birdog1960

what do you think he meant by this statement:"the result is a uniquely American gold rush for those who provide everything from wonder drugs to canes to high tech implants to CT scans..." i think i know what he's getting at and agree completely.

other governments are getting it more correct compared to our private/public system in terms of results versus costs. (i'll grant that many, if not all, have their problems but not as serious as ours in regards to costs) are you arguing that american gov't is uniquely destined for failure in this regard.

did anybody notice the bit about employment opportunities and potential earnings for salesmen for items like mri machines for companies like seimens? these facts are emblematic of the problem to me. americans are effectively led to believe that more is always better even if there isn't evidence to support that contention. if they don';t get more they feel they are being cheated. this is certainly the case for many radiologic studies.. these are profit centers for health systems and they seem happy to do as many studies as they can. doctors often do them out of fear of malpractice cases. in both cases, the root cause is the desire to make money off of the system. and plenty of people are making plenty of money that is not going towards providing effective care. this is where a board of true experts defining national evidence based standards of care would help immensely. unfortunately, the seed has been planted in the minds of the american public that the purpose of such a board would be to limit effective care when it could truly be to provide it more effectively. this, of course, is directly confronting the goals of many in the game: increased profits.

huh? then why the operating margins brill cites for the big systems? that's not all coming from private payers.

well if you want to point to someone who misinterpreted the article, how bout meazza? he thinks it's about rich and poor getting different levels of care. i guess that's because the patient that went to texas for cancer care chose a "cadillac" option for care. first of all, that wasn't brill's point. secondly, the cost wouldn't likely have been much lower at podunk community hospital. THAT was the point i believe brill was making.. and the idea that everyone gets equal care regardless of ability to pay is a strawman. i didn't read brill nor have i read any mainstream proponents of universal coverage demanding it. most want chevy levels of care for everyone. if you want more bells and whistles and can afford it, that's fine. to me those are the profit sources that are most appropriate for exploitation if we continue to insist on a for profit system.

no, if you read the article and especially if you listened to brill on pbs , you'd understand that he thinks that the healthcare industry has been at full employment and is making record profits in a recession because very often demand is not discretionary and there's little competition for price. prices are not disclosed to direct individual payers til after the fact. small providers are getting squeezed out by massive "nonprofits" that often are the largest and best paying employers in an area, often with huge top executive salaries. they lobby the govt at levels that dwarf even the military contractors. while private insurers take a cut of healthcare spending amounting to billions, they are losing ground in the power battle with the large systems. the only players having any success at modulating costs recently have been the gov't programs: medicare and medicaid. and this entire ridiculous scenario is uniquely american. because we are the only country that prioritizes profits, at nearly every level of care provision, over actually providing care. yes, that includes malpractice lawyers but also layers and layers of managers and businessmen whose primary purpose it is to maximize profit at every enterprise including insurance. profit taking costs the payers, whether individuals, insurance companies or the government. no matter your opinion on the solution, it's very clear that this system is failing and is unsustainable. with health costs comprising nearly double that of most other developed countries as a proportion of gdp, we cannot compete effectively for costs of products produced with these costs factored in.

yes. as stated in the piece, the gov't pays less for nearly everything in healthcare due to it's massive purchasing power. less than private insurers and much less than unfortunate uninsured individuals. what's needed is the political will to ramp down payment on everything in healthcare using this purchasing power and to not exclude things like drugs, devices and durable equipment...that, and for private insurers to get out of the way.

removing the middle man.

no. the point is healthcare is MORE expensive in the US...way MORE expensive. absolutely and relative to GNP. the pages after the first one make this point quite effectively. and where are all those extra dollars going? well, a bit more to you and me (we make more on average than our international colleagues) but way more to hospitals and health systems and suppliers (pharma, medical devices, medical sales, durable equipment sellers etc i.e.: businessmen). do we need businessmen to provide good care? maybe, but we could certainly get a better deal. actual providers and the people we serve (especially) are losing. and (crocodile tears here) insurers are starting to lose relatively as well. the game is a loser for all but a few. single payer was impossible this time around...but obamacare is a start. i'm thinking a national formulary with periodic bids to enter would be a bit more effective.

keep laughing...the scooter store is big bucks but pales in comparison to big pharma. you know, the ones that advertise direct to consumers (patients) that they need the newest brand name drug when a generic, that they refuse to even attempt to prove superiority to, is available at a fraction of the cost. we're the only nation to allow such advertising that i'm aware of. and to what end? we have a bastardized system with public and private interests negotiating an uneasy peace. and guess who is losing? have any of you even read the Brill piece yet? comments?

