blue Cross, for instance -- so I end up not being able to refer my patients to some of our top specialists. This problem, in addition to the mass of paperwork and diminishing reimbursements, is enough of a reason for me to consider dropping out as well.

Bottom line: None of the current plans, government or private, provide my patients with the care they need. And the care that is provided is increasingly expensive and requires a big battle for approvals. Of course, we're promised by the Obama administration that universal health insurance will avoid all these problems. But how is that possible when you consider that the medical turnstiles will be the same as they are now, only they will be clogged with more and more patients? The doctors that remain in this expanded system will be even more overwhelmed than we are now.

I wouldn't want to be a patient when that happens.

Dr. Siegel, an internist and associate professor of medicine at the NYU Langone Medical Center, is a Fox News medical contributor.
Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31053


NYT
« Reply #129 on: April 25, 2009, 08:15:26 AM »

ama Tactic Shields Health Care Bill From a Filibuster
               E-Mail
Send To Phone
Print
Reprints
ShareClose
LinkedinDiggFacebookMixxMySpaceYahoo! BuzzPermalinkBy CARL HULSE
Published: April 24, 2009
WASHINGTON — At the prodding of the White House, Democratic Congressional leaders have agreed to pursue a plan that would protect major health care legislation from Republican opposition by shielding it from last-minute Senate filibusters.

Skip to next paragraph
Blog
 
The Caucus
The latest on President Obama, the new administration and other news from Washington and around the nation. Join the discussion.

More Politics News
The aggressive approach reflects the big political claim that President Obama is staking on health care, and with it his willingness to face Republican wrath in order to guarantee that the Democrats, with their substantial majority in the Senate, could not be thwarted by minority tactics.

While some Democratic senators were reluctant to embrace the arrangement, Mr. Obama made clear at a White House session on Thursday afternoon that he favored it, people with knowledge of the session said.

Mr. Obama has given way in some battles with Congress, but the new stance suggests he may be much less willing to compromise when it comes to health care, his top legislative priority, even if it means a bitter partisan fight.

The no-filibuster arrangement is fiercely opposed by Republican leaders, who say health care is too important to be exempted from the Senate rules that usually mean major bills must win support from 60 senators.

At the White House meeting this week, Mr. Obama told senators from both parties that he did not want a health care overhaul to fail if it came up a vote shy of the 60 needed to break filibusters, the people with knowledge of the session said. Republicans have used the procedure themselves in the past, but Senator Mitch McConnell of Kentucky, the Republican leader, told Mr. Obama in the meeting that that approach was likely to heighten partisan tensions in Congress.

The arrangement is spelled out in a tentative budget agreement reached Thursday night between Congressional leaders and the White House, allowing health legislation that meets budget targets to be approved by a simple Senate majority, under a process known as reconciliation.

Democrats say they intend to use the process as a last resort, and will include a provision in the budget that would not trigger the Senate shortcut until Oct. 15. That would leave the door open for months of negotiations over health care legislation, which the Democrats hope to deliver by the end of the year.

“Virtually everyone who has been part of these discussions recognizes that reconciliation is not the preferred way to write this legislation,” said Senator Kent Conrad, Democrat of North Dakota and chairman of the Senate Budget Committee. “But the administration wants to have a reconciliation instruction as an insurance policy.”

Mr. Conrad said the decision not to invoke the no-filibuster rule until mid-October was intended “as a signal that people are very serious and want this to work through the normal give-and-take.”

But that might not mollify Republicans, who say that once Democrats have the ability to fast-track the measure they will have no incentive to negotiate seriously with Republicans.

Republicans have threatened to use their own procedural weapons to bog down the Senate if Democrats adopt a budget that restricts filibusters on an issue as important as health care.

“The floor of the Senate will become a very untidy place if they start using reconciliation for major policy,” warned Senator Judd Gregg of New Hampshire, senior Republican on the budget panel.

Mr. Conrad and Representative John M. Spratt Jr. of South Carolina, the House Budget Committee chairman, were hammering out final details of the $3.5 trillion budget in talks with the administration that were expected to head into the weekend.

“Most issues have been resolved,” Senator Harry Reid of Nevada, the majority leader, said Friday, “but there are some that have not.”

The Democrats can rely on 58 votes in the Senate, and expected to add a 59th once the courts finish their review of the disputed election in Minnesota. But Mr. McConnell said that using the no-filibuster approach on health care “without the benefit of a full and transparent debate, does a disservice to the American people.”

“It would make it absolutely clear they intend to carry out their plans on a purely partisan basis,” he said.

Mr. Conrad had advised against using reconciliation, saying it did not lend itself to such a complex issue as health care.

But Mr. Conrad came under intense pressure from the White House, his own Senate leadership and the House to include it, to guard against Republicans’ using the filibuster to kill a health care bill. Proponents of reconciliation note that House and Senate Republicans have so far stood almost united against the new administration’s major initiatives.

Besides the agreement to use reconciliation, negotiators were coming to terms on lingering tax issues and the overall level of domestic spending, with the amount originally requested by Mr. Obama expected to be reduced by about $10 billion for 2010. The White House was pushing for final approval of a budget by Wednesday to put a successful coda on the Obama administration’s first 100 days.

The tentative agreement would also apply reconciliation rules to a less-partisan fight over student lending, but does not include filibuster protection for energy or climate-change legislation.

Senator Max Baucus, Democrat of Montana and chairman of the Finance Committee, said Friday that he would prefer not to pursue health legislation through the reconciliation process.

“I think it gets in the way,” Mr. Baucus said, explaining that his goal was to produce a health care bill that could “get significantly more than 60 votes.”

“If we jam something down somebody’s throat, it’s not sustainable,” he said.

But other leading Democrats say they need the ability to circumvent filibusters if Republicans refuse to negotiate. They noted that Republicans often relied on reconciliation when they held power, notably using it to enact President George W. Bush’s tax cuts in 2001 and 2003.

Senate rules give the minority party, in this case the Republicans, ample ability to snarl the legislative process in a chamber where much activity is conducted under agreements between majority and minority leadership.

Republicans could force multiple votes on mundane matters, slow walk administration nominations, force Democrats to spend days teeing up bills for debate and require lengthy bills to be read in full. In 2005, Democrats threatened to bring the Senate to a halt using similar tactics when Republicans said they would strip them of the ability to filibuster judicial nominations. That showdown was averted.

Now, Republicans would run some political risk of being portrayed as obstructing health care and other initiatives sought by a popular new president if they were seen as shutting down the Senate out of pique.

Robert Pear contributed reporting.
Logged
ccp
Power User
***
Posts: 4052


« Reply #130 on: April 27, 2009, 09:54:33 AM »

It is not so much that there is a shortage of doctors as much as shortage in some areas.  In my area there is too many doctors.
But anyway:

Obama administration concerned about growing shortage of primary-care doctors
by Robert Pear/New York Times Sunday April 26, 2009, 9:59 PM
Washington -- Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the number of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.

The officials said they were particularly concerned about shortages of primary-care providers who are the main source of health care for most Americans.

One proposal -- to increase Medicare payments to general practitioners, at the expense of high-paid specialists -- has touched off a lobbying fight.

