birdog1960 Posted July 10, 2012 Share Posted July 10, 2012 If your point is that rational actors will act in there own best interests, I agree. If your point is that we should kill the golden goose because some don't have as many eggs as others, you've lost me. well, if you consider a system that costs multiples of many other systems while rendering measurable results for it's entire population greatly inferior to those same systems a "golden goose" then you won't likely find your way out with a garmin. Link to comment Share on other sites More sharing options...
Smears Posted July 10, 2012 Share Posted July 10, 2012 If your point is that rational actors will act in there own best interests, I agree. If your point is that we should kill the golden goose because some don't have as many eggs as others, you've lost me. First of all, there is no such thing as economic rationing. There is only supply and demnand. Secondly, yes. Yes he did choose to be uninsurd as a byproduct of the poor life choices he made to put himself in his situation. If I choose to cross the street without looking and I get hit by a car, I'm the one who caused the outcome, as it was my own choices which led me there. Yes Im sure they have the means to correct their situations just like you or I. Maybe they can join the military and fight for us "successful" people. Link to comment Share on other sites More sharing options...
TakeYouToTasker Posted July 10, 2012 Share Posted July 10, 2012 well, if you consider a system that costs multiples of many other systems while rendering measurable results for it's entire population greatly inferior to those same systems a "golden goose" then you won't likely find your way out with a garmin. Our system costs more because it absorbs almost all of the technology and R&D costs as well as having the highest regulatory cost burden. Without our coattails to coast on their treatment technology would stagnate and their costs would spiral out of control, collapsing their already stumbling systems. Link to comment Share on other sites More sharing options...
birdog1960 Posted July 10, 2012 Share Posted July 10, 2012 Yes Im sure they have the means to correct their situations just like you or I. Maybe they can join the military and fight for us "successful" people. and i'm sure he'd be more than happy to return all the grocery carts and clean the store in place of those who are uninsured due to poor choices. btw, grocery stores might be a poor example, at least in the case of wegmans. was just back to wny for a family reunion and the store we were in was amazing. i did a little research and they're highly ranked for employee issues as well. now, it seemed more expensive than the local chains around me but if that's the price for quality and fairness to employees, i'm willing to pay it. we could use a few more businesses like wegmans. i wish they'd go national. Link to comment Share on other sites More sharing options...
TakeYouToTasker Posted July 10, 2012 Share Posted July 10, 2012 Yes Im sure they have the means to correct their situations just like you or I. Maybe they can join the military and fight for us "successful" people. Some do and some don't, but they all have the freedom to try and better themselves. It's great to live somwhere where individuals can choose to get a leg up by getting a second job, taking night classes ar the local community college to improve their employability, or join the military to earn a life of respect, a free education and job training, and a resume boost unattainable elsewhere. If these choices can't lure them away from their miserable lives breaking down boxes behind the Safeway, then they don't care enough about their own wellbeing to better themselves, and in making that choice they have willfully chosen to live with the consequences of their own poor decision making. And I'm sorry, but I just can't bring myself to care more about getting them out of their bad spot than they do. Link to comment Share on other sites More sharing options...
Smears Posted July 10, 2012 Share Posted July 10, 2012 and i'm sure he'd be more than happy to return all the grocery carts and clean the store in place of those who are uninsured due to poor choices. btw, grocery stores might be a poor example, at least in the case of wegmans. was just back to wny for a family reunion and the store we were in was amazing. i did a little research and they're highly ranked for employee issues as well. now, it seemed more expensive than the local chains around me but if that's the price for quality and fairness to employees, i'm willing to pay it. we could use a few more businesses like wegmans. i wish they'd go national. Good point Wegamns does rule Some do and some don't, but they all have the freedom to try and better themselves. It's great to live somwhere where individuals can choose to get a leg up by getting a second job, taking night classes ar the local community college to improve their employability, or join the military to earn a life of respect, a free education and job training, and a resume boost unattainable elsewhere. If these choices can't lure them away from their miserable lives breaking down boxes behind the Safeway, then they don't care enough about their own wellbeing to better themselves, and in making that choice they have willfully chosen to live with the consequences of their own poor decision making. And I'm sorry, but I just can't bring myself to care more about getting them out of their bad spot than they do. I cant disagree with most of that but dont agree with some either. Link to comment Share on other sites More sharing options...
