Doc Posted May 17, 2012 Share Posted May 17, 2012 got any other unfounded theories you want to advance? i don't think anyone looking at these numbers would describe them as "dwindling". and do you see a precedent in single payor countries for the destruction of primary care? While not seeing a marked earnings increase, i see a stronger presence and reliance on primary care physicians with less costly care and generally better outcomes. and dc, i didn't blame republicans in congress for the compromise on health care. while they certainly didn't help, there were several conservative dems that killed any chance for single payor, the plan that i and the 18000 physicians and med students in the organization i cited support. and yes, i believe that if obama had seen any realistic path to get there, he would have championed it as well. we saw how well trying to push for too rapid change in health care worked for clinton. When did I say the med school enrollments would take a hit now? I didn't. I said that IF Obamacare gets implemented, there will be mass retirements and fewer applicants to med schools, straining an already strained group. As it stands right now, there is a good chance Obamacare is struck down or repealed. As for a greater reliance on primary care, how do you fancy that that will change, when you're theoretically adding 30 million people to the aforementioned overburdened group of doctors? Do you think the frequent flyers that populate the ERs that will now theoretically be going to a PMD instead will be satisfied with an appointment every year? Or will they recidivate back to the ERs? Here in CT, state workers are required to get their screening exams, or face a $2000 fine. I had a patient for a colonoscopy a few weeks back who worked for the state, who lamented that he had to get this done. I told him "no, you want to get this done." His wife agreed with me. How about they implemented something like that? A mandate to get a checkup or face a fine? I mean, IF we're really talking about reform. Link to comment Share on other sites More sharing options...
birdog1960 Posted May 17, 2012 Share Posted May 17, 2012 (edited) When did I say the med school enrollments would take a hit now? I didn't. I said that IF Obamacare gets implemented, there will be mass retirements and fewer applicants to med schools, straining an already strained group. As it stands right now, there is a good chance Obamacare is struck down or repealed. As for a greater reliance on primary care, how do you fancy that that will change, when you're theoretically adding 30 million people to the aforementioned overburdened group of doctors? Do you think the frequent flyers that populate the ERs that will now theoretically be going to a PMD instead will be satisfied with an appointment every year? Or will they recidivate back to the ERs? Here in CT, state workers are required to get their screening exams, or face a $2000 fine. I had a patient for a colonoscopy a few weeks back who worked for the state, who lamented that he had to get this done. I told him "no, you want to get this done." His wife agreed with me. How about they implemented something like that? A mandate to get a checkup or face a fine? I mean, IF we're really talking about reform. the only thing salient about your colonoscopy story is that in places with single payor there's generaly no need for an anesthesiologist at a colonoscopy. actually, it's not been the norm anywhere that i've worked or trained. i used to do my own sigs and know internists in rural areas that do their own colonoscopies with conscious sedation. complications from sedation or from any cause in this procedure are rare. why would you want to add the considerable cost of anesthesia to this procedure? oh right, this is for profit medicine. charge what the market can bear... 30 million more covered lives...and you come to the conclusion that primary care doctors would become dinosaurs? might it be that you're concerned that nurse anesthetists could do even more of the considerable work they already do in your job at lower cost? now that makes some sense. ACA talk in this topic too! Ahhh! Where have I been all your life 3rdnlng? Can you just explain your view here as well as you can? yeah, well, this is pretty typical...some of the far right loons argue that obama didn't produce what he promised (which in this case would have been single payor) while others simultaneously argue that what he did was a brilliant, stealth, trojan horse move. either way, he's hated by the right. Edited May 17, 2012 by birdog1960 Link to comment Share on other sites More sharing options...