Family doctors and internists are pressing Congress for an increase in their Medicare payments. But medical specialists are lobbying against any change that would cut their reimbursements. Congress, the specialists say, should find additional money to pay for primary care and should not redistribute dollars among doctors -- a difficult argument at a time of huge budget deficits.

Some of the proposed solutions, while advancing one of President Barack Obama's goals, could frustrate others. Increasing the supply of doctors, for example, would increase access to care, but could make it more difficult to rein in costs.

The need for more doctors comes up at almost every congressional hearing and White House forum on health care. "We're not producing enough primary-care physicians," Obama said at one forum. "The costs of medical education are so high that people feel that they've got to specialize." New doctors typically owe more than $140,000 in loans when they graduate.

Lawmakers from both parties say the shortage of health-care professionals is already having serious consequences. "We don't have enough doctors in primary care or in any specialty," said Rep. Shelley Berkley, Democrat of Nevada.

Sen. Orrin G. Hatch, Republican of Utah, said, "The work force shortage is reaching crisis proportions."

Even people with insurance are having problems finding doctors.

Miriam Harmatz, a lawyer in Miami, said: "My longtime primary-care doctor left the practice of medicine five years ago because she could not make ends meet. The same thing happened a year later. Since then, many of the doctors I tried to see would not take my insurance because the payments were so low."

To cope with the growing shortage, federal officials are considering several proposals. One would increase enrollment in medical schools and residency training programs. Another would encourage greater use of nurse practitioners and physician assistants. A third would expand the National Health Service Corps, which deploys doctors and nurses in rural areas and poor neighborhoods.

Sen. Max Baucus, Democrat of Montana, chairman of the Finance Committee, said Medicare payments were skewed against primary-care doctors -- the very ones needed for the care of older people with chronic conditions like congestive heart failure, diabetes and Alzheimer's disease.

"Primary-care physicians are grossly underpaid compared with many specialists," said Baucus, who vowed to increase primary-care payments as part of legislation to overhaul the health-care system.

The Medicare Payment Advisory Commission, an independent federal panel, has recommended an increase of up to 10 percent in the payment for many primary-care services, including office visits. To offset the cost, it said, Congress should reduce payments for other services -- an idea that riles many specialists.

Dr. Peter J. Mandell, a spokesman for the American Association of Orthopaedic Surgeons, said: "We have no problem with financial incentives for primary care. We do have a problem with doing it in a budget-neutral way. If there's less money for hip and knee replacements, fewer of them will be done for people who need them."

The Association of American Medical Colleges is advocating a 30 percent increase in medical school enrollment, which would produce 5,000 additional new doctors each year.

"If we expand coverage, we need to make sure we have physicians to take care of a population that is growing and becoming older," said Dr. Atul Grover, the chief lobbyist for the association. "Let's say we insure everyone. What next? We won't be able to take care of all those people overnight."

The experience of Massachusetts is instructive. Under a far-reaching 2006 law, the state succeeded in reducing the number of uninsured. But many who gained coverage have been struggling to find primary-care doctors, and the average waiting time for routine office visits has increased.

"Some of the newly insured patients still rely on hospital emergency rooms for nonemergency care," said Erica L. Drazen, a health policy analyst at Computer Sciences Corp.

The ratio of primary-care doctors to population is higher in Massachusetts than in other states.

Increasing the supply of doctors could have major implications for health costs.

"It's completely reasonable to say that adding more physicians to the work force is likely to increase health spending," Grover said.

But he said: "We have to increase spending to save money. If you give people better access to preventive and routine care for chronic illnesses, some acute treatments will be less necessary."

In many parts of the country, specialists are also in short supply.

Linde A. Schuster, 55, of Raton, N.M., said she, her daughter and her mother had all had medical problems that required them to visit doctors in Albuquerque.

"It's a long, exhausting drive, three hours down and three hours back," Schuster said.

The situation is even worse in some rural areas. Dr. Richard F. Paris, a family doctor in Hailey, Idaho, said that Custer County, Idaho, had no doctors, even though it is larger than the state of Rhode Island. So he flies in three times a month, over the Sawtooth Mountains, to see patients.

The Obama administration is pouring hundreds of millions of dollars into community health centers.

But Mary K. Wakefield, the new administrator of the Health Resources and Services Administration, said many clinics were having difficulty finding doctors and nurses to fill vacancies.

Doctors trained in internal medicine have historically been seen as a major source of frontline primary care. But many of them are now going into subspecialties of internal medicine, like cardiology and oncology.


Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31053


« Reply #131 on: April 27, 2009, 10:27:01 AM »

The folks who ran Katrina now look to takeover the people's remaining medical freedoms.  A giant clusterfcuk comes , , ,  cry
Logged
DougMacG
Power User
***
Posts: 5875


« Reply #132 on: April 29, 2009, 12:08:43 PM »

Crafty: "The folks who ran Katrina..."   or as we say in Mpls, the folks who brought us the bridge...  How come the same liberals demanding government-run healthcare aren't clamoring to move into public housing?

Steve Forbes makes many good points in this piece, also some very specific improvements to the current system that could easily be done now at no cost: "Allow mandate-free insurance policies... Permit people to buy health insurance across state lines... Make it easier for small businesses to buy insurance in a pool... Equalize the tax treatment of premiums... Raise limits on contributions to HSAs and on deductibles.

http://www.forbes.com/forbes/2009/0511/017-opinions-steve-forbes-the-fight.html

The Fight

The biggest domestic battle since the Clintons tried to nationalize health care in the early 1990s is about to unfold. Sometime in June the Obama Administration will formally introduce its plan to deal with the problem of the 46 million Americans who don't have health insurance. But the proposal will have far larger--and more ominous--implications for the country than the number of uninsured. This will be President Obama's attempt to do what the Clintons couldn't: truly socialize American health care. Make no mistake: Obama's plan will be the Administration's absolute top priority, trumping new energy taxes and the forced unionization of private-sector workers. Irrevocably sinking Washington's claws deep into an area constituting 17% of the economy is too great an opportunity for this Administration to pass up.

The President will propose that the government set up its own health insurance company, a Medicare-for-everyone system. The purpose, as he puts it, will be to provide competition with the private carriers. But this won't be competition; it will be a de facto government takeover.

The Administration will portray opponents as heartless for not wanting to do something about the uninsured. It will proclaim that private carriers make too much money and spend too much on overhead and marketing and that a nonprofit government insurer can make insurance affordable for those who currently don't get it through their employer or are out of a job.

Health care socialists will declare, "Look at Medicare. Despite its flaws and incomplete coverage it still provides a fantastic, affordable safety net for tens of millions of the elderly. Why can't we do that for everyone?"

Such a scheme would be a disaster. It would destroy innovation and lead to shortages and rationing. All the frustrations we experience with our current higgledy-piggledy system will pale beside the replacement's increasingly subpar care, ever lengthening lines for basic services and ever longer waits for "elective" surgeries.