Doc Posted July 10, 2012 Share Posted July 10, 2012 and you've missed the point. outcomes are what most rational people would see as th e important measure. if you have great access to a system with relatively bad outcomes, it's really not doing you much good now is it? and rationing happens here every day just not to you and the rest of your foresome. if you haven't heard there's 40+ million uninsured. th etwo are related in the sense that if applicants are primarily motivated by money to enter a profession, their actions may also be motivated by money within their profession. i suggest you look to the field of finance for some recent examples. I see you bought the "40 million uninsured" fairy tale. And how do you envision quality outcomes being implemented? Give me an example. Link to comment Share on other sites More sharing options...
birdog1960 Posted July 10, 2012 Share Posted July 10, 2012 (edited) I see you bought the "40 million uninsured" fairy tale. And how do you envision quality outcomes being implemented? Give me an example. a good place to start would be prenatal care...ya know like they do in the UK. a home nurse assigned to at risk mothers to guide them through the time. then move to covered and comprehensive management of chronic diseases with affordable generic meds and treatment algorithms, dietary classes etc. keeping only several thousand diabetic pts off dialysis would save big bucks as would keeping heart failure and copd pt out of the hospital. pushing immunization programs for adults as well as children. ensuring generic meds without fail for everyone with chronic diseases would save millions if not billions in hospital costs.(europe has a pill with aspirin, beta blocker,statin and ace in 1- guess why the us doesnt? think that might help compliance for cardiac pts?) discussing end of life care and advanced directives at every physical (aca already provides for this) cost effective proven screening at reasonable intervals aimed at those most likely to benefit. elective interventions and heroic measures offered on the basis of most likely to benefit and rationed on that basis. Like it? didn't think so... oh, and i forgot, repressive sin taxes on tobacco, alcohol and junk food to pay for their full cost to public health and simultaneously decrease consumption. Edited July 10, 2012 by birdog1960 Link to comment Share on other sites More sharing options...
Doc Posted July 10, 2012 Share Posted July 10, 2012 a good place to start would be prenatal care...ya know like they do in the UK. a home nurse assigned to at risk mothers to guide them through the time. then move to covered and comprehensive management of chronic diseases with affordable generic meds and treatment algorithms, dietary classes etc. keeping only several thousand diabetic pts off dialysis would save big bucks as would keeping heart failure and copd pt out of the hospital. pushing immunization programs for adults as well as children. ensuring generic meds without fail for everyone with chronic diseases would save millions if not billions in hospital costs.(europe has a pill with aspirin, beta blocker,statin and ace in 1- guess why the us doesnt? think that might help compliance for cardiac pts?) discussing end of life care and advanced directives at every physical (aca already provides for this) cost effective proven screening at reasonable intervals aimed at those most likely to benefit. elective interventions and heroic measures offered on the basis of most likely to benefit and rationed on that basis. Like it? didn't think so... oh, and i forgot, repressive sin taxes on tobacco, alcohol and junk food to pay for their full cost to public health and simultaneously decrease consumption. Yeah, I really hate preventative care (which is what you're talking, and not what I asked, about). Lord knows I've been railing against trying to keep people healthy! Now that we've dispensed with that canard, and since you brought it up, preventative care is only as effective as the patient. What needs to be done is to create a mandate for people to get preventative care, because people have all sorts of excuses for putting-off routine checkups, as you no doubt know. In CT for example, state workers getting insurance through the state are being fined (taxed?) $2000 if they don't have preventative care like a colonoscopy at age 50. But even then, I actually had one guy complain about it, and I all but called him an idiot to his face for complaining that the government was trying to keep him healthy. His wife agreed he was being an idiot. Which shows that even in the face of a mandate, people still won't be happy (and aren't, as Obamacare's approval numbers show). I've been saying that Obamacare does NOTHING to cure the disease, which is poor health habits, and just pours money into masking the symptoms. Eventually the disease will win out. I'm also a big proponent of generics. I use them whenever I can. And patients can ask for them. Most want the latest and greatest and don't care because it's like a buffet for them. But I see that while you espouse that everyone should be given affordable health insurance, you also espouse rationing based on merit. Do you really believe that would go over well, given our litigious society? And would that pertain to private insurance patients, or just those on public insurance? Would there be an appeals system if the "death panel" rendered a verdict the patient's family didn't like? Actually ehat I was actually asking about is something you alluded to in the past and broached again: physician payments for "quality outcomes" versus fee-for-service. As a PMD, how do you envision being paid under such a system? Do you think anyone in any field would agree to be paid based on quality outcome? Much less a complex field like medicine? Doubtful at best. Link to comment Share on other sites More sharing options...