Doc Posted May 17, 2012 Share Posted May 17, 2012 (edited) the only thing salient about your colonoscopy story is that in places with single payor there's generaly no need for an anesthesiologist at a colonoscopy. actually, it's not been the norm anywhere that i've worked or trained. i used to do my own sigs and know internists in rural areas that do their own colonoscopies with conscious sedation. complications from sedation or from any cause in this procedure are rare. why would you want to add the considerable cost of anesthesia to this procedure? oh right, this is for profit medicine. charge what the market can bear... 30 million more covered lives...and you come to the conclusion that primary care doctors would become dinosaurs? might it be that you're concerned that nurse anesthetists could do even more of the considerable work they already do in your job at lower cost? now that makes some sense. Great, with single payor, I won't be doing colonoscopies anymore. Fine by me. Hopefully we can get rid of labor epidurals as well. Or sedation altogether. It should be either general or nothing. Does Obamacare do all that? Now that we're off that tangent, can get back to the real point, which was mandating preventative care? If we're truly trying to reform delivery of care? Merely mandating insurance for emergencies/major diseases means nothing if people don't use it for preventative care. How is that going to be accomplished under Obamacare? And my point about PMDs is that many will retire early and few of the people who DO go to med school will enter the field. Why go through all that when you can spend less time and money to become a PA or APRN, and get paid the same? Do you realize there are "doctor of nursing" degrees that are being offered, so that nurses can claim to call themselves "doctor?" And don't worry about me. I'm less worried about being replaced by a nurse than you should be by being replaced by one, or a PA. Although it will be interesting to see how this will work, considering they'll be expected to treat more things themselves, but with inferior training than a PMD. Edited May 17, 2012 by Doc Link to comment Share on other sites More sharing options...
B-Man Posted May 17, 2012 Share Posted May 17, 2012 The problem for Obama and the Left this time around is that they have to make an actual sales pitch, and judging from their efforts, they don’t know how to talk effectively enough to middle America to succeed at it. This problem starts at the top. “Obama’s big problem, I think, is that he is no longer the president he said he would be. Above all, he’s stopped trying to be that president.”- Clive Crook . Link to comment Share on other sites More sharing options...
Doc Posted May 17, 2012 Share Posted May 17, 2012 Might not exactly be breaking news, but the 2012 presidential race is gonna get ugly: http://news.yahoo.com/blogs/ticket/super-pac-plans-attack-obama-ties-rev-jeremiah-132518668.html Link to comment Share on other sites More sharing options...
birdog1960 Posted May 17, 2012 Share Posted May 17, 2012 Great, with single payor, I won't be doing colonoscopies anymore. Fine by me. Hopefully we can get rid of labor epidurals as well. Or sedation altogether. It should be either general or nothing. Does Obamacare do all that? Now that we're off that tangent, can get back to the real point, which was mandating preventative care? If we're truly trying to reform delivery of care? Merely mandating insurance for emergencies/major diseases means nothing if people don't use it for preventative care. How is that going to be accomplished under Obamacare? And my point about PMDs is that many will retire early and few of the people who DO go to med school will enter the field. Why go through all that when you can spend less time and money to become a PA or APRN, and get paid the same? Do you realize there are "doctor of nursing" degrees that are being offered, so that nurses can claim to call themselves "doctor?" And don't worry about me. I'm less worried about being replaced by a nurse than you should be by being replaced by one, or a PA. Although it will be interesting to see how this will work, considering they'll be expected to treat more things themselves, but with inferior training than a PMD. sure, anyone looking at health care reform has put the best interests and priorities of anesthesiologists at the very top of the list and your assertion that it's either general or nothing is the stuff of a groundbreaking position paper. What are you waiting for? finally, the numbers once again don't support your contentions (interesting that you never seem to cite any). look at numbers for doctors per 1000 and nurses in countries with universal care like japan, netherlands, uk. you'll see more docs and nurses both, in proportion to the us population, all the while at lower cost and equal or better outcomes. Link to comment Share on other sites More sharing options...