Let's clear up some of the myths. Both Medicare and Medi-caid are heavily subsidized by privately insured patients, to the tune of $90 billion a year. Federal reimbursement in these two programs is far below cost, which is why an increasing number of doctors are refusing to treat or are substantially cutting back on the number of Medicare and Medicaid patients they see.

Medicare and Medicaid are rife with fraud. Unlike private insurers, the government refuses to spend real resources on routing out the wrongdoing: overbilling, overtesting and charging for visits not made or tests not given.


Obama beat them at presidential politics in 2008. Now he hopes to achieve what they conspicuously didn't do in health care.

The quality of care will decline. Health care "outcomes" for Medicaid patients are substantially below those of similar private-insurance patients. Fees are so low that patients are often treated more like ill, undesirable cattle.

Socialized systems are anathema to innovation. Breakthroughs in medications, diagnostic tools and medical devices require substantial capital investment and entail high risk. In the pharmaceutical industry, barely one in 250 promising compounds ever makes it to the marketplace. In the 1960s western Europe was a font of new medicines. But nationalized medicine put a stop to that. Today most of the breakthroughs come from the U.S. Even when another country invents something, it is in the U.S. that the product is fully developed. For example, the MRI breakthrough was achieved by a Brit, but MRIs are much more widely used in the U.S.

Medicare is no exception to this anti-innovation bias. As health care expert John C. Goodman, CEO of the National Center for Policy Analysis, has noted:

"Almost no one talks to his or her doctor on the phone. Why? Because Medicare doesn't pay a doctor to talk to you on the phone. And private insurers, who tend to follow Medicare's lead, don't pay for phone consultations, either. The same goes for e-mail: Only about 2% of patients and doctors e-mail each other--something that is normal in every other profession.

"What about digitizing medical records? Doctors typically do not do this, which means that they can't make use of software that allows electronic prescriptions and makes it easier to detect dangerous drug interactions or mistaken dosages. Again, this is something that Medicare doesn't pay for. Likewise patient education: A great deal of medical care can be handled in the home without ever seeing a doctor or a nurse--e.g., the treatment of diabetes. But someone has to give patients the initial instruction, and Medicare doesn't pay for that."
pic

A federal government insurance company, with its subsidies, will attract more and more people from private plans. Instead of overtly running providers such as Aetna ( AET - news - people ) and UnitedHealthcare out of business, the federal government will take them over through mandating what they can and cannot do, as well as "reinsuring" private carriers for costs above certain levels. In other words, nongovernment insurance companies will become vassals and virtual subsidiaries of the Washington-run system.

What are the alternatives to this health care nightmare? There are many positive, nongovernment things that could instead be done.

--Allow mandate-free insurance policies. True catastrophic health insurance--not the current dollar-for-dollar coverage--is very affordable.

--Permit people to buy health insurance across state lines. Removing such barriers would sharply increase competition.

--Make it easier for small businesses to buy insurance in a pool, whether through trade associations or other kinds of affiliations.

--Equalize the tax treatment of premiums. Companies get a tax deduction for health insurance premiums, as do the self-employed. Why not give that break to employees who choose to buy their own individual policies? They would get a deduction or a refundable tax credit (meaning if they don't have a tax liability they'd get an actual check from Uncle Sam). Many small businesses offer no insurance, or those that do may offer policies some workers find unsatisfactory. These folks should have the ability to easily get their own alternatives.

--Raise limits on contributions to HSAs and on permissible deductibles.

All of these ideas would substantially cut the number of un-insured. For those truly uninsurable, why not give them the medical equivalent of food stamps and subsidize their catastrophic health insurance premiums through private companies?

President Obama says he wants to make health care affordable for all. Applying free-market principles to health care would do just that. Even with private-sector insurance there isn't a true free market--not when most expenses are covered by third parties. The key is to give consumers, not businesses and government bureaucracies, control of their health care dollars. Having businesses put money into workers' HSAs would be preferable to today's system. Once consumers actually control the money, they will apply pressure to get more value for it. After all, it's theirs.

Free-market dynamics have worked in virtually every other part of the economy, spurring production and innovation and helping us get more for less. Food is even more basic than health care. We don't have a third-party-payer system for food (except for food stamps). Result: Today people spend a smaller portion of their income for food than they did decades ago. And the variety of foods is greater than ever. Free markets can do the same with regard to health care; governments manifestly cannot.
« Last Edit: April 29, 2009, 04:17:21 PM by Crafty_Dog » Logged
JDN
Power User
***
Posts: 2004


« Reply #133 on: April 29, 2009, 04:06:24 PM »

Some good ideas Doug,

But, you said..... and I basically agree.....

Free-market dynamics have worked in virtually every other part of the economy, spurring production and innovation and helping us get more for less. Food is even more basic than health care. We don't have a third-party-payer system for food (except for food stamps). Result: Today people spend a smaller portion of their income for food than they did decades ago. And the variety of foods is greater than ever. Free markets can do the same with regard to health care; governments manifestly cannot."

Except for Medicare, the medical system is basically free market, yet it doesn't work, i.e. people are paying more for medical care than ever before.  Why?

My 2 cents.
People expect the "best".  Yet using food (as you did) for example, some people eat steak and some people eat hamburger.  And the system works.  In medical care everyone wants the newest and the best, but doesn't want to pay for it.  Tough choices need to be made.

Also, ease of entry.  Now, all doctors get paid the same whether they went to Harvard Medical School or Montana Tech.  Lawyers in contrast usually earn more if they went to Harvard versus the joke of a college; why not Medical?  And why not allow easy entry for foreign medical MD's if they pass the medical exam here?  Again, it works for lawyers.  Yet doctors keep a closed community limiting the number of doctors in America to
artificially raise incomes.  Is that right?  Some doctors as you pointed out are declining Medicare patients.  What about the Doctor's oath?

Bottom line, people expect the best, but will not pay for it out of their own pocket.  Tough choices, who gets what procedures, what technologies, what drugs, etc must be made otherwise a competitive system will never work.  America pays more than nearly any other country for their health care, and yes, for the high tech issues like cancer etc it is the best, but for the everyday Joe, our morbidity is not superior to most industrialized countries. 

And then we get back to the issue of whether Medical care is a right, like a Fire Department, Police Department, roads, etc available and equal for all, or is only the best available to the affluent.  Is that right???  Maybe yes, maybe no. 

But something needs to be done, that is a given...
Logged
Body-by-Guinness
Power User
***
Posts: 2788


« Reply #134 on: April 29, 2009, 05:33:13 PM »

Quote
Except for Medicare, the medical system is basically free market, yet it doesn't work, i.e. people are paying more for medical care than ever before.  Why?

Whoa! Not sure an informed discussion can follow a statement as inaccurate as that. The current US system is a heavily regulated, oddly constructed hodgepodge that spins off perverse incentive with great frequency. Most health insurance is provided through a person's employer, for instance, rather through any free market vehicle hence driving a wedge between the market and the health insurance decision making process. Until recently many health insurance policies did very little to reward good decision making and punish bad decision making on the part of the insured, again divorcing tangible consequences from market forces. Then a given employer's policy wasn't transferable to a new job, which prevents some from making market oriented vocational decisions as they are tied via pre-existing conditions or other situations to their current employer. Then there are the uninsured who receive basic medical services via the ER with those costs passed on to the insured, rules and regs that prevent an insurer in one state from competing in another, duchies and principalities such as Massachusetts passing all manner of regulations meant to insure all that instead drives doctors out of the system, FDA regs, EPA regs, regs that keep the pain ridden and terminally ill from easily accessing narcotic analgesics and so on. And all these examples of non-market oriented mechanism are what leap to mind with a few minutes thought. A little research would doubtless reveal considerably more.

