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Index » Regional/Local » USA/Canada » Health Care Page: 1, 2, 3 ... 251, 252, 253  Next
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kurtster
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Posted: Apr 25, 2017 - 7:22pm

 westslope wrote:
What ludicrous statement?

 I wrote:  This must be a very depressing article for people who believe in easy, magic fixes. 
 
This ludicrous statement ... 

This will definitely not appeal to Trump supporters where there are no negative externalities or 'Tragedies of the commons' but simply opportunities for highly motivated, hard-working, righteous, decent folks.   
 

  
and then you mentioned ...
 
 
As for game theory, you are clearly not familiar with it, otherwise, you might not have voted for Trump.  If you are at all interested, the wikipages are a good source of information.  Look up 'game theory', 'social dilemmas', and if you don't mind something a little more technical:  'Evolutionarily stable strategy'.

Game theory has revolutionized economics and many other fields.  It offers compelling explanations of freeway congestion, overfishing, resource depletion, pollution, anthropogenic climate change, low voter turnout, overpopulation, violent conflict escalation, arms races. 

This is the first time I see you mention game theory.  Was not in the post I replied to.  I'm more confused than before.

 

haresfur
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Location: The Golden Triangle
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Posted: Apr 25, 2017 - 7:13pm

 westslope wrote:

User fees would incentivize people to self-select before jamming up the ER.  It is a common problem here in anti-user fee Canada. 

 
I think that's a false economy. The thing about medical care, is that we depend on the experts to understand the severity and diagnose appropriately. How do I know if that chest pain is a hear attack or indigestion? I shouldn't have to say I'm going to save money and wait until the morning to see my doctor. What about that 40 C fever? What about 38 C? A monetary incentive is different for a rich person or a poor one. Is it ok for the rich to go to the emergency room, simply because they can afford it? You will either end up with people spending money they don't have on treatment or forgoing potentially needed treatment because of the cost.

Just treat people. Triage them down the priority list so they wait a while longer if it's a cold.

I actually would consider a very minor fee for doctor visits, like maybe $10-20. That was recently rejected here but a small amount psychologically will make people think and buy into their care without really being much of an impediment. I'd put in a rule that treatment couldn't be refused if someone can't pay and that follow-up visits for the same condition are free. If you have cancer, we won't keep dinging you every week.
ScottFromWyoming
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Posted: Apr 25, 2017 - 6:48pm

 haresfur wrote:

I think all hospitals should have a 24 hr doc-in-the-box next to the ER. Triage the patients that come in and shunt the small things to the doctor or nurse there. As a bonus, if someone comes in just to see the doctor and they are having a heart attack, then it's a gurney ride not an ambulance.

 
Absolutely. We want our ERs to be available when there's a real need. When we have to justify them by prorating the cost across all customers, that doesn't make sense. That just means that if everyone is more judicious and lucky, and the number of ER visits drops by half, that would make them think they need to double the rates they charge. It just needs to be there and be ready and not have this bottom-line looming over everyone's head.
ScottFromWyoming
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Posted: Apr 25, 2017 - 6:44pm

 Red_Dragon wrote:

nice.

 
 
westslope

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Posted: Apr 25, 2017 - 4:14pm

 haresfur wrote:

I think all hospitals should have a 24 hr doc-in-the-box next to the ER. Triage the patients that come in and shunt the small things to the doctor or nurse there. As a bonus, if someone comes in just to see the doctor and they are having a heart attack, then it's a gurney ride not an ambulance.

 
User fees would incentivize people to self-select before jamming up the ER.  It is a common problem here in anti-user fee Canada. 
westslope

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Location: BC desert


Posted: Apr 25, 2017 - 4:08pm

 kurtster wrote:

I've been reading this thread for the past several days and finally had to say something because of this ludicrous statement.

I have not the foggiest idea of what the hell you are trying to say here about Trump supporters and cancer.

Today is the 8th anniversary of my stem cell infusion to bring me back from the dead in my battle with an incurable Stage IV NHL.  I am a Trump supporter as well.

........

 
What ludicrous statement?

 I wrote:  This must be a very depressing article for people who believe in easy, magic fixes. 

That applies to lots of people, not just Donald Trump supporters.   It is the story of modern health in rich western countries:  people looking for quicky, easy fixes.  

Mind you Trump campaigned on quick, easy fixes and as President has emphasized the quick and easy albeit with little success to date.  That is what happens when you vote in a populist demagogue.  

