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 Post subject: Obama s-care tactics
PostPosted: Fri Nov 05, 2010 3:46 pm 
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http://www.youtube.com/watch?v=8HnkxIh62dQ

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PostPosted: Fri Nov 05, 2010 5:01 pm 
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Obama's head in the sand.

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PostPosted: Sat Nov 06, 2010 12:31 am 
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When lefists lay into the guy, you know he *****.

And this is pretty mild.

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PostPosted: Sat Nov 06, 2010 1:22 am 
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The guy from post one lays into CER or "comparative effectiveness research." He calls it a "rationing board." He then goes on to confuse it with cost effectiveness research. The difference is that the first, the real one, is about finding out which therapies give you the bigger bang for the buck. This is just sensible. Imagine selecting a car without knowing the price. It's insane. You want your doctor choosing between therapies without knowing which one is better or more cost effective because the research was never done? Nuts. But this is how it's almost always done, because most research is designed to get drug B a market share by showing it's better than placebo and NEVER comparing it to established drug A, because then the new expensive drug might underperform. I do not know of ANY physicians who oppose CER or think it is leftist or Obamish, although I'm sure a few are out there (maybe stumping for Republicans right now).

His bit about the national coordinating treatment protocols for specific patients coming from Washington is TOTAL BULLSHEET. There is absolutely no basis in fact that a doctor would get slammed 100k fines for not following the government rules. AMA is quite powerful, and they would have blown up Washington if this were possible. And jail? What a crock. What programs like this actually do is ask you to do something that is almost always appropriate: say, give an aspirin for a heart attack. If you won't because the patient has an allergy, you simply indicate that. And you're golden. I deal with this kind of stuff everyday. Even places that do poorly are not being held accountable for their poor performance, anyway; ramping up a system in which hospitals ARE rewarded for performance will take a very long time. And we desperately need to do it. Far, far too often we are not providing proven care when we have no good reason. The performance for blood clot prevention in the hospital is 20-50% at most hospitals. A coin toss, at best! You want to leave it that way when your grandma is admitted for pneumonia?

46% of doctors leaving medicine over Obamacare? BULL. Wonder why you never heard of this before? Because it's not true. When I chased down the numbers, 8% of doctors surveyed said they would TRY to leave medicine IF reform was passed (without a public option--as it happened). 8%. 1% said they'd RETURN to medicine. 22% said they'd consider trying early retirement. How many liberals followed through on their threats to move to Canada if Bush was reelected? See the details here--follow the link at the bottom.

http://www.themedicusfirm.com/pages/med ... lth-reform

Let me also point out that if we do not start thinking about cost effectiveness, and yes, rationing care by cost, we will be Greece, within a few decades. The system is collapsing RIGHT NOW because politicians are scared to tell you that we cannot have doctors making decisions on whims without evidence base or using therapies that cost huge amounts of money without appreciable benefit (revisit my Avastin thread if you need more info on that). It's like when you go building you next house, remember to tell the construction crew to use whatever materials they want, regardless of cost, based on how they feel that day, even if it's not up to code, and you'll just borrow some more money from your kids or China to pay the difference between that and the house you should buy.

If we do not start using cost as a consideration, we're done for. We need an NHS style board to make these decisions and we need it in 1970.

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PostPosted: Sat Nov 06, 2010 2:54 am 
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http://www.youtube.com/watch?v=H30zTv40 ... re=related

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PostPosted: Sat Nov 06, 2010 8:52 am 
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Question: why is a guy who looks like he's in his 40s called 'the young turk' ?

Yeah, this is the side of things I'm seeing across the board on the left, and you know what? I'm THRILLED!!! If they follow through, in 2012, they will push through a candidate for prez (not to mention candidates for the House and Senate) even farther left than B.O. Then, regardless of how well Republicans have done in the House, Democrats are going to lose in bigger numbers than they did this year. Why is this good?

Because people calling themselves Progressives are living in a delusion. They believe progressives outnumber moderates in this country. They believe that conservatives are a tiny (albeit loud these past couple of years) portion of the population, and that progressives are not.

I just want to burst that bubble, and see them really come unhinged. :lol:


America hired Obama, in part, because he claimed (like Bush before him) that he was a uniter, not a divider. Instead, we're going to end up divided in so many ways, and by far nastier means. I think this is already out of Obama's hands. He's a lame duck already. There is NO WAY the Democrats can do what the left wing wants them to do. Their connection to reality is unplugged.

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Last edited by Jason Rees on Sat Nov 06, 2010 10:06 pm, edited 1 time in total.