It galls me when the housing crash is called a failure of the free market when massive government intervention, political favor granting, and ill-considered tinkering had much to do with it. Similarly it strikes me that any discussion of the current health care system is doomed to failure if its initial premise is that we are currently operating under a free market system where health care is concerned. Indeed, when attempts at market based reforms are demagogued as they were last election cycle and when nanny state supporters struggle ceaselessly to impose a single payer system I'm surprised the term "free-market" is even raised in this debate as it's clearly not part of the current health care paradigm.
« Last Edit: April 29, 2009, 05:39:04 PM by Body-by-Guinness » Logged
Body-by-Guinness
Power User
***
Posts: 2788


« Reply #135 on: April 29, 2009, 05:37:46 PM »

A piece written just prior to the election that speaks to the points made above:

www.heritage.org
Candidates' competing prescriptions for health care
by Robert E. Moffit, Ph.D.
October 24, 2008 |
[back to web version]
Approximately 47 million Americans lack health coverage. It's a huge problem.

To their credit, both major presidential candidates have both ponied up ambitious plans to deal with it. Their approaches are expansive and expensive. And that's where the similarities end.

When it comes to the future of America's health system, John McCain and Barack Obama hold two very different visions.

The Obama health plan would centralize power in Washington.

Increasingly, federal officials would hold the purse strings and make the decisions on health care delivery.

The McCain plan would decentralize control over health care financing and decision-making, empowering individuals and families. In the public health arena, states would retain authority rather than cede power to the feds.

In the case of both plans, some crucial details are sparse. But it's easy to spot the major differences in approaches taken by the candidates.

To expand coverage, Sen. Obama would take four major steps:

Create a new national health plan. The new government health plan would enroll those without job-sponsored coverage and those not eligible for coverage under existing government health programs, such as Medicaid and SCHIP.
Create a national health insurance exchange. The exchange would be the ultimate regulatory "watchdog," making sure that private health plans competing with the government plan met the same regulatory standards as those applied to the new federal health plan.
Impose a "play or pay" employer mandate. Employers would be expected to offer their workers a level of health coverage set by the government. Those who didn't would have to pay a new federal tax - of an unspecified amount - which would be used to help finance the new government plan.
Embrace new regulatory initiatives governing health care delivery by physicians and other medical professionals, and expand existing government health programs - particularly Medicaid and SCHIP.
Just how much that would entail government control over medical practice is, again, unclear.

No doubt, Obama's approach would take a big bite out of the uninsured problem. But not as much as you might think.

His approach adds millions to the public health rolls by skimming millions from private health plans - especially employer-based plans.

The Lewin Group, the country's most authoritative health econometrics firm, estimates the plan would extend government health coverage to 48.3 million Americans. But nearly half of those (47 percent) are currently insured through their employers. They and their families would "gain" government coverage because the Obama approach makes it economically advantageous for their companies to discontinue their health benefits and dump them into the government-run plan.

The McCain plan calls for three major steps:

Replace federal tax breaks exclusively for employment-based coverage with a universal health care tax credit ($5,000 for a family, $2,500 for an individual). The new health care tax credit would replace the current employees' tax exclusion, not the employer's deduction.
Create a national market for health insurance. Individuals and families could buy state-regulated health insurance plans anywhere in the country, not just in the state where they happen to live.
Implement a "guaranteed assistance program." The feds would give states financial assistance to provide affordable coverage for the 2 million to 5 million Americans considered "uninsurable" due to serious medical conditions. This would be accomplished through state-based high-risk pools or similar mechanisms
Like Obama, McCain would also promote changes in care delivery with an eye toward securing greater value for health care dollars.

Independent analysts generally see McCain's proposal, powered by the universal health care tax credit, as producing a rapid expansion in private health coverage and a reduction in dependency on government programs. The Lewin Group estimates it would extend private insurance coverage to an additional 26.5 million Americans. Millions of Americans on Medicaid, a welfare program, would transition over to private health insurance. The net reduction in the ranks of the uninsured, according to Lewin: 21.1 million.

The most common concern about the McCain plan focuses on its financing.

Some critics imply his proposal to pay for the tax credit by taxing health benefits amounts to a tax increase. In truth, however, this approach would yield a major tax cut to the vast majority of Americans, particularly for the middle class. Analysts at the Urban Institute estimate the change in tax treatment would leave the typical family roughly $1,200 ahead annually.

The financial question pales in comparison to the far larger issue at hand: the direction this country will take in crafting a 21st century health system. Sen. Obama's plan would take us on the path to a government-controlled system. Sen. McCain's approach would shift the reins of health care financing and selection into the hands of individuals and families.

Robert Moffit, is director of the Center for Health Policy Studies at The Heritage Foundation.

http://www.heritage.org/Press/Commentary/ed102408a.cfm
Logged
DougMacG
Power User
***
Posts: 5875


« Reply #136 on: April 29, 2009, 11:13:08 PM »

"Except for Medicare, the medical system is basically free market"

Guinness answered this better, but I was going to say that sure - it's a free market - about like OPEC, lol.  Government based healthcare and government rules and mandates I think are a huge part of the market and as Forbes demonstrates, set the tone for how things are done in the rest of the market.  I would not favor a totally unregulated market in medicine, but if we want control on costs we have to find a way for competition and consumer choices to flourish.

Healthcare was compared with the market for food but high-tech might be a more insightful comparison.  I can buy a computer model that has been proven for a few years and widely available for a few hundred bucks.  Or I can buy the very latest experimental high tech device barely out of the lab for maybe hundreds of thousands.   In every other area we balance those choices with our budget and our circumstances.  Not with other people's money available and life and health choices on the line.  In health care we keep wanting the newest and latest treatment no matter the price or whether or not the performance is proven and we demand that someone else pay for it.

Do you want government to ration these decisions or prices and individual choices to do that?  Neither is perfect, but I prefer leaning toward the price mechanism and free choices over the bureaucracy as much as possible.

Studies show that a lion's share of health care costs, especially the more recent increases, go toward our treatments during our last 6 months of life.  Basically we are denying our own mortality, and then dying anyway.  If you made those treatment choices out of your own saving, and imagine if you had the right to pass your earned, accumulated wealth on to your family, would you still want to pay any price and fight every fight even the ones not winnable while knowing that you are spending the last of your family's inheritance?
Logged
JDN
Power User
***
Posts: 2004


« Reply #137 on: April 30, 2009, 10:07:03 AM »

Quote
Except for Medicare, the medical system is basically free market, yet it doesn't work, i.e. people are paying more for medical care than ever before.  Why?