birdog1960 Posted July 11, 2012 Share Posted July 11, 2012 Yeah, I really hate preventative care (which is what you're talking, and not what I asked, about). Lord knows I've been railing against trying to keep people healthy! Now that we've dispensed with that canard, and since you brought it up, preventative care is only as effective as the patient. What needs to be done is to create a mandate for people to get preventative care, because people have all sorts of excuses for putting-off routine checkups, as you no doubt know. In CT for example, state workers getting insurance through the state are being fined (taxed?) $2000 if they don't have preventative care like a colonoscopy at age 50. But even then, I actually had one guy complain about it, and I all but called him an idiot to his face for complaining that the government was trying to keep him healthy. His wife agreed he was being an idiot. Which shows that even in the face of a mandate, people still won't be happy (and aren't, as Obamacare's approval numbers show). I've been saying that Obamacare does NOTHING to cure the disease, which is poor health habits, and just pours money into masking the symptoms. Eventually the disease will win out. I'm also a big proponent of generics. I use them whenever I can. And patients can ask for them. Most want the latest and greatest and don't care because it's like a buffet for them. But I see that while you espouse that everyone should be given affordable health insurance, you also espouse rationing based on merit. Do you really believe that would go over well, given our litigious society? And would that pertain to private insurance patients, or just those on public insurance? Would there be an appeals system if the "death panel" rendered a verdict the patient's family didn't like? Actually ehat I was actually asking about is something you alluded to in the past and broached again: physician payments for "quality outcomes" versus fee-for-service. As a PMD, how do you envision being paid under such a system? Do you think anyone in any field would agree to be paid based on quality outcome? Much less a complex field like medicine? Doubtful at best. any such system would need to take pt compliance into account. my current incentive pay does. if i document that i strongly recommended a screening test but it was refused, that generates the same credit to me that it would if accepted. it's really not that difficult to incentivize docs to do the right thing. getting them to agree on what is the right thing is more difficult but there are plenty of widely accepted guidelines to begin with. Link to comment Share on other sites More sharing options...
Doc Posted July 11, 2012 Share Posted July 11, 2012 any such system would need to take pt compliance into account. my current incentive pay does. if i document that i strongly recommended a screening test but it was refused, that generates the same credit to me that it would if accepted. it's really not that difficult to incentivize docs to do the right thing. getting them to agree on what is the right thing is more difficult but there are plenty of widely accepted guidelines to begin with. Again you're talking preventative medicine, and I would bet that most docs "strongly recommend" screening tests at the appropriate age. But if the patient refuses, how is the system any better for it. Just because you documented it? You still have patient non-compliance, which again, is the root cause of all the problems. Link to comment Share on other sites More sharing options...
birdog1960 Posted July 11, 2012 Share Posted July 11, 2012 (edited) Again you're talking preventative medicine, and I would bet that most docs "strongly recommend" screening tests at the appropriate age. But if the patient refuses, how is the system any better for it. Just because you documented it? You still have patient non-compliance, which again, is the root cause of all the problems. the system is better for it because some people listen. if it's even 10% (as i would estimate success in initial smoking cessation discussions) that makes a significant economic and health impact on the system. it matters. probably more than many of the glamorous, expensive procedures and tests that so many ill informed pts believe will save them from themselves. and you would be wrong about docs preaching screening universally. the newly covered medicare wellness visit, during which all of this preventive planning is reviewed has been ignored by the vast majority of docs. the low number of exams that have been coded for in the 1.5 years of it's availability is astounding. it's actually fairly well reimbursed but it takes time and i suspect some believe they can do better seeing 3 or 4 uncomplicated sick visits in the time. maybe they can. that's where changing the incentives comes in. Edited July 11, 2012 by birdog1960 Link to comment Share on other sites More sharing options...
