birdog1960

it's standard of care to see diabetics every 3 months. a long term sugar test (hgba1c)is done at every visit. the cash cost for a private pay pt for the lab alone is about $40 even though the test cost less than $5 when done on a large scale. diabetics rarely have only one diagnosis, especially those who have had the disease for a long period. they suffer the myriad complications which develop often even with good control. the majority of pt on dialysis are diabetics. google the staggering cost of dialysis in the us. even early in the course, many patients have hypertension and high cholesterol as comorbidities. treating and following these cost even more. i've cited some examples of much less expensive single payor systems with better outcomes than ours. do you have any for your proposed system? why reinvent the wheel and experiment with unproven strategies? isn't that what liberals are so frequently accused of?

you linked a single newspaper article from 1999. show me some real data. how bout this one. raw data can be found at the commonwealth fund report.

this is an important point. in my case, the best nurse practitioner i ever employed was scooped up by a cardiology group that paid her nearly double what i was (or could, due to much lower reimbursement). even among mid levels, primary care is unpopular. mostly because of pay but also because it's broad and vast. in their shortened training it's easier to master one area than all of them. the aca addresses this to some degree as you noted in an earlier post. it encourages primary care at the expense of specialists. but again there's good data to support cost effectiveness with better overall outcomes in a systems with higher ratios of primary care to specialists. that's the opposite of what we now have in the u.s.

unless i'm misunderstanding you, you describe chronic disease as a marginal problem. i'm saying it's not marginal at all. millions of people have chronic diseases. in 2010, the cdc estimated 20.1 million americans have diabetes. (don't know where i saw the 50% estimate - in retrospect that seems impossibly high). i did appreciate your lack of appreciation for the current bastardized system. but i don't agree with your solution. the best way to get the best care for the most people at the lowest price is single payor. many other successful and wealthy countries have studied the problem and come to that conclusion. their outcomes speak for themselves. edit: 50% was a number estimated for diabetics + prediabetics by 2020. number is from united health so take it with several morton's salt boxes.

btw, as an aside here's a discussion on the use of "payor" vs "payer". articles supporting it seem use the former more often. don't know why.

$25 visits aren't gonna do it. i realize that's an arbitrary number but the "simple" or mundane problems being seen are arbitrary too. they're not always simple. fairly often, they're a symptom of a much larger, much more expensive problem, neglected for years especially in the uninsured population. you can't put a $25 band aid on diabetes, which by most estimates will afflict 1/5 the population in the not too distant future. chronic disease is exceedingly common. plus, that number won't cover overhead in even a very efficient office. that larger risk pool including young, healthy patients is exactly what single payor provides. it is also simpler. hospitals and offices would only have to bill one payor. one standardized system to deal with for reimbursement, credentialing, appeals etc. for far too long, private insurance companies have cherry picked the healthiest pts leaving the sickest for the taxpayers to insure (or to fail miserably trying to fend for themselves). cut that out and the cost per "insured" life on the gov't program comes screaming down. taxpayers are subsidizing their already huge profits by picking up the very high bills for the sickest folks. and the private insurers add nothing of value to the health of the country. they're just an unnecessary expense. it's absurd...unless your in the insurance biz.

thanks. we did lose some food before i figured it out. i'm not sure why the previous owner wired it this way but he had stereo stuff in the same outlets so i guess to protect them. i think he had a fridge in the same outlet though. with that kind of hit and so little damage, i guess i can assume my house is grounded well? the fuse at the telephone pole was a pretty big cylindrical thing so i imagine that takes quite a bit to be blown.

i'll start by saying i know very little about wiring/electrical stuff. my house was hit about 2 weeks ago. or maybe it was the single power pole out front (we live in the country). anyway, the fuse at the pole was blown and had to be replaced by the power co. when the power returned we had no internet and that had to be fixed at the box on the outside of the house. a bank of outlets in my basement was dead but i found that one (that has a fridge plugged in) had the cgfi breaker blown at the outlet. i reset that and all the other outlets are fine. seems weird to me that an outlet breaker controls all those other outlets but i guess it works like a breaker in the actual breaker box? do i need an electrician to check this out or is that how it's supposed to work? fortunately, there were alot of stereo components plugged into the "dead" bank of outlets (through a surge suppressor that wasn't tripped) and all escaped damage except a wii that will no longer read discs. was working about a week before but kids were playing with it at a party and it could just be a dirty laser but it's prolly fried the driver. only other thing ruined was the vonage box that they replaced for free. i guess i got off pretty light.