Doc Posted May 17, 2012 Share Posted May 17, 2012 sure, anyone looking at health care reform has put the best interests and priorities of anesthesiologists at the very top of the list and your assertion that it's either general or nothing is the stuff of a groundbreaking position paper. What are you waiting for? finally, the numbers once again don't support your contentions (interesting that you never seem to cite any). look at numbers for doctors per 1000 and nurses in countries with universal care like japan, netherlands, uk. you'll see more docs and nurses both, in proportion to the us population, all the while at lower cost and equal or better outcomes. Wait, how would anesthesiologists not being involved with colonoscopies or not performing epidurals anymore "put the best interests and priorities of anesthesiologists at the very top of the list?" There would be a ton of lost revenue for us. Obviously you missed my point, which was if we're going to eliminate anesthesiologist involvement in colonoscopies because it's unncessary, why not eliminate epidurals since they're also unnecessary, since hundreds of millions of women have given birth without them over the course of history? Why not eliminate sedation for cases that could otherwise be done under straight local? I'm proposing real cost-cutting measures here, and ones that would hurt my bottom line. That is, IF we're really talking about true reform, and I think everyone BUT you knows we're not. As for the numbers in countries like Japan and the Netherlands, I LMMFAO when people compare them to the U.S. It's comparing apples to oranges. What's even funnier is this and other socialist programs are slowly but surely failing, but we want to move TOWARDS them? Link to comment Share on other sites More sharing options...
dayman Posted May 17, 2012 Share Posted May 17, 2012 (edited) yeah, well, this is pretty typical...some of the far right loons argue that obama didn't produce what he promised (which in this case would have been single payor) while others simultaneously argue that what he did was a brilliant, stealth, trojan horse move. either way, he's hated by the right. Well there is no public option in the exchange so what it really was (IMO, he'll never admit it) was an outdated talking. Update your talking points already guys. As for there being less PCPs in the future, won't happen either way (my opinion). With or without Obamacare the industry is shifting and the demand for specialist services will decline while the demand for PCP will rise. This will happen as the pay structure changes (happening right now with private insurance companies independent of Obamacare) and the patients will be paying more out of pocket for the special services they do ultimately need (thus allowing the market to work like a free market, lowering prices etc etc). It's a slow process though but some of the reform is poised to have Medicare lead the way and possibly speed this up (but that would depend on Obamacare surviving). I see no signs of medical school enrollment falling right now, and I'm not sure I look at increased demand for PCP services long term equating to less PCPs long term. Just can't see it. Would be willing to listen more though...if there is something I missing (totally possible) Edited May 17, 2012 by TheNewBills Link to comment Share on other sites More sharing options...
C.Biscuit97 Posted May 17, 2012 Share Posted May 17, 2012 OMG. Once Romney is in office, all of the US' problems will be solved!!! Link to comment Share on other sites More sharing options...
birdog1960 Posted May 17, 2012 Share Posted May 17, 2012 Well there is no public option in the exchange so what it really was (IMO, he'll never admit it) was an outdated talking. Update your talking points already guys. As for there being less PCPs in the future, won't happen either way (my opinion). With or without Obamacare the industry is shifting and the demand for specialist services will decline while the demand for PCP will rise. This will happen as the pay structure changes (happening right now with private insurance companies independent of Obamacare) and the patients will be paying more out of pocket for the special services they do ultimately need (thus allowing the market to work like a free market, lowering prices etc etc). It's a slow process though but some of the reform is poised to have Medicare lead the way and possibly speed this up (but that would depend on Obamacare surviving). I see no signs of medical school enrollment falling right now, and I'm not sure I look at increased demand for PCP services long term equating to less PCPs long term. Just can't see it. Would be willing to listen more though...if there is something I missing (totally possible) agree completely. inpatient surgeries are down significantly in our regional system and this is being attributed to the factors you mentioned. this really hurts the hospitals cuz that's where the big profit margins are. but it's also where the big costs are. and for those same reasons more and more people are looking at nonsurgical options, adding to primary care demand. factor in the need for close follow up for complicated chronic conditions to avoid uncompensated hospital readmissions and you won't find many slow primary care offices. will supply and demand changes realign reimbursement? maybe but i'm not holding my breath that that will involve huge increases for primary care but rather decreases for specialties. either way, the result will be more incentive for future docs to choose primary care. Link to comment Share on other sites More sharing options...
jjamie12 Posted May 17, 2012 Share Posted May 17, 2012 OMG. Once Romney is in office, all of the US' problems will be solved!!! Definitely not. However. At the very least, he has a long track record of solving problems, along with a demonstrated ability to work with the other side of the aisle. Two things that cannot be said about President Obama, in my opinion. Both of which are vitally important in a President, obviously. Link to comment Share on other sites More sharing options...
