birdog1960

"social darwinism"...now that's a catchy phrase. kinda like it.

i noticed he was mentioned last night at the cma awards. another nice piece here.

we do that every visit anyway by taking a history. if in doubt, detecting nicotine in urine is a simple test. very little beauracray involved. as far as the election cycle, ya think obama got into this at all to get more votes? this was poltical bravery rarely before seen.

he worked a lot with bella fleck. never got the pleasure to see Mr. Scruggs but knowing he was in the same league as fleck tells you all you need to no about his talent. sounds like he was also a pioneer. i'll bet he lived a full and robust life. edit: just pulled up this great interview between the two. pretty cool stuff.

the committee to make these types odf decisions is already in the bill if i understand it correctly. this was tom daschle's idea which he described in his book prior to the bill being passed. it's called the federal coordinating council for cognitive effective research. this is the group some have pointed at screaming "death panel". it seems we both agree that something like it is necessary. therefore, you're espousing liberal principles knowingly or not. i think the fact that we're both apparently crossing an imaginary ideologic line in the sand is a good thing. it would be great if those in power would do the same.

i don't see those two things necessarily being incompatible. because you cover treatment for a diabetics preexisting diagnosis doesn't mean they have to be eligible get a bypass if they smoke. it means they are insured for treatment of their diabetes which actually saves money by less folks needing dialysis , wound care, amputations and the like. it's not all or nothing just because they are able to get insurance.

it's a good point. i wonder how americans would feel about lifestyle conditions for certain procedures: documented smoking cessation before bypass surgery, documented alcohol/drug abstinence before treatment of hepatitis, weight loss in obese patients before joint replacement etc. i think it's very reasonable. you?

maybe some of the people who support it are unaware. i'm certainly not. my point is that many of the people who oppose it are aware and this may well be the basis of their opposition.

agreed. and you have safe harbor protocols for both diagnosis and treatment that define the standard of care which is likely to be lower than most of the overusers now expect. my theory is that many understand this already and understand that to provide basic health care to everyone, they will need to give up their access to cafeteria medicine.

it also shows that the uninsured don't access care very often. from this data we can't conclude that they don't access it enough but mortality data does allow us to. so if you believe in medical darwinism, you may well be correct on the cost issue. i assumed, you, like me, had concluded we had evolved sociologically from our existence as pack animals. in the current model, the privately insured are paying $1000/year for the uninsured to get poor care. that's not a great bargain either.

some data relevant to the discussion: "many or most of the patients with the higher health care costs in the nation have private insurance and higher relative incomes and are white."

when in rome...

disrespect and snarkiness may win the day here but i don't think it works so well in the supreme court, even among conservatives. the exception, of course being, when a justice does it.

um, isn't the point of the debate to persuade justices to vote your way? ya think jousting and gamesmanship like this advances his purported purpose? you applaud, i applaud but for very different reasons.

my argument works just fine if you accept the premise that private insurance is totally unecessary to the delivery of health care to a population.

yes, it's the overpaid primary care docs fault for the high costs. how many docs do you think could be paid on the salary of united healthcare's ceo?

on cue...almost. i don't think we give transplants to the drug dealers wife. we don't give them to 71 yo billionaires unless there are no candidates with better expected outcomes or an adequate supply of hearts. that leaves a lot in between. speaking to your other point, did anyone notice the exchange yesterday about keeping a provision of the bill, in the event that the mamdate is ruled unconstitutional, thaat would cost the insurance industry billions? only caught soundbites yesterday, but presume it was due to the preexisting condition clause. could his be the trojan horse to put down insurers? could the writers of this bill be that brilliant? finally, none of dc's ideas address the need for universal coverage. obviously it's not a goal for him but is for many folks. put that in the "must have" category and devising a scheme gets complicated. anyone who thinks about it for a while will likely conclude that single payor is the best way. it just wasn't gonna pass. the pay at the counter idea is ridiculous on it's face. the vast majority of my patients couldn't pay out of pocket for a single hospital stay for pneumonia much less heart surgery. from a humanist standpoint this would result in untold needless deaths. from a financial, the collapse of the hospital system.

kinda like that term...might have been more effective to add "titanic sized".

maybe we need to hear the rest of the argument and context....from my understanding the medicaid debate was in part to be about whether the federal gov't could demand the states to follow the changes in the bill as a condition of the feds funding the vast majority of it. sounds like she's arguing that giving the states that money is not coercion. sounds reasonable to me. if they don't take the money they don't have to do it. need to hear the rest of the story and confirm or refure that.

may well have been $1000. i think i hit traffic when that part came on. was it kagan or the feds' lawyer who said that?

all of these calculations become much simpler if cost shifting to subsidize uninsured care is taken out of the equation. this was actually discussed by the supremes. someone (kagan?) mentioned a number of about $800/year that patients with insurance pay extra to cover this cost shifting.

magna cum laude from harvard law, dean of harvard law...i know, means nothing to you guys but there's a titanic sized boatload of lawyers who would give both their nuts for the credentials that this dufus holds. and yes,dc, appeal to authority...but it's very good authority that's being flippantly challenged here.

maybe scalia read the forbes script? now who's reading the teleprompter talking points?

says the future law student. sure, kagan's got nothin on you.