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PostPosted: Sat Nov 06, 2010 3:01 pm 
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IJ wrote:
But this is how it's almost always done, because most research is designed to get drug B a market share by showing it's better than placebo and NEVER comparing it to established drug A, because then the new expensive drug might underperform.


There is a push going right now to throw out decades worth of tests against "placebos" because they don't have to tell us what's in the "placebo". Turns out that things which have been stated to be "placebo" are anything but. In one case it's now been shown that the effectiveness of a diabetes drug was extremely over-exaggerated because the effectiveness was compared to the "placebo"... which just happened to contain... a form of sugar! In another case, a heart drug was tested against a "placebo" that evidently (records are spotty) that contained... fish oil. Even "placebos" can have an effect depending on what's in them.

I don't have my text of the "health-care" bill with me right now, so I won't get into that until I have direct cites.

On the "costs" of medicine, I do have two comments:

1] It is possible (and there is a significant number of people who are doing so) to get the equivalent health-care in other countries (where the MDs are trained in the U.S. & U.K.; they use the same machinery to perform the same tests; the hospitals are clean & modern; the same medications are available) for a fraction of the costs here in the U.S.

2] The U.S. system is setup so that those who work are paying for those who don't. Then when someone who's paid into the system finally needs the use of their insurance, they get shuffled to the back of the line while those who've either not paid or hardly paid get put to the front. Why not take care of those who've paid for it over time and let those who haven't paid for it get in line (like they do in a lot of other countries).

(I freely admit that this is my experience and observation for my family and myself over the last ~25 years. Two side notes on this: first, when my parents both got sick in the same year, their entire medical costs were $17k and the insurance company paid out $14k... My dad's premiums had been running ~$9k for years before that and went up to ~$15+k the next year... He could have been "self insured" and made out big time. On one occasion, the hospital made my parents come up with CASH before they would treat my Mom because they said the insurance company took too long to pay... in the same waiting room was someone who'd never paid into the system, but was covered by our government and they were given the red carpet treatment without having to come up with a dime because the hospital got their money without scrutiny from the government. Second, in my case, I've either paid personally or between me and various employers ~$12-15k/yr for a very long time - decades - and the most that has ever been paid out for me and/or my family in any one year has been ~6k... pretty damn lucrative for the insurance business, then again look who has the largest buildings. A couple of years ago I was denied a therapy recommended by two different MDs because the insurance company refused to pay the ~$3-4k for it. IF I had been self-insured I could have paid that 4 times over that year! BUT, government regulations make it basically impossible - and now illegal under this new health-care law - for me to privately pay for any of this. I HAVE TO pay through/using an insurance company! In fact, it was recently suggested to us by an MD that we would be better off going for the MA government insurance over private insurance because it wouldn't cost me anything and the coverage is really good... almost as good as what I'm paying ~$1500/month for! And I'm going to get taxed "extra" because I'm considered to have a "Cadillac plan"! Sorry for the rant...)

In the U.S., government regulations (protections actually) have caused our prescription prices to soar, alternatives to be ignored, created the need for hospitals and MDs to charge more in order to compensate for reduced insurance & medicaid/medicare payouts as well as a litigious society that punishes the good while protecting the bad.


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PostPosted: Sat Nov 06, 2010 9:03 pm 
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If you want cheaper health care just go to a veterinary office. They use the same equipment and in some cases the same medicine but charge a fraction of the cost. The cost I had to pay for Prednisone for a dog with skin allergies was no where near what my grandfather was paying for it at the same time, even when corrected for dosage differences. X-Rays for the pets at a vet's office don't even come close to the cost of ones the human members of the family have had at doctors offices and hospitals. Minor outpatient surgery on my oldest daughter to treat a trigger-thumb was about 10X more than the major thoracic/abdominal surgery one of my dogs had when a perforation in its diaphragm was allowing abdominal organs to enter the thoracic cavity. I wrote a check for the dog's surgery the day after it happened, even though it was an unplanned emergency surgery; never can afford that for anything done to the kids/wife. In fact we still have not fully recovered from a ~four-year (2003-7) string of expensive health issues in the family that wiped out our savings, shot our debt sky high, and very nearly drove us to bankruptcy, and that was with a decent employer-provided health-insurance plan. Of course without the insurance we would have been bankrupt many times over.

Obviously people tend to be willing to pay more to treat themselves/family versus treating animals, so doctors will aways be able to charge more than vets can, but I don't think that begins to come close to explaining the huge disparity that exists in the costs for similar/same treatments and tests. For one thing vets also do not have the same overhead in terms of regulations and malpractice that doctors/hospitals do. Are such extra "protections" really having a positive effect that is worth the enormous extra costs?