DC Tom Posted May 17, 2012 Share Posted May 17, 2012 OMG. Once Romney is in office, all of the US' problems will be solved!!! I believe the Obama/Biden '08 campaign has that slogan trademarked. Link to comment Share on other sites More sharing options...
fjl2nd Posted May 17, 2012 Share Posted May 17, 2012 The problem for Obama and the Left this time around is that they have to make an actual sales pitch, and judging from their efforts, they don’t know how to talk effectively enough to middle America to succeed at it. This problem starts at the top. - Clive Crook . Where do you find these quotes? Lol. All polling shows middle class America feels like Obama best looks out for them, not the uber-rich guy. He evens win in the "values" category. Romney has to work to do himself to connect with the average American. Link to comment Share on other sites More sharing options...
Magox Posted May 18, 2012 Share Posted May 18, 2012 Where do you find these quotes? Lol. All polling shows middle class America feels like Obama best looks out for them, not the uber-rich guy. He evens win in the "values" category. Romney has to work to do himself to connect with the average American. Yet they believe that Romney will be better for the economy. Go figure. Link to comment Share on other sites More sharing options...
birdog1960 Posted May 18, 2012 Share Posted May 18, 2012 Yet they believe that Romney will be better for the economy. Go figure. maybe. note the new dem campaign showing how wonderful bain was to middle class workers whose companies they killed while getting rich and "improving" the economy. when asked about it, a romney staffer wouldn't comment other than to state "our intention is to make this a referendum on obama's presidency". we'll see how it plays... Link to comment Share on other sites More sharing options...
meazza Posted May 18, 2012 Share Posted May 18, 2012 maybe. note the new dem campaign showing how wonderful bain was to middle class workers whose companies they killed while getting rich and "improving" the economy. when asked about it, a romney staffer wouldn't comment other than to state "our intention is to make this a referendum on obama's presidency". we'll see how it plays... Yes surprisingly private equity partners buy out lame duck companies and try to make them better but keep on with your narrative. Link to comment Share on other sites More sharing options...
birdog1960 Posted May 18, 2012 Share Posted May 18, 2012 Yes surprisingly private equity partners buy out lame duck companies and try to make them better (or break them up or close them down) but keep on with your narrative. fixed Link to comment Share on other sites More sharing options...
meazza Posted May 18, 2012 Share Posted May 18, 2012 fixed Are you dense? If they were broken up and sold, don't you think that's what they are worth? A company is worth far more as a going concern than split up as you try and portray it. Link to comment Share on other sites More sharing options...
IDBillzFan Posted May 18, 2012 Share Posted May 18, 2012 maybe. note the new dem campaign showing how wonderful bain was to middle class workers whose companies they killed while getting rich and "improving" the economy. when asked about it, a romney staffer wouldn't comment other than to state "our intention is to make this a referendum on obama's presidency". we'll see how it plays... Not maybe, definitely. And the problem with going after Bain is that it's nothing new to Romney, who is running ads from people who have succeeded BECAUSE of Bain, as well as a crushing ad that shows real people in America who voted for Obama but know they made a mistake and now realize Obama was all talk and no leadership. In the end, the ads won't matter so much as the results, and there is nothing about this economy or unemployment issue that is expected to improve enough by November. Unemployment numbers going down means jack to the electorate if the electorate is part of the millions of people giving up on trying to find work. And you know why? Because Obama has absolutely, postively NO idea how to fix our problems. He only knows how to divide and blame. More and more Americans are realizing that four more years of his blind leadership will only make things worse. Link to comment Share on other sites More sharing options...
birdog1960 Posted May 18, 2012 Share Posted May 18, 2012 Are you dense? If they were broken up and sold, don't you think that's what they are worth? A company is worth far more as a going concern than split up as you try and portray it. i'm sure the 1000's of gm workers that vote fully agree with you. i didn't say it was surprising, i inferred it wouldn't play well. note the distinction. Link to comment Share on other sites More sharing options...
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