Whoa! Not sure an informed discussion can follow a statement as inaccurate as that. The current US system is a heavily regulated, oddly constructed hodgepodge that spins off perverse incentive with great frequency. Most health insurance is provided through a person's employer, for instance, rather through any free market vehicle hence driving a wedge between the market and the health insurance decision making process. Until recently many health insurance policies did very little to reward good decision making and punish bad decision making on the part of the insured, again divorcing tangible consequences from market forces. Then a given employer's policy wasn't transferable to a new job, which prevents some from making market oriented vocational decisions as they are tied via pre-existing conditions or other situations to their current employer. Then there are the uninsured who receive basic medical services via the ER with those costs passed on to the insured, rules and regs that prevent an insurer in one state from competing in another, duchies and principalities such as Massachusetts passing all manner of regulations meant to insure all that instead drives doctors out of the system, FDA regs, EPA regs, regs that keep the pain ridden and terminally ill from easily accessing narcotic analgesics and so on. And all these examples of non-market oriented mechanism are what leap to mind with a few minutes thought. A little research would doubtless reveal considerably more.

It galls me when the housing crash is called a failure of the free market when massive government intervention, political favor granting, and ill-considered tinkering had much to do with it. Similarly it strikes me that any discussion of the current health care system is doomed to failure if its initial premise is that we are currently operating under a free market system where health care is concerned. Indeed, when attempts at market based reforms are demagogued as they were last election cycle and when nanny state supporters struggle ceaselessly to impose a single payer system I'm surprised the term "free-market" is even raised in this debate as it's clearly not part of the current health care paradigm.

Let me try...

Albeit some years ago, having worked for William Mercer (Benefit Consultants) for a number of years, representing large 50,000+ee employers, I assure that these employers (the buyers) are interested in reducing costs.  HMO's have become prevalent; deductibles have been raised, higher co-pays were instigated, networks established, etc all with the express purpose of lowering costs.  For a number of years, group plans have rewarded good decision making and punished bad decision making.  As for the market, well the market (competing insurance companies) are the ones who fought for pre-existing clauses.  And large groups, basically self insured likes pre existing clauses as well.  Do you want to hire and employee, pay him 30K but absorb a 500K medical expense?  Market forces have denied these people coverage.  Again, market forces denied the transferability of coverage; who wants a new sick employee?  Better to have a short form medical questionnaire and deny coverage to the uninsured or ill.  It was only the government intervention that COBRA came about.  Better than nothing a lifeline to some.

I agree, the uninsured bog down the ER room.  But again, market forces deny coverage to these people.  It will take the government to intervene to provide coverage. 

As for state regulation, why on other posts is "state's powers " lauded and encouraged?  Yes, a few states implement silly rules, but I doubt if many doctors leave the state because of it.  Nor many employers for that matter; they just suck it up.  And oddly, market force again usually will dictate which rules and regs are passed; employers don't sit on the butt; but rather offer stiff opposition to almost any law increasing costs.  I remember when pregnancy wasn't covered and a few states started to mandate the coverage.  There was a huge fight, market forces wanted to deny coverage, but in the end government intervened.  And I think we are better off.

As for keeping the pain ridden and terminally ill from easily accessing narcotics, well in our litigious society, it is not easy.  You may want your loved one to have these medications, and if they die from the medication and/or become addicted logic your logic (and mine) says you eased their pain.  But someone else may not agree.  And who is to decide? And think about the possible abuse.  Those drugs are cheap; it is not a cost issue, but a safety issue.

Free market?  There are lots of insurance companies competing here in California.  And a doctor is free to choose how to run his practice.  My doctor for example will not take any HMO and only a very few (high paying) PPO's.  He prefers  cash.  A new doctor just out of school to increase their business often will sign up for any HMO that will take him.  Ask at UCLA if the top oncologists will take HMO.  The answer is a resounding "NO".  I know from a friend's personal experience.  That is the free market at work.

In review the issues of transferability, pre-existing conditions, uninsured, etc are essentially denied coverage because of "free market" not in spite of; frankly it's not profitable business; that's easy.  It takes the government to intervene to demand coverage and make a level playing field otherwise why should a business enter a non profitable market?

The issue is choices, hard choices.  As I said before, we want our cake and eat it too.  Frankly, I like and agree with most of Doug's immediately preceding posted comments.  Choices; but America wants the newest and best medical care for everyone and if it isn't offered America is indignant.  Some choices need to be made.  Maybe an insurance company is best, or the government, but individuals?  It's tough to say "no, don't use an MRI (even though it's better) a CT Scan is good enough".  I can choose my computer based upon my financial situation and need, but I want the "best" medical care for my family whether I can pay for it or not.  And I will let you (not personal Doug) decide not to spend the family's inheritance not to keep your wife alive later in life; it's tough... albeit logical.  We are too emotionally attached.

I'm not saying an all government plan is the answer.  I am saying that something needs to be done.  And yes, there is waste.  But the government  needs to mandate that somehow everyone will be insured.  That pre-existing condition clauses don't exist, etc.  Medical care is not buying a new computer, it is a life at stake. 



Logged
Crafty_Dog
Administrator
Power User
*****
Posts: 31053


« Reply #138 on: April 30, 2009, 11:06:20 AM »

Re transferability:

Doesn't this issue have its roots in the wage and price controls of WW2?  IIRC the govt did allow health insurance to become part of the payments to workers without taxing it-- but if an individual wants to buy insurance on his own, he must do so with after tax dollars.  Yes?
Logged
DougMacG
Power User
***
Posts: 5875


« Reply #139 on: April 30, 2009, 11:14:39 AM »

"And I will let you (not personal Doug) decide not to spend the family's inheritance not to keep your wife alive later in life; it's tough... albeit logical.  We are too emotionally attached."

Don't worry JDN, nothing personal taken, but you read me wrong.  I am saying that it IS a valid choice to spend your own money on heroic health measures, or mansions yachts and trips around the world instead of leaving a nest egg. But it doesn't work for ALL of us to choose the highest cost solutions on everything and then demand that someone else pay for it - and keep costs down.
Logged
DougMacG
Power User
***
Posts: 5875


« Reply #140 on: April 30, 2009, 11:29:14 AM »

"Doesn't this issue have its roots in the wage and price controls of WW2?  IIRC the govt did allow health insurance to become part of the payments to workers without taxing it-- but if an individual wants to buy insurance on his own, he must do so with after tax dollars.  Yes?"

Yes, though you can make limited pre-tax HSA contributions (health savings account). 

Sure enough, health care was federalized though the tax code.  JDN makes a good point about states rights.  I will indulge him on that and agree with any move that takes the feds completely out of the health care business, and auto manufacturing, and housing/mortgages, and ...
Logged
JDN
Power User
***
Posts: 2004


« Reply #141 on: April 30, 2009, 12:00:45 PM »

"And I will let you (not personal Doug) decide not to spend the family's inheritance not to keep your wife alive later in life; it's tough... albeit logical.  We are too emotionally attached."

Don't worry JDN, nothing personal taken, but you read me wrong.  I am saying that it IS a valid choice to spend your own money on heroic health measures, or mansions yachts and trips around the world instead of leaving a nest egg. But it doesn't work for ALL of us to choose the highest cost solutions on everything and then demand that someone else pay for it - and keep costs down.