Doc Posted July 11, 2012 Share Posted July 11, 2012 (edited) the system is better for it because some people listen. if it's even 10% (as i would estimate success in initial smoking cessation discussions) that makes a significant economic and health impact on the system. it matters. probably more than many of the glamorous, expensive procedures and tests that so many ill informed pts believe will save them from themselves. and you would be wrong about docs preaching screening universally. the newly covered medicare wellness visit, during which all of this preventive planning is reviewed has been ignored by the vast majority of docs. the low number of exams that have been coded for in the 1.5 years of it's availability is astounding. it's actually fairly well reimbursed but it takes time and i suspect some believe they can do better seeing 3 or 4 uncomplicated sick visits in the time. maybe they can. that's where changing the incentives comes in. Yeah, just like they are now. Because few doctors talk about preventative care and the lack of exams is their fault. I don't know who's been brainwashing you birddog, but they'd give Scientologists a run for their money. Edited July 11, 2012 by Doc Link to comment Share on other sites More sharing options...
TakeYouToTasker Posted July 11, 2012 Share Posted July 11, 2012 Ahhh, I see that the conversation has regressed to the merits of the politics of forced compliance. A hypothetical question: If it could be demonstrated that a nuclear household with two married parents of the opposite gender consistently produced children with better mental health and stability, with a better foundation to create a life and future for themselves at a much higher rate than any other kind of familial arrangement, and as a result it made administering essential government services more economical, would it be OK to impose regulations disallowing any other type of arrangement? Why or why not? Link to comment Share on other sites More sharing options...
3rdnlng Posted July 11, 2012 Share Posted July 11, 2012 Ahhh, I see that the conversation has regressed to the merits of the politics of forced compliance. A hypothetical question: If it could be demonstrated that a nuclear household with two married parents of the opposite gender consistently produced children with better mental health and stability, with a better foundation to create a life and future for themselves at a much higher rate than any other kind of familial arrangement, and as a result it made administering essential government services more economical, would it be OK to impose regulations disallowing any other type of arrangement? Why or why not? Nice Again, welcome to the board. Link to comment Share on other sites More sharing options...
DC Tom Posted July 11, 2012 Share Posted July 11, 2012 Ahhh, I see that the conversation has regressed to the merits of the politics of forced compliance. A hypothetical question: If it could be demonstrated that a nuclear household with two married parents of the opposite gender consistently produced children with better mental health and stability, with a better foundation to create a life and future for themselves at a much higher rate than any other kind of familial arrangement, and as a result it made administering essential government services more economical, would it be OK to impose regulations disallowing any other type of arrangement? Why or why not? I say yes. But only because I'm a misanthrope. Link to comment Share on other sites More sharing options...
birdog1960 Posted July 11, 2012 Share Posted July 11, 2012 Ahhh, I see that the conversation has regressed to the merits of the politics of forced compliance. A hypothetical question: If it could be demonstrated that a nuclear household with two married parents of the opposite gender consistently produced children with better mental health and stability, with a better foundation to create a life and future for themselves at a much higher rate than any other kind of familial arrangement, and as a result it made administering essential government services more economical, would it be OK to impose regulations disallowing any other type of arrangement? Why or why not? i don't see any reference to forced compliance. incentivized compliance was discussed. and if the converse was proven true, ie that non nuclear families were found to have an adverse effect on mental health and stability resulting in excessive costs to society, then yes, they should be disincentivized. doesn't current tax law already do this? don't some people still get married primarily for the tax breaks when they otherwise might not? i don't see a problem with it. tax laws have long been used to steer behavior deemed beneficial to society. but that's not the same as forced compliance. seems a majority of scotus felt the same way about the aca. Link to comment Share on other sites More sharing options...
TakeYouToTasker Posted July 11, 2012 Share Posted July 11, 2012 (edited) I see. So, if someone doesn't pay the fine (tax) for what their keeper insists they should do, what happens? Also, you're appealing to both popularity and authority, which are both logical fallacies. I say yes. But only because I'm a misanthrope. Ha! Edited July 11, 2012 by TakeYouToTasker Link to comment Share on other sites More sharing options...
Rob's House Posted July 11, 2012 Share Posted July 11, 2012 i'm guessing there aren't many teachers, social workers, nurses, clergy or underpaid academics at your club. mine neither... Dude, half the fields you just mentioned are ideal for risk averse people who want income security. Link to comment Share on other sites More sharing options...
Rob's House Posted July 11, 2012 Share Posted July 11, 2012 well, if you consider a system that costs multiples of many other systems while rendering measurable results for it's entire population greatly inferior to those same systems a "golden goose" then you won't likely find your way out with a garmin. Specifically, which measurables are you basing your conclusion on? Link to comment Share on other sites More sharing options...
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