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PostPosted: Sun Nov 07, 2010 1:15 am 
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Look im canadian, and while i think canada can learn from europian countries on our healthcare system, i agree with our system.

Thing is, if obama really wanted change, he would have caused far more contreversy and would not care about be elected for the next term. He would shake the system.

But he doesn't care about change, never intended it. It's a slogan.


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PostPosted: Sun Nov 07, 2010 7:39 am 
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"If you want cheaper health care just go to a veterinary office."

This is somewhat true. Usually true. Here, there are market constraints on prices, so they're not totally insane. People actually pay the vet, not a copay. People buy the medicine, not a copay. The lawyers have largely stayed out of it. But when the vet asked me to buy lasix for my dog with heart failure after doing 4 extra films without asking me, and get an echo and see a dog cardiologist, I got the same medicine for 1/4 the cost by prescribing it myself (ok we cant all do this) thru costco, and looking up the dose for enalapril for dog heart failure and doing the same again. Dog doesn't need an echo and blood work at 14. He'll get better or he won't. In fact, he made it to 16 was a sad balloon heart. Poor little Omar. He was a good boy.

Panther I don't think we'll see research against placebo "thrown out" but we will expect to see more information about the placebos used in the future. A pill sized amount of sugar is not going to do much to someone's diabetes control, or people could fix their diabetes as much as a medicine does by cutting out 3 pills worth of sugar a day. Oh, if it were only so. The fish oil probably made the drug appear LESS effective.

Certainly the care is cheaper elsewhere; we've created a fantasy land where cost is no object, or you will get accused of rationing. Here it's a sin to mention the equivalent of the $500 toilet seat but it's the same exact problem.

As for people who've paid into the system getting shuffled to the back of the line, I've never, ever heard of this. Lines are pretty short at the ER, and they take people by acuity not reverse order of paying. Procedures can be a bear to get if you're uninsured; insured people they're see next day a lot of the time. Or soon. As far as your example with the government vs private insurance--well, I guess I don't doubt you. There are certainly some private insurances that are nightmares to deal with, sucking up hours of doctor's time to get anyone on the phone for approvals. The government stuff IS easier to deal with. Less red tape is one of the economies of scale we get from evil, wrong headed ideas like public options.

You'll have to go into more detail about how it's illegal for you to pay privately for this. Currently, you can pay out of pocket all you want. Under Obamacare, you'd have to pay a tax or have insurance. You could still pay privately, right? If you think about it, you DO have insurance, even if you're uninsured. It's called the ER and EMTALA, and you'll get top notch care provided by paying people if you neglected to stay insured over the years then have a crisis.

Part of the "protections" you're referring to are patent protections. This is a pluses/minuses kinda thing. Do you like the best research in the world benefiting you? Then you will want companies incentivized to do it. Do you want your drugs cheap and generic ASAP? There will be early boons and possible less innovation in the future. Should we pay out for things we really want and need, like new antibiotics? That's handouts to corporations. Should the NIH do the work and have government develop the drugs? Well that's government healthcare at its worst. Pick your poison. Recently, the government asked the makers of a useful drug called midodrine to do more safety work to show it was ok to use; they responded by planning to drop it completely. And we offered patent protection to an old drug, colchicine, in return for valuable research on certain conditions. Now people who use colchicine for gout are finding it only at sky high prices. I do not have a good solution to this one, but the countries that buy their drugs cheaper do so using their national healthcare purchasing power and government power over drug companies.

Jason, the pendulum swings left and right in this country. Do you think that if the Palins and O'Donnells of the right get power we won't see a backlash in weeks once we realize they can't spell? What I would like to see is the end of power wielded by two parties each controlled by the fringe wackos. The moderate party could run this place right away if it ever got started. Incidentally, this country still has a huge problem not even knowing what's going on. Some of Obama's biggest problems are the fact that he's a muslim, that he increased taxes, and that the economy is shrinking. But... here's an excerpt from the article where I found this:

"For example:

By 52 percent to 19 percent, likely voters say federal income taxes have gone up for the middle class in the past two years.

Except, that's just not true.

The Obama administration has cut taxes -- largely for the middle class -- by $240 billion since taking office on Jan. 20, 2009. A program aimed at families earning less than $150,000 that was contained in the stimulus package lowered the burden for 95 percent of working Americans by $116 billion, or about $400 per year for individuals and $800 for married couples. Other measures include breaks for college education, moderate- income families and the unemployed and incentives to promote renewable energy.

