birdog1960

this is a very good analogy. i am still amazed that so many fans readily accepted and continue to accept nix and gailey, especially when wilson teased of big name, big money signings. the difference is that kc has a next generation owner and buffalo does not.

has the potential to be one of the worst in nfl history...talent wise there might be 2 players in the top 200 in the league and many in the bottom 200

titans...i'd go to nashville a couple times a year..have always enjoyed it when i've gone to biils- titans games there (except the last playoff game)

and yet, people defend wilson for his putrid legacy

yeah but wilson knows him

i'm somewhat familiar with the issues that you address. we've had an EMR since about 1999. it's constantly upgraded yet i find it very user unfriendly and actually adds significant time to my work day rather than saving time. i hear this complaint from most of my colleagues. most systems also end up producing "cookie cutter" notes in which 2/3 of the note is filler or regurgitation of previously documented data. when will we have an accurate voice recognition system with the ability to meaningfully parse notes? this seems to be the holy grail of emr. i agree that whole books have been written on the subject. if you read Daschle's book then you can see that i fundamentally agree with his approach. this however involves wholesale change to the current system rather than incremental efficiency changes (which i agree, need incorporation). in regards to cost versus price, health care has not had an open market for decades. private insurers take their lead from medicare in valuing services in almost every instance. it is difficult and sometimes illegal for me to "collude" with my colleagues to negotiate prices. an example in the us that refutes your point is drug costs. most drugs can be bought in other countries for much less but americans are legally forbidden to buy them from these places. in short, exclusive of the problems you put forth (which are real and important), the primary cause of the high cost of health care in the us is greed. take the profit making possibilities out and much of this (fraud and abuse, malpractice threats, defensive medicine etc) goes away.

a little off topic but still relevant....my final nickname for wang, levitre and wood-----Ralph's Nuts

clearly there's waste...enormous waste and a fair amount of fraud. i had a rep from a scooter company come in with a patient to an appt after she saw him walking more slowly than everyone else in mcdonalds. dtc drug advertising should've been outlawed years ago (like it is everywhere else in the world). crooked durable medical equipment dealers are as common as garden slugs...and the list goes on. there exist multi specialty physician groups in the US that are very efficient (geisinger and mayo come immediately to mind) yet their costs are still higher than many groups in socialized national systems no argument here concerning waste and defensive medicine spawned from the threat of malpractice. so...how do you propose fixing it? i propose best practice guidelines (ie protocols) set by a national board of experts (primarily clinicians but with the token ethicist and requisite bureaucrat thrown in) with safe harbors for malpractice buuilt in. fraud and abuse must be vigilantly and ruthlessly monitored and prosecuted. the private sector hasn't been wildly successful in these matters either in the health care arena. it's really only the govt that can adequately address the problems. if the govt lacks the will to do it, it won't change but if they aren't given the tools, we'll never know if they have the will. what's your proposed solution? and you can add demand with constant supply and control cost if you are the sole payor and determiner of price.

the only plausible explanation is that someone with dementia made this deal

i don't know...over on ppp they were bashing the ivy league pretty hard the other day. i don't hold out too much hope for admiration of oxbridge.

they ARE written about here but every time the messenger is shot, not the people who deserve it. there doesn't seem to be a single journalist trusted by this this board that covers the bills. it's not the writers, it's the readers. it's been easier to blame the writers for being "negative" than to admit the truth which has been exposed over and over. now it's just impossible to disregard.

you should consider running for office on that position. it's a sure winner.

or like spreading risk over a much larger segment of the population including young, healthy people. the problem with increasing the age requirement is that this worsens the unemployment picture by delaying retirement for many people (as does increasing the age for SS benefits). btw, i never said cost cutting was limited to rationing, only that it will be required for substantial savings....and for the umpteenth time-administrative as well as total cost for govt administered medicare are less than privately administered insurance including medicare. in the case of medicare advantage programs, total cost to insure was up to 20% higher when administered through private insurers (even thought taxpayers pay the cost of both programs). please cite a reference that shows otherwise.