i know. couldn't resist conceding an advantage for a shot a oc. but i'm more than ok with single payor, as you know. there realistically needs to be enough incentive for prospective med students to go 6 figures in deb,t so reimbursement can only go so low. i'm a pragmatic liberal.

you do realize that the average doctor made much less before the advent of medicare, right? the average octagenarian (there were many less of them) received much less care? yeah, i think medicare is a very good thing. the vietnam war? entirely different matter. but lets not cloud the issue. brevity is good.

there's a big problem with your math at the end. medical care hasn't been based on the free enterprise system, supply and demand, since medicare was enacted. doc's who see a majority of medicare and medicaid patients have had their prices set for years - my entire career. yes, demand will increase but prices for the govt payers are determined by the govt and have been for decades. even in negotiations with private insurers, individual, independent doctors are prohibited by law from joining together to negotiate prices. the insurers have had the upper hand for years. so many of us are accustomed to it and have adapted. guess how...we work longer hours and see more patients or we accept lower pay. and that's what's likely to happen here. and by design, i believe, the bill will begin the boulder rolling downhill towards an alternative to the current model of private insurance. on that, we agree.

thus the "as well"

soros isn't running for president. i don't like big money running the show here any more than you. i suspect i like it less. soros, despite his faults, is on the right side of most issues, in my opinion. without him, the aca would likely not be law and rupert murdoch and people like him would still be dominating the media. i'm not an absolutist. i'll take that trade off.

might the british monetary policy at the time have had something to do with this? or are you surmising it was an inside job? and a billion dollars? how much do you think the brits have spent supporting our forays into the middle east?

he stands for the core principles of the left. he supports those principles with his money. his money affords him access and influence, same as any big donor (and worse since the citizen's united scotus ruling). these are facts of life in our current political system. no way around it. in contrast, i don't believe the koch's want a bunch of grassroots, loosely connected, unbeholden everymen running the country. it doesn't serve their interests. there money is there to buy influence in a party that supposedly openly rejects such arrangements.

see my earlier response to this same point. i'm under no illusions about soros. the difference is that his goals and beliefs and mine coincide mostly. i'd be willing to bet that the koch's and many tea party members don't.

so the koch's are selflessly funding the tea party out of patriotism and the good feeling this "grassroots" organization brings them? no quid pro quo? nothing expected as roi? historically, they've always acted so selflessly. this would be right in character. whatever helps you sleep at night...

he's been notably absent from the discussion since then. don't think he got the red meat he was looking for.

So what's the verdict on songs?

yeah. i'd stay away from doctors who look dorky and have gray beards as well. go for the ones that look like they spend most of their time in singles bars.

i agree. that will help the providers to do the right thing. stop the incentive to do more and more. but patient demand and expectations need to be controlled as well. people need to bear at least a significant part of the huge costs of extraordinary care so that they at least consider that not doing it is a reasonable option. i think we're talking about the same thing: basic care for everone. out of pocket costs for elective tests and procedures and payment reform away from fee for service.

if it's considered standard of care on a national basis i believe it will be much easier to defend. maybe i'm delusional but i think those standards will be evidence based and aimed at providing the best care to the most people. if that's not the goal then i can understand opposition.

current law provides protection to insurance companies for refusing to pay for care on the basis that they aren't refusing actual care. guess who gets caught holding the short straw in this instance. i don't know of a successful malpractice case for refusing care against an insurance company. do you?

the response is hardly surprising. it's only rationing when services are withheld from you or yours. it's not rationing when they are, as now, withheld only from the un or underinsured and the critic is not included in this group. there will always be a tiered system with those who can afford more, getting more.. i think it better that the lowest tier has basic care. others disagree. the current system and it's costs are unsustainable even with the willful rationing of the uninsured. what is the alternative to rationing of the insured to attain sustainability? as stated previously, it already happens by men behind curtains at private insurance companies. why the outrage at transparency? doc, do ypu suppose no one has died in the us as a result of those decisions?

heard a snippet from a romney speech refuting obama's idea by citing steve jobs and apple...only problem is jobs foundation was largely built by public dollars spent at nasa.