 
As for game theory, you are clearly not familiar with it, otherwise, you might not have voted for Trump.  If you are at all interested, the wikipages are a good source of information.  Look up 'game theory', 'social dilemmas', and if you don't mind something a little more technical:  'Evolutionarily stable strategy'.

Game theory has revolutionized economics and many other fields.  It offers compelling explanations of freeway congestion, overfishing, resource depletion, pollution, anthropogenic climate change, low voter turnout, overpopulation, violent conflict escalation, arms races. 


Red_Dragon

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Posted: Apr 25, 2017 - 4:01pm

 ScottFromWyoming wrote:

Charlie got a split lip up in the mountains a couple of years ago. We cleaned it up, put ice on it, came back to town... and Justine still thought it needed to be looked at. Even tho he's covered, I still thought, Sunday night at the ER, this isn't going to be a responsible use of the ER, so I told them when I walked in that I just wanted someone to confirm that ice and ibuprofen was going to be fine. They hesitated but eventually the head nurse spoke up, said "leave this one alone." I mean, he agreed that it didn't warrant stitches and would be fine without all the rigamarole. But yeah it sucks having to be reluctant to ask for help. If it were all single payer, they wouldn't be so worried about losing money by giving free advice.
 
And they talk about death panels. 

 
nice.
haresfur
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Posted: Apr 25, 2017 - 3:53pm

 ScottFromWyoming wrote:

Charlie got a split lip up in the mountains a couple of years ago. We cleaned it up, put ice on it, came back to town... and Justine still thought it needed to be looked at. Even tho he's covered, I still thought, Sunday night at the ER, this isn't going to be a responsible use of the ER, so I told them when I walked in that I just wanted someone to confirm that ice and ibuprofen was going to be fine. They hesitated but eventually the head nurse spoke up, said "leave this one alone." I mean, he agreed that it didn't warrant stitches and would be fine without all the rigamarole. But yeah it sucks having to be reluctant to ask for help. If it were all single payer, they wouldn't be so worried about losing money by giving free advice.
 
And they talk about death panels. 

 
I think all hospitals should have a 24 hr doc-in-the-box next to the ER. Triage the patients that come in and shunt the small things to the doctor or nurse there. As a bonus, if someone comes in just to see the doctor and they are having a heart attack, then it's a gurney ride not an ambulance.
ScottFromWyoming
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Location: Powell
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Posted: Apr 25, 2017 - 3:37pm

 Red_Dragon wrote:

Yeah, we subscribe to a service via our city utilities bill that covers the part of the ambulance ride that our insurance doesn't cover. That helps. Still, there's all the other stuff once you arrive at the ER. My point was that the LAST thing people should have to think about when they are sick or injured is "how much is this going to cost!?"

 
Charlie got a split lip up in the mountains a couple of years ago. We cleaned it up, put ice on it, came back to town... and Justine still thought it needed to be looked at. Even tho he's covered, I still thought, Sunday night at the ER, this isn't going to be a responsible use of the ER, so I told them when I walked in that I just wanted someone to confirm that ice and ibuprofen was going to be fine. They hesitated but eventually the head nurse spoke up, said "leave this one alone." I mean, he agreed that it didn't warrant stitches and would be fine without all the rigamarole. But yeah it sucks having to be reluctant to ask for help. If it were all single payer, they wouldn't be so worried about losing money by giving free advice.
 
And they talk about death panels. 


Red_Dragon

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Posted: Apr 25, 2017 - 3:13pm

 ScottFromWyoming wrote:

That's about right...
 
Hey, so, we pay $65 a year for membership in Reach Air medical ... they'll transport us by helicopter should we have an episode that needs emergency transportation. Seems pretty reasonable so a few years ago I mentioned how I definitely heard more helicopters these days but that still wouldn't be enough people on the program to pay for it and the guy said that Oklahoma (where the company has offices) subsidizes the pool pretty well. All the people in rural areas with good insurance... and those without, who pay the full nut. And those who thought they had good coverage but don't. So, anyway, might be worth looking into.

 
Yeah, we subscribe to a service via our city utilities bill that covers the part of the ambulance ride that our insurance doesn't cover. That helps. Still, there's all the other stuff once you arrive at the ER. My point was that the LAST thing people should have to think about when they are sick or injured is "how much is this going to cost!?"
ScottFromWyoming
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Posted: Apr 25, 2017 - 2:49pm

 Red_Dragon wrote:
In America....