me too, brother. as i said earlier, i hope this is a sign of things to come. we have a med student in the office right now. a drug rep was selling me on one of the new osteoporosis drugs that costs thousands a year. she was stupid enough to ask me "but don't you want the best for your patients?". i pointed to him and said "yes, but i also want him to be able to make a living after he finishes his indentured servitude." i just think we need to attempt to balance things for everyone in the system. seems to me it's way out of kilter right now.

the laws against the kind of crap the scooter store has done for years are in place. they haven't been properly used. who do i blame? i'd bet that the folks at the scooter store have some friends in high places.... does that make the entire medicare system a failure? do i have patients with legitimate needs for a scooter? have i complained to medicare in the past about the scooter store? no. yes. yes. so what's the answer? take away the incentive... lower profit margins for mobility devices or open the business to bids. i'm sure an actuary could estimate approximately how many scooters should be truly needed per 1000 medicare recipients. pay an amount proportional to that number of patient at reasonable profit. have certified examiners determine need. and while they're at it, open bidding for prescription drugs for a national formulary.

i actually linked it in the obamacare irony thread but doubt anyone i was arguing with looked at it. they had brill on bps the other night...very impressive. the ONLY way we get costs under control is through gov't intervention. this is the natural history of for profit medicine -escalating, unaffordable costs for care. there is virtually nothing in that article that i would argue with. in related news, http://www.mysanantonio.com/news/local_news/article/Raid-not-a-first-for-Scooter-Store-4303667.php. don't know how these shysters have existed so long but better late than never. hopefully this is the start of a major crackdown on fraud and abuse.

i write references for colleagues and students frequently. it's understood in my professional community that "reference inflation" is the norm. from what you've described i would use the word "adequate" a few times in my reference. that will likely have the desired effect and you can feel comfortable about your honesty.

we get it. you're a literal person....to the letter. that kind of thinking usually comes at the expense of creativity.same old used the word "seedless", i transposed it to "sterile" and we eventually came to the conclusion that, indeed, monsanto can produce nonreplicating seed which i would think is important to this court case.

well, now it's official; you pay no attention to what anyone with opposing ideas says, kinda like the echo chamber that worked so well for the right last election. check out the post about terminator seeds or f1 hybrids: ie seeds that do not reproduce true to seed.. just because you and dc can't imagine it doesn't make it impossible.

i hope that he does well and that you get a chance to sleep.

this reuters financial writer http://finance.yahoo.com/news/analysis-jumbo-mortgages-back-far-212528722.html finds the term descriptive as well...probably a liberal.

i suppose....in observing many people over many years i've come to the conclusion that wealth and happiness aren't directly correlated. plenty of examples of unhappy wealthy people in pop culture. conversely, some with little or no wealth are very happy. it does, however, seem that being mean and spiteful is correlated with unhappiness, in my experience. whether that's cause or effect, i don't know. probably both.

http://www.npr.org/b...-drone-industry is this the next apple? anyone with more information on this budding industry?

i got the barenaked ladies reference, which is very appropriate to this thread, but i don't remember them mentioning ketchup.

who the hell eats ketchup with macaroni and cheese? mine is always accompanied by a slice pof bread and peanut butter.

you're rich if you're content with what you have, feel secure, fullfilled, loved respected and happy. he with the most happiness wins.

factcheck concluded that the evidence didn't support fred thompson's contention that 1/2 the 45 million reported uninsured were that way by choice. it also points out that by "choice" isn't really accurate as many categorized as such can't afford the premiums - which were considerably lower when the article was written than now.the forbes article subtracts those who are illegal immigrants and those who qualify for some form of govt assistance from the total of the uninsured before the aca takes effect. then adds them back in to come up with the 30 million remaining uninsured estimated after it takes effect. " dishonest" would desrribe that analysis charitably.as i said, the number of uninsured is debated. it's still a big number, whichever groups numbers you believe.

http://aspe.hhs.gov/health/reports/05/uninsured-cps/index.htm while these numbers are from 2005, they don't support your contention. 21% are foreign born noncitizens. that leaves 40 million americans the great majority are low earners who can't afford average premiums of 12K/year. people between jobs get sick, too. and your willing to write off 12 million people that are denied coverage for preexisting conditions? nevermind, rhetorical question. got any citations to support your numbers?