Glad nothing personal taken.

Yes, It is a valid choice how to spend your own money, however I think people can logically find it rather easy not to buy the mansion, yacht(s) smiley or trip around the world in their late years.  Yet difficult to deny their wife the best care (i.e. most expensive).  I'm not sure you can equate the two.  It's a tough choice, although I concede your logic, such decisions are often made with emotion; logic doesn't enter into it.  "Because it's expensive, "Let them die" or don't do another round of the latest Chemo ($5000 for 10 pills+++) cocktail" is hard to say...  Will/Do people consciously accept a lower level of medical care for lower quality of care in exchange for lower cost?  Especially on the life threatening issues?  I'm not sure...  And is that even right?
Logged
Body-by-Guinness
Power User
***
Posts: 2788


« Reply #142 on: April 30, 2009, 12:17:39 PM »

Quote
Albeit some years ago, having worked for William Mercer (Benefit Consultants) for a number of years, representing large 50,000+ee employers, I assure that these employers (the buyers) are interested in reducing costs.

I certainly assume they are. But they are not the end user of the health product and hence have little impact on the decision making occurring at the time a health service is provided. A system where consumers are insulated from market forces is not a "free-market," and hence should not be indicted as a free market failure.

Quote
HMO's have become prevalent; deductibles have been raised, higher co-pays were instigated, networks established, etc all with the express purpose of lowering costs.  For a number of years, group plans have rewarded good decision making and punished bad decision making.

Which is why I said "until recently." Still, in my market and most others there are non-HMO choices that many opt for, as I did recently having grown annoyed with the HMO habit of rationing care via long waits and bureaucratic hoop navigation when seeking anything other than preventative care.

Quote
As for the market, well the market (competing insurance companies) are the ones who fought for pre-existing clauses.  And large groups, basically self insured likes pre existing clauses as well.  Do you want to hire and employee, pay him 30K but absorb a 500K medical expense?  Market forces have denied these people coverage.  Again, market forces denied the transferability of coverage; who wants a new sick employee?  Better to have a short form medical questionnaire and deny coverage to the uninsured or ill.  It was only the government intervention that COBRA came about.  Better than nothing a lifeline to some.

As mentioned, non-free market forces such as limiting plans to a given state prevent innovation that might allow folks with ongoing illness to band together and seek specific treatments. My mother had multiple sclerosis and died due to its complications, but was limited throughout her life by the insurance available through my father's employer. There is a very active MS community out there, as there is for many illnesses, and it doesn't take a lot of imagination to envision an entrepreneur who caters to a targeted market creating a plan focussed on a specific set of needs. Throw portable health insurance into the mix and I'm confident innovation would occur. Alas, non-market based interventions prevent this from occurring, necessitating government intervention such as COBRA.

Quote
I agree, the uninsured bog down the ER room.  But again, market forces deny coverage to these people.  It will take the government to intervene to provide coverage.
 

Hmm, I'm having some trouble wrapping my head around this statement. Isn't it market forces that deny this same group yachts? Need we demand government intervention to address this inequity too? I was going to use the example of higher end housing, but in fact the government did intervene on that front, I remember reading somewhere. Remind us how that turned out.

Again, the debate as you framed it is that the free market has failed to provide health care, though as hopefully has been established, the market isn't free so indicting it for failures such as these puzzles me. Moreover, attempts to introduce free market devices such as tax free medical savings accounts that would provide the uninsured with an incentive to save money and participate in something like a High Deductible Low Premium insurance plan are routinely nixed by the very same government officials who favor single payer schemes. Just a coincidence, no doubt. Markets are stifled, then blamed by the political types. Good work if you can get it, I guess.

Quote
As for state regulation, why on other posts is "state's powers " lauded and encouraged?

MA is welcome to make all doctors wear pink mohawks and walk around flapping their arms like birds if they'd like, just don't call it an expression of the free market, yes?

Quote
Yes, a few states implement silly rules, but I doubt if many doctors leave the state because of it.  Nor many employers for that matter; they just suck it up.  And oddly, market force again usually will dictate which rules and regs are passed; employers don't sit on the butt; but rather offer stiff opposition to almost any law increasing costs.

"Taxachusetts" as some of its residents less than fondly call it is in fact is experiencing contractions in employment and population that predate the recession, is trying to come up with schemes to tax people who live in neighboring states because of the high cost of living those folks live elsewhere but work in MA, is looking at ways to recover sales tax when residents make purchases outside the state to avoid high rates, etc. My very liberal sister the Boston lawyer has even gotten to the point where she is connecting the dots; I'd be very surprised if these same circumstances don't impact medical care.

Quote
I remember when pregnancy wasn't covered and a few states started to mandate the coverage.  There was a huge fight, market forces wanted to deny coverage, but in the end government intervened.  And I think we are better off.

Back when I started riding BMW motorcycles we use to say "you can get a Beemer in any color you want as long as it is black." Similarly, you can get any sort of insurance you want, as long as it's offered by your employer. Wish there was a way to lay a wager over what would have happened if portable insurance had been around back then; I'd be willing to bet pregnancy insurance would have come along quicker if it was something people could have easily opted for, but that choice, ie the free market, was disallowed by employers. Indeed, a lot of what you cite in fact refutes the premise that the markets are free. Is this being noted or am I gonna start wondering why I'm participating in a counterproductive loop?

Quote
As for keeping the pain ridden and terminally ill from easily accessing narcotics, well in our litigious society, it is not easy.  You may want your loved one to have these medications, and if they die from the medication and/or become addicted logic your logic (and mine) says you eased their pain.  But someone else may not agree.  And who is to decide? And think about the possible abuse.  Those drugs are cheap; it is not a cost issue, but a safety issue.

And so the free market is invoked and trumped in the same paragraph. If we are talking about markets let's talk about markets. If we are talking about morality or whatever let's stick to that. The drug example, however, is a very straightforward one illustrating just how far the medical market is tainted by non-market forces, which again gives lie to your premise.

Quote
Free market?  There are lots of insurance companies competing here in California.  And a doctor is free to choose how to run his practice.  My doctor for example will not take any HMO and only a very few (high paying) PPO's.  He prefers  cash.  A new doctor just out of school to increase their business often will sign up for any HMO that will take him.  Ask at UCLA if the top oncologists will take HMO.  The answer is a resounding "NO".  I know from a friend's personal experience.  That is the free market at work.

Wow, I can't find the energy to start unraveling that. Here's a question you can pose to your doctor: does he think he'd see more patients or fewer if everyone had portable insurance unburdened by government regulation? I think the answer is obvious, and if it is what does it say about the rest of your arguments?

Quote
In review the issues of transferability, pre-existing conditions, uninsured, etc are essentially denied coverage because of "free market" not in spite of; frankly it's not profitable business; that's easy.  It takes the government to intervene to demand coverage and make a level playing field otherwise why should a business enter a non profitable market?

I trust my responses to this point make it clear that I disagree with your summary, and similar sorts of government interventions like the recent one in the housing market speak for themselves.