You have an anxiety attack that's so severe that you think you're having another heart attack. An ambulance get called (in this town $1300 just to show up) you are taken to the emergency room, spend a night in hospital and receive a complete cardio workup and find out that your heart is just fine. Get discharged and go home to wait for the bills to show up, further increasing your anxiety.

yay. 

 
That's about right...
 
Hey, so, we pay $65 a year for membership in Reach Air medical ... they'll transport us by helicopter should we have an episode that needs emergency transportation. Seems pretty reasonable so a few years ago I mentioned how I definitely heard more helicopters these days but that still wouldn't be enough people on the program to pay for it and the guy said that Oklahoma (where the company has offices) subsidizes the pool pretty well. All the people in rural areas with good insurance... and those without, who pay the full nut. And those who thought they had good coverage but don't. So, anyway, might be worth looking into.
Red_Dragon

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Posted: Apr 25, 2017 - 2:33pm

In America....

You have an anxiety attack that's so severe that you think you're having another heart attack. An ambulance get called (in this town $1300 just to show up) you are taken to the emergency room, spend a night in hospital and receive a complete cardio workup and find out that your heart is just fine. Get discharged and go home to wait for the bills to show up, further increasing your anxiety.

yay. 
black321
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Posted: Apr 25, 2017 - 12:20pm

 ScottN wrote:

The bolded statement is, imo, the nut of the problem.  It is an obvious conflict of interest when a care provider has, in its best interests, the goal to minimize costs (withhold or minimize HC services), in order to maximize profits.
In a company that has long been the poster child for this contradiction, see United Health Corp.'s recent announcement of compensation for its CEO of $31.3M. That compensation is lower, by far, than for some other years.

HC is expensive because it is profit driven.  People do die because services are withheld, or are inferior/inadequate.

 
There are no shortage of moral questions when it comes to profit in health care.  Practitioners no doubt should make a handsome salary, given their expense and time commitment to their trade, but why should a shareholder profit from your cancer, infection, car accident...?  (i have issues with the whole maximizing shareholder profit motive of public companies, largely due to the fact it typically means short-term profit). 
miamizsun

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Posted: Apr 25, 2017 - 12:01pm

 miamizsun wrote:

venter speaking about his work

 
his partner in HLI Brad Perkins



ScottN
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Posted: Apr 25, 2017 - 11:29am

 Steely_D wrote:

We're not going to get a single answer on this, because we're touching different parts of the elephant.

Doctors are a heterogenous group, and some are incompetent. Some are thieves or malicious. Some are competent but overwhelmed by something (volume of work, personal issues, whatever) and do a poor job. Some are competent but thwarted by the system or circumstance they're in. Some are competent and manage to give great care. 

Similarly, health plans are varied. There are for-profit ones, which are beholden to their shareholders to turn a profit. They must use whatever means they can to do that.
There are non-profits, who need capital to provide care and expand and retrofit and meet regulatory demands - so they need money as well.

So we pick a part of the elephant that we've touched and describe it with certainty, but disagree with those who've touched a different part.

 
Let's hope we can someday touch an elephant that is the proxy for UHC.  Access to health care should be a right, as is education, protection (from?) by police,national defense,  roads, etc., etc.  That HC is profit-driven is the primary problem, imo.
kurtster
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Posted: Apr 25, 2017 - 10:27am

 islander wrote:

For someone who is alive today directly because of science, technology and smart talented people, you are a mean spirited, myopic, conspiracy consuming nutjob. about 90% of the time when I read you posts I just find myself shaking my head and wondering what's gone so wrong in your world. Really, I feel bad for you. I hope you find some peace in this world.

 
Make no mistake, I am both grateful and eminently aware of how lucky I am.  

But I got over survivors guilt a long time ago.  I also have no problem plain speaking about health care.  Just calling em as I see them.

ymmv ... and with you it will ...

.
edit going out the door:  A psychological workup is required before you can have the transplant.  It must be determined that your head is screwed on straight and that you are mentally tough enough to endure what comes next.  If you don't pass that test, no transplant for you, regardless of everything else.  You may find that cold blooded and heartless.  But I just found it the way it is.  Sometimes there are no exceptions, no matter how much clout or money you might have.

You must be deemed worthy of the expense you are about to incur.

.
deal with it.

 


kurtster
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Posted: Apr 25, 2017 - 10:22am

 Steely_D wrote:

We're not going to get a single answer on this, because we're touching different parts of the elephant.

Doctors are a heterogenous group, and some are incompetent. Some are thieves or malicious. Some are competent but overwhelmed by something (volume of work, personal issues, whatever) and do a poor job. Some are competent but thwarted by the system or circumstance they're in. Some are competent and manage to give great care. 