Even a plurality of Democrats believe Obama has raised taxes. Poll respondents also think the U.S. economy is continuing to shrink, when in fact it has grown for the last five quarters."

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PostPosted: Thu Nov 18, 2010 12:35 am 
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Finally, we have a real death panel convening. It's, like you might expect, in a blue state. A Dem state. A liberal, fascist death panel with the goal of nationalizing your healthcare and cutting benefits (and killing patients) to save money is now meeting in the Marxist state of....

ARIZONA.

http://www.npr.org/2010/11/11/131215308 ... ts-at-risk

Now how many Arizonans think that Obama is out to kill your benefits (by expanding them)? This shows to me 1) the inevitability of rationing and 2) the disconnect between political theatre and political reality.

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PostPosted: Thu Nov 18, 2010 1:35 am 
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Speaking of political theatre, would NPR have reported on that if it were happening in, say, MA?

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PostPosted: Fri Nov 19, 2010 3:43 am 
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Jason Rees wrote:
Speaking of political theatre, would NPR have reported on that if it were happening in, say, MA?

Nope... They didn't report the outsourcing of 20 percent of jobs in my former MA employer (all of IT to Nepal of all places) to avoid the state universal health care requirements. And ObamaCare is modeled after the Massachusetts plan. Go ahead, Ian, try to paint it Conservative. We can do this all day long.

And besides... I can't see how cutting benefits - particularly to Medicaid - has anything to do with liberalism. The larger point is that Arizona gets to make its own choices. I'm all for the individual states CONTINUING to make THEIR OWN choices about health care financing. It isn't the business of the federal government.

The wise and frugal states will have the lowest taxes and thus attract the most industry. More industry will mean more revenue (including for the state) and greater employment. Meanwhile states with the richest welfare benefits will attract the greatest number of non-workers. Competition is a wonderful thing.

I had a pretty interesting conversation with a brilliant young Chinese woman from Beijing (Yale MPH grad) who came to work for my present company the same day I did. She talked to me about their culture, and how the children are expected to take care of their parents when they get older. (I know how that goes...) To do otherwise would be to bring great shame upon yourself. I remarked how in this country, the government has usurped what used to be a family responsibility, and the kids in turn have evolved culturally to abandon their parents once they leave home.

And we wonder why China owns a good chunk of our economy today. It isn't just that they don't always fight fair economically.

- Bill


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PostPosted: Sat Nov 20, 2010 2:04 am 
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Bill I think you miss my point again, and I don't know which fantasy Ian you've been arguing with all this time. I'm not painting rationing as conservative. I'm complaining that the conservatives, republicans, teas, whatever had a concerted, deliberate plan to make the democrats look like killer rationers when in fact all the "death panel" fuss was about was reimbursing doctors to speak to patients about crucial end of life planning (the patient's plans!). It was total, cynical, complete BS, and it largely worked. Point #1.

Rationing is coming, period. Or we can follow Greece into the hole. THAT is point #2. I'm all for rationing. As you would remember from dozens of my other posts if you weren't handicapped by assuming I have signed up for the Democratic Party line.

Interesting side note about parent care an China. I agree partly, but their culture has long valued ancestor / parent / grandparent care more than ours. I think that even if government didn't provide resourced for eldercare, Americans would be financing other ways to put the folks in a home. This is partly because we take care of sickly people who wouldn't survive terribly long in a home environment, for one. Additionally, China is changing. Women there don't want to be child-parent caretakers as much.

http://libcom.org/history/1949-2007-women-workers-china

"The daughters' desire for success reflects the values of competition and effi­ciency which have been highly promoted in the changeover to the market economy." (Liu: 133) The daughters by no means want to repeat the past of their mothers. While for the mothers, their wage labor was just a job, and promotion and ca­reer was not important, the daughters are differ­ent. They think about their personal development. They do not want to sacrifice themselves for the family, they do not want to live for their children (or their parents) (Jaschok: 122). Nevertheless, the daughters partly use the services of their mothers who take care of their grand-child while the daughters lead their own life and use their time in a different manner. The daughters do not want to sacrifice themselves for the family, but they leave their mother in exactly that position.13"

While I am not prepared to review all of NPR's coverage of the MA healthcare reform, you seem fairly confident they have never mentioned reclassification of workers to skirt their new duties. They do have a number of negative impacts mentioned on their website:

http://www.pbs.org/wgbh/pages/frontline ... rica/mass/

Even if they haven't mentioned it, it's still... true.

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