I feel an attack of the snarkies coming on so I'm gonna leave it there. I'm not hardwired in a manner that allows me to calmly discuss a premise as its antithesis is cited as evidence. If you are going to persist in identifying the free market while citing examples that are not part of free markets as I understand them, then perhaps it's time to define the term so discussion can proceed sans the cognitive dissonance that starts my acid tongue waggin'.
« Last Edit: April 30, 2009, 01:15:18 PM by Body-by-Guinness » Logged
JDN
Power User
***
Posts: 2004


« Reply #143 on: April 30, 2009, 02:09:59 PM »

BbyG said, "Here's a question you can pose to your doctor: does he think he'd see more patients or fewer if everyone had portable insurance unburdened by government regulation? I think the answer is obvious, and if it is what does it say about the rest of your arguments?"

I don't think my doctor worries too much about government regulation slowing down the number of patients visited; he is pretty full 5-6 days a week right now.  His income might be affected by the paperwork, but then free enterprise insurance company's paperwork is much if not more to blame as well.  As for portability, yes, it's a great idea.  Never happened until the government stepped in and demanded COBRA.  Free enterprise is driven by profit; nothing wrong with that.  But actuarially there is little or no profit in portability, or covering people who banded together with MS or Cancer, etc.  Imagine going to an underwriter and say, "Hey, I've got a group of 5000 people diagnosed with cancer or MS or... would you like to cover them?"  Again, it will never happen.  Only the government can intercede. 

And don't forget, if you feel so strongly you can always opt out of your employer's plan and chose an individual plan.  It will cost you, but if you can get covered it's portable.  I like that and that's why I have an individual high medical savings account for many years.  I don't want to ever be left high and dry with a pre-existing condition if my employer decides to close the office.

And it IS a discussion on morality as well; it cannot be avoided.  No one would say buy the biggest and best yacht versus a dinghy if you are are a tight budget; it is a luxury.  But is medical care a "luxury"?
Or a necessity?  And if I never could afford my yacht, one would say "oh well" but if I died because I couldn't afford or obtain insurance, well... something is very wrong...  It's different. And morality IS an issue.
Logged
Body-by-Guinness
Power User
***
Posts: 2788


« Reply #144 on: April 30, 2009, 03:00:40 PM »

As long as "free-market" and "morality" aren't conflated within a discussion I don't have an issue. Just don't argue one while introducing the other and behaving as though they are one in the same.
Logged
Body-by-Guinness
Power User
***
Posts: 2788


« Reply #145 on: May 01, 2009, 07:32:00 AM »

So last night I had a wan notion: how 'bout if we start a movement to make any health insurance scheme produced by congress and signed by the president be beta tested for an election cycle--4 years--by congress and all federal employees and then have the efficacy of that plan reviewed by the GAO? If it's something they want to foist on the nation then they can prove that it works first.

A pipe dream, I realize, and even if it were to occur congress itself would insert little clauses in line 10,583 that would give them access to the sort of backdoor care patrician a$$holes demand, but they exempt themselves from so much of what they drop on others it'd be nice to see it turned around, for once.
Logged
DougMacG
Power User
***
Posts: 5875


« Reply #146 on: May 04, 2009, 11:54:57 PM »

From 'Rest in Peace' , Sen. Specter blamed the Republican party for the death of Jack Kemp.  My first reaction is just bad manners; sounds like Specter is getting angry and bitter along with growing old. I saw Specter on the shows - he is not senile but getting a little slower and sadly desperate in his cling to power.  For his new party, though, this type of thinking is an accepted pattern.  They said the same things about cures they say should have happened for Christopher Reeves and Michael J. Fox. 

Besides bad manners, one issue with Reeves and Fox is the stem cell issue and the other with Specter, Kemp and cancer is about public spending. (Let's leave stem cell controversy for another day.)

Public spending on medical research is Specter's beef (or maybe he's just rambling because he saw a camera and microphone on - like Biden does).  My view is out of the mainstream, but I think the federal government should be a whole lot smaller, the cost should be a whole lot lower, privately we would be a whole lot wealthier and then our favorite form of charity might be to give money directly to medical research for the ailments that are most likely to strike our families.  Cancer research is certainly at or near the top of anyone's list.

Ironically, prostate cancer might be one of the most likely types many people here might face and the survival rate here is the U.S. under our current, 'failed' system with underfunded research is far higher than in the countries with the national healthcare systems that we strive to emulate.

If we were to slash all the programs out of the budget that aren't called for in the constitution I would hopefully cut medical research last, but I would prefer to see it off of coercion-based funding. That's just me, but I wouldn't put a man on the moon at taxpayer expense either.

One objection I always have is that we measure compassion (and results) in dollars spent.  As some watching the global warming fiasco have noticed, science at major institutions sometimes seems to be more about the funding than about the cure or the truth.  Published results always seem to call for more study needed and more funding.  CCP, you have more real world exposure to the medical research side than most of us so let us know what you see...

Another related point is that in health care we spend a huge portion of the money on the last 6 months of life.  In the federal budget other than medical research we spend zillions on programs that are either counter productive or lower in benefit to cost ratio than crucial medical research.  Setting priorities means putting something AHEAD of something else for funding, not just sending more and more to every feel-good bill that ever passed a previous congress.  Did Specter make clear what we should spend LESS on in order to fund eternal life?

Two ideas for government involvement in research:  a) offer rewards for results instead of funding for study, or b) consider buying up the best patents and then making 'the cures' available everywhere for free, a public good.

MD's here may see it differently but I doubt that there is 'a cure' or elimination for cancer.  I think that we just trudge forward with better preventions, better treatments, better results and longer life expectancies just like we are doing and seeing now.

[If Specter really wanted to save lives and protect the weakest among us, he could change his position on the first issue he mentioned having in common with his new party, pro-choice support for abortion rights.]

CCP and others, your thoughts?
Logged
Body-by-Guinness
Power User
***
Posts: 2788


« Reply #147 on: May 05, 2009, 12:06:31 PM »

Quote
As some watching the global warming fiasco have noticed, science at major institutions sometimes seems to be more about the funding than about the cure or the truth.  Published results always seem to call for more study needed and more funding.

I subscribe to an RSS feed from Eureka Alert, a journal of breaking scientific research, but find myself marking all the items as read when in fact I haven't seen them because most the headlines try to work in some wan relationship to AGW in. It's freaking embarrassing to read piece after piece where some author/committee is so starved for funding/attentions that they come up with crap like "Global Warming Responsible for Lower Rate of Circumcision in Sub-Saharan Africa." The whole AGW boondoggle has turned into a warped funding talisman, a talisman that is diametrically opposed to the values of science. It is downright scary to think that we are raising a generation of scientists who think that cargo cult funding schemes have to be incorporated into every scientific effort; I've little doubt this regimen of perverse incentive will bite us on the fanny down the road.
Logged
ccp
Power User
***
Posts: 4052


« Reply #148 on: May 06, 2009, 01:49:12 PM »

Doug,
I am not an expert on cancer research but from what I have read about ongoing research over the years suggests that Specker's remarks are no less ridiculous, absurd, and downright stupid.