yes, exactly. lets break this down. premises: medicare at best will be solvent in its current iteration til 2029. medicare currently pays the vast majority of health care costs for the elderly and the disabled. if these individuals were forced to buy insurance on the open market, it would be unaffordanle to the vast majority of americans (any guess what the premium would be for a diabetic, cardiac patient age 80? anybody pondering early retirement ever price a policy for a healthy 50 yo?) if medicare were to be privatized, it would have to be hugely subsidized by the govt (eg medicare advantage program), medicare has a cost advantage over private insurance in regards to administrative costs. ok? nothing controversial there..anyone take exception so far? conclusions: govt must be involved in the funding of health insurance if the majority of elderly and disabled are to be covered. medicare needs to cost less to remain solvent. to cut costs substantively, medicare will need to reduce benefits. reducing benefit=rationing which=denying care for some currently covered items. ok so far? here's where i predict the argument starts. Who is in the best position to decide the parameters for rationing? i contend its the govt. the reasons are many and some have already been put forth earlier but the biggest would be: to take profit out of the decision making process, to allow the decisions to be made based on clinical data and societal preferences and to have universal policies follwed for and by all. in the case of medicare, this isn't the govt taking over the role of private insurers but continuing it's current role with stricter, necessary cost controls. once again, private insurance paid for directly by the elderly without govt subsidy (as a sole option) simply isn't an option if we are to cover any significant percentage of this high risk population. the case study is 45 years of medicare. this was cited as evidence that administrative costs in medicare are less than private insurance. this is simply a fact based on data collected over that 45 year period.

it's as simple as controlling utilization by refusing reimbursement. private insurers do it right now, all the time.

charlie weiss and romeo crennel as coordinators have done more than enough in their careers to be considered pretty solid. they certainly proved their worth against the bills over the years. and remember who the chiefs offensive coordinator was before pioli promptly fired him? yup, chan gailey. the bills are the anti-chiefs.

we haven't tied or beaten 8-8 since 04 not that i'm aware of but he was on the market

it's a relevant comparison. i'd be dancin in the street if littman resigned.

if they go 8-8 form their worst season (2-14) in 08, i'd say he's done pretty well. if they make the playoffs he'll likely be named nfl executive of the year.

the chiefs are 3-0 in pioli's second season as gm. i know that 3 games doesn't make a career but he's looking pretty good right now. he came into a similar situation in kc to what the bills have now. he could have been the bills gm in place of our marketing guru in 09. he demanded total control which many thought clark hunt would never give. wilson never would have. still, wouldn't a 45 year old, widely respected up and comer available in 09 been preferable to our marketing guy or even our current gm? i'll bet we wouldn't have picked maybin where we did last year with him at the helm. then again, wilson probably doesn't know him.

there is always a choice. that's why it's called ELECTIVE surgery. despite what you may have been led to believe, there are conditions and situations where doing less is the correct decision and there are things that can't be fixed. despite what americans want to believe, medicine can't keep anyone alive and functioning well forever. even artificial joints have finite lifespans (much shorter than the ones we're born with). I frequently hear pts say they wish they never had x,y,z elective surgery. they are sold on the possibility of extended youth even when, at times, the odds of improvement over conservative care are not good. injections are a small fraction of the cost of surgery. the most prudent course of action in many cases (doctors also being mortals, without the ability to divine the future) is conservative treatment in elective cases with surgery only considered when all other options have been extinguished and even then, not offered to poor candidates. "upselling" could be mitigated by adherence to best practice guidelines (based on outcomes data) being instituted and followed. so how is this concept "looking for reform in the wrong place"?

it IS making things better from a budgetary stand point. even if one accepts your nihilistic view of the budgeting process, the reform model is still better in a relative sense to what we had from a fiscal perspective. more emphasis on primary care benefits me but it also benefits society as a whole. the systems that produce the best results at the lowest cost worldwide are those that rely heavily on primary care. consider the example of the 20% copay for medicare advanced above. then consider the case of an elderly patient mulling knee replacement. if he's faced with $10k+ of the cost he's more likely to come to me first for joint injections and medical treatment than to jump into an expensive surgery frought with possible complications with marginally better outcomes. thats a win- win.

ah. so your solution is to throw our hands up int the air and all say "whatever" in unison. good thinking!

i say: are you channeling bill o'reilly? bad choice.i say "overstate the improvement (which implies that some improvement will result)" and "indeed improves" from the cbo coupled with the actual medicare trustees report probably places what will actually happen somewhere in the middle (which is often the case). either way, both opine that the bill IMPROVES the fiscal problems, not worsens them as some contend. either way, more has to be done so that 20 somethings paying in to medicare get some benefit. this is going to mean rationing eg: a national formulary, cost benefit analyses on therapeutic and diagnostic procedures and screenings, an open discussion and agreement on end of life care etc,etc. thus my contention that this is a work in progress...baby steps....we will have to see much bigger and more radical changes in order to keep medicare solvent for the next generation and the next after that. both parties understand this. you're seeing the dems approach, although the end game is still vague. you saw the repubs approach with the medicare advantage programs which was the first step towards privatizing medicare and handing it over to the big private insurers who will then do the rationing.

predicted solvency til 2029 (assuming health reform bill allowed to play out)...12 year improvement in prediction since passage of health reform bill.