Similarly, health plans are varied. There are for-profit ones, which are beholden to their shareholders to turn a profit. They must use whatever means they can to do that.
There are non-profits, who need capital to provide care and expand and retrofit and meet regulatory demands - so they need money as well.

So we pick a part of the elephant that we've touched and describe it with certainty, but disagree with those who've touched a different part.

 
Exactly.
kurtster
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Posted: Apr 25, 2017 - 10:18am

 steeler wrote:

This paragraph from your post stood out for me (as did some in a previous post by Steely that was addressing the incentives in  a pre-paid medical system versus those in a pay-as-you-go).  In this paragraph, you first pose that there are "well meaning doctors who just don't know what is really going on" in terms of big-picture treatment of cancer.  At the end of that paragraph, though, you also note that it often is in the best financial interests of doctors and providers to not pursue high-cost treatment.  To me, those 2 statements have to be mutually exclusive because a doctor who believes that certain treatment is called for and does not pursue it because of financial reasons is not "well-meaning."  I also would say that a doctor who is not keeping up with what is going on is committing malpractice. Both of those points should not fade into the background in this  kind of discussion. In my view, the doctors are not innocent victims/pawns in these scenarios.       

 
True that.  I was trying to keep this in a general context for the sake of just trying to get my points out and not be confrontational.  It was very late at night.

Its kinda hard to speak in a way that doesn't get all holier than thou on this subject because I am a health care professional and I am also a patient at what is arguably one of the best health care providers in the world.  Is it fair to judge health care as a whole using the Cleveland Clinic as my standard ?   On the other hand, everyone wants to have a CCF or Mayo Clinic in their backyard.  It just doesn't work that way.

And the HMO vs PPO thing.  I can tell you that hardly anyone in the health care biz has an HMO unless that it is their only option because of employment circumstances.  HMO's are wonderful things on paper until you get really ill.  The problem with cancer, since that is what we're talking about, is that perfectly healthy people get cancer.  That is where the HMO starts falling apart.  A protocol takes over to establish the need for advanced treatment, that is more expensive and also usually farmed out to someone else, again adding to the expense.  With cancer, time is of the essence and people die while trying to get through the protocol process and being approved for higher levels of care.  This would be how a government operated health care system would and does operate.

To address financial pressure on the decision makers / gatekeepers.  Their job description is to make sure that any unnecessary care and added expenses does not happen.  An HMO makes a second decision very difficult to accomplish and if it disagrees with the HMO's diagnosis, the HMO will review everything again, ironically adding additional expense, but worse yet further delays.  That and the gate keepers in the system are usually the least or lowest qualified medically in the chain.  They get to challenge an MD's opinion and win more often than not and slow down the process.

A PPO eliminates the gate keeper and lets an informed patient choose their specialty MD and place of service without getting prior approval.  Yes it is fee for service, but when you get cancer, its all ala carte, unless for example, you go into the CCF for a stem cell transplant, then its a flat fee for however long it takes to either walk out or die trying.  I guess its the least that they can do ... :).  But it is an amazing thing as well as an anomaly in the fee for service system.  Whatever it takes without regard to money once you start.  IIRC correctly, I had 3 or 4 CT scans in one week when things were getting dicey for awhile.  And I was taken right down with no waiting for a table.

Anyway, I have to cut this short.  Just got a call back from my onc's office for a request I made an hour ago to get seen for something that's been bugging me for the past three weeks.  I have to be on the road in 45 minutes.  Same day service ...   This is a weird time of the year for me mentally as its the anniversary an all.  

{#Meditate}
 
Steely_D
We got nothing in common. No, we can't talk at all
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Posted: Apr 25, 2017 - 10:04am

 ScottN wrote:
HC is expensive because it is profit driven.  People do die because services are withheld, or are inferior/inadequate.
 
We're not going to get a single answer on this, because we're touching different parts of the elephant.

Doctors are a heterogenous group, and some are incompetent. Some are thieves or malicious. Some are competent but overwhelmed by something (volume of work, personal issues, whatever) and do a poor job. Some are competent but thwarted by the system or circumstance they're in. Some are competent and manage to give great care. 

Similarly, health plans are varied. There are for-profit ones, which are beholden to their shareholders to turn a profit. They must use whatever means they can to do that.
There are non-profits, who need capital to provide care and expand and retrofit and meet regulatory demands - so they need money as well.

So we pick a part of the elephant that we've touched and describe it with certainty, but disagree with those who've touched a different part.
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