There has been more money spent on cancer research than anything as far as I know.

Treating much less curing cancer is simply *that complex* and *that challenging*.  More dollars he implies?  What/who do you throw more dollars to?  There are only so many researchers.  There are only so many avenues that are discovered to explore at any given time.  There is only so much we can learn at a time. It takes *years* if not decades of study to prove anything one way or the other.  Why we haven't even been able to prove if doing a prostate screening blood tes (PSA) is beneficial or harmful after many years of trying to figure it out!

I am not clear how much of the confusion is based on *misunderstanding* by the media, politicians, public, etc.  I am not sure how much of it is grandstanding by scientists themselves who are no less interested in money, politics, power, fame, other agendas than the rest of humanity.  don't let the fact that they research cancer fool you into thinking they are all so noble and pure.  Quite the contrary.  Some of stories I have heard from researchers are not pretty with regards to pettiness.

I am really not sure.  But taken on the face of it, Spector's comments seem totally irresponsible.

As for your two ideas:

***Two ideas for government involvement in research:  a) offer rewards for results instead of funding for study, or b) consider buying up the best patents and then making 'the cures' available everywhere for free, a public good.****

I think the first is a bad idea because most research ends in failure.  *At least* to the tune of 90%.  So I think that will stiffle a lot of research.   Who wants to pay for something that has unusually high risk? 

As to the second, I think it is an *excellent* idea.

Just my two cents.

"




Logged
Body-by-Guinness
Power User
***
Posts: 2788


« Reply #149 on: May 06, 2009, 05:31:33 PM »

http://www.reason.com/blog/show/133357.html


Tenth Circuit to Hear Arguments Today on the Science Behind Painkiller Prosecutions

Radley Balko | May 6, 2009, 4:12pm

A couple of weeks ago, Jacob Sullum blogged about a case in Kansas where the government seems to be targeting not only Stephen Schneider, a physician specializing in pain treatment and his wife Linda, but also Siobhan Reynolds, who heads up the pain patient advocacy group the Pain Relief Network.

Reynolds has become a sort of shoestring-budgeted PR machine for doctors under investigation whom she believes are getting railroaded. She educates local media on pain treatment, including the sometimes very high doses of medication needed to treat patients who have built up a tolerance to opiods. Her efforts in the Schneider case have resulted in some refreshingly balanced coverage. And that apparently has Assistant U.S. Attorney Tanya Treadway steaming.

As Sullum noted, last year Treadway tried to impose a gag order on Reynolds. She was denied. Several of Schneider's patients who had spoken out on his behalf say shortly after, federal agents forced their way into their homes, in one case confiscating a letter Schneider had written from prison.

So Treadway is now calling Reynolds the "subject" of a grand jury investigation into possible obstruction of justice. Treadway has asked Reynolds to turn over all of her correspondence with pain patients, attorneys, the Schneiders, and just about everyone else in any way associated with the case. Reynolds is fighting the subpoena, and is now represented by the ACLU.

Last year, Treadway also attempted to bar the Schneiders from obtaining court-appointed counsel, citing their considerable wealth. The problem is that everything the Schneiders own is subject to forfeiture, meaning any attorney who agreed to take their case would do so knowing there would be a pretty good chance he'd never get paid. The government essentially argued that the accused couple should have no counsel in court (unless they could find someone to take the case pro bono), and be barred by law from having anyone defend them in public. When all of that failed, they asked for a change in venue, claiming that patients and Reynolds speaking out for the Schneiders had tainted the jury pool.

Treadway's efforts are particularly egregious given that it has become pretty standard practice for U.S. attorneys to issue press releases and sometimes even call press conferences to announce when a physician has been indicted for over-prescribing painkillers—as they did in the Schneider case. The government can work the media and jury pool all it likes. But when a suspect gets an advocate who knows how to work the media, they first try to shut her up with a gag order, then intimidate her with a grand jury investigation.

But Treadway's aggressiveness may well come back to bite her. Her office originally tried to link the Schneiders' practice to 56 alleged patient overdose deaths. U.S. District Judge Monti Belot balked, and threw out all of the deaths but four. He then sternly warned Treadway not to appeal his decision. Belot also instructed the government not to use inflammatory descriptions like "pill mill" in front of the jury, another common tactic in these cases.

Treadway appealed anyway, delaying the Schneiders' trial by months. The interesting thing is that her appeal allowed the defense to file a cross-appeal that will challenge not only Treadway's attempt to link the Schneiders to the four remaining deaths, but also the government's entire methodology of using "red flags" and questionable links to patient deaths to prosecute pain doctors. Reynolds, who has seen a lot of these cases, says it's the first case she can recall where a federal appeals court will hear arguments on whether the government's system of identifying what it says are drug diverting physicians is scientifically sound enough to be admitted into evidence.

One red flag the government uses, for example, is to look for physicians who simply prescribe a raw number of pills that investigators say is too high, a practice pain advocates say has made doctors afraid of engaging in the high-dose opiate therapy course of chronic pain treatment that's been so effective. Other red flags include doctors who spend what investigators say is too little time with patients to make an accurate diagnosis, a problem pain advocates say has become increasingly common not because more doctors are selling scripts to addicts and drug dealers, but because the few doctors who do still treat chronic pain are overwhelmed with patients whose former doctors have been arrested, stripped of their licenses, or run out of business by investigations.

The Schneiders' brief also argues that the government's practice of linking deaths to opioids is problematic because such deaths often include patients who merely had high concentrations of opiates in their systems and died unexpectedly. Several of the patients who died of heart attacks, for example, weren't checked for signs of heart disease. The heart attack plus a high concentration of opiods in their system was enough for the government to link the opiods to the heart attack.

The government's argument that the Schneiders were causing a disproportionately high number of deaths also rests on comparing the number of clinic patients who died to the population at large, instead of to the number of patients undergoing treatment at a clinic not suspected of any wrongdoing. It isn't all that difficult to see how patients undergoing treatment for chronic pain might have a higher mortality rate than the general population.

The federal government has been using these arguments to prosecute doctors for years, but to this point, there has never been a formal hearing to determine if there's any actual science behind them. Pain specialists are skeptical. The general consensus is that red flags are fine for identifying potentially problematic doctors by, say, a medical board, but they're simply not enough to find a doctor guilty of criminal wrongdoing. Pain specialist and pain organizations have also long decried the arbitrariness with which the red flags and ambiguous links to patient deaths are applied. Today, the U.S. Tenth Circuit Court of Appeals will hear their complaints.

There would be some poetic justice here if Treadway's aggressive tactics in the Schneider case were to result not only in a fatal blow to her own cause, but in the Tenth Circuit becoming the first federal appeals court to call into question the very foundation of how the government builds its case against pain physicians.

Prior Reason coverage of the pain issue here.
Logged
Pages: 1 2 [3] 4 5 ... 28 Print 
« previous next »
Jump to:  

Powered by MySQL Powered by PHP Powered by SMF 1.1.19 | SMF © 2013, Simple Machines Valid XHTML 1.0! Valid CSS!