birdog1960

"arrogant" and "too much heinlein"" are mine. it's helpful to have a guidebook. can't tell the players witnout a scorecard.

heard a dc think tank attorney-consultant address this. said appeals and stalls would make it almost impossible for this to go to SC before 2014 when the bill opens up the gates to 30 mil uninsured. will be very difficult to close the gates once they are opened. he recommended assuming the law will remain and planning accordingly.

to see utilization trends, make plans based on them, predict winners and losers and improve the model. and you're right-that's the only chance if you want to lay your bet on that side. the constitutionality argument aint goin nowhere.

if? the only question is how far it goes from here. hospitals all over the country are sending management types and chief medical officers to geisinger and mayo to see how to do it right and float thnrough the change. people are using massachusetts as a case study. but guess what: no death panels in the recent legislation or in mass. many argue end of life care policies should be instituted but no one's been willing to do it. i would predict guidelines on counselling patients as a first step. were a long way from any form of "death panels".

sorry about your mom. i'm sure many of us have had similar experiences and it's always extremely difficult. rest assured that in the current iteration of our health care system, it's highly unlikely that she'd have been referred to hospice, especially at age 59, if there were any hope of recovery, however slight.

no, just a bad typist. so sue me

i can only type with one hand. the others not behind my back. transcriptionists are great to know.

you're worried about me disrespecting other posters because of grammar while you misrepresent the largest organized religion in the country? i'll wager a days pay that i know more about hospice than either of you through my 20 years as an internist caring for hundreds of hospice patients and many more critically ill and dying patients. i can't recall one instance of ever experiencing interference or condemnation from a Catholic priest. i have rarely had issues with any clergy from any faith in such cases. if there's disagreement its usually with the family or due to the patients own strohgly held beliefs which are always respected and deferred to. i have served with clergy on ethics committees and almost always found them reasonable and willing to listen but not always of the same opinion as me. the problem as i see it, comes when these beliefs are forced on nonbelievers . that isn't happening in individual hospice patient cases that i'm involved with.

thanks for a well presented explanation. i can't help thinking however that if there were a mandatory service requirement (as in switzerland or israel) or even a draft, it would be less expensive (in dollars) not to mention more equitable and allow for greater flexibilty . (it would be a political disaster, however) pensions ,benefits and perks could be lessened since there wouldn't need to be enticements for service. a sizable minority of those who wouldn't otherwise volunteer would get out as soon as possible. the argument can then be made that paying the contractors pays for the safe keeping of the economically advantaged. i would further argue that outsourcing IT for private companies profit and outsourcing warriors meant to ensure the military interests of a nation are two very different things.

i'm not writing a thesis or professional correspondence. it seems people can discern my meaning ,so what difference does it make if i don't hit the caps or apostrophe key? grammar issue or not, it's not cool to be a pompous ass.

that's good. i admire his writing and like to think i'm as good at my job as he is at his- plus, the Little Willies tape he recommended is really good...might suit you well. i am shocked though.

try not being a pompous ass

it absolutely will lead to rationing...just not economic rationing that we have now

ah...that's where fee for service has failed. despite good intentioned docs, the temptation is sometimes too great especially if the pt wants to keep going or the family wants it. the more you do. the more you make. its also the reason why 50 million CT scans were done last year on 330 mil americans (that and malpractice worries). the implication for tiered medicine is lack of access for the middle class and below. we are already seeing concierge practices where pts pay retainers of several thousand dollars for better access to their md. insurance of any kind is generally not accepted and pt panel are severely limited. docs make substantially more money for less work. given the shortage of primary care docs and 30 million more pts who want access in 2014, this will likely become a huge problem soon.

ever heard of howard dean?

the public and the profession would demand that doctors dominate the "panels". a patient's own family doctor would almost certainly be intimately involved. medicine is about as close to a meritocracy as you'll find in the US. 90%+ of successful med school applicants are in the top 10% academically and even some of these wash out during the rigors of training. reputation is mostly based on performance and i doubt poor performers would be asked to sit on such a panel. therefore, i feel your fears of incompetents running the show are unfounded.

c'mon. nobody? how bout if he is refused but agrees to pay cash for the heroic measures? i think i can guess your answers but what about the implications?

here's a hypothetical to test your committment to this issue: ralph wilson has demetia (in actuality at age 90 the odds are 1:1), pneumonia, renal failure and congestive heart failure. all are reponding poorly to conservative treatment. do you want medicare to pay for heroic measure if he says he wants them (and you know he does)?

Dr. Byock at Dartmouth is a brave and articulate spokesman. his position is not all that popular and that's why it's unlikely the politicians will pick up the banner.

recent legislation that passed with broad support allows hospice patients to enroll but still choose aggressive intervention while in hospice. this.i believe, is a backwards step.

it's a banner day. i wholeheartedly agree. the culprits in many instances are estranged family members who show up at the end feeling guilty and want "everything done for mom" because of their own negligence. there are statistical tools available that can give quite accurate and precise odds on a patient with multi system organ failure leaving the hospital. less than 1% seem a reasonable cut off (heck, .1% would be a start) but many people, especially the elderly would disagree. and then there would be the religious arguments making those surrounding persistent vegetative states look simple...

thanks. i guess we can agree occasionally!

private insurance is not considered a solution by many liberals. it has not controlled costs or provided for cost effective care and never will as long as there is fee for service. do more, make more doesn't work in health care. thus single payer with outcomes based reimbursement is the favored model of many progressives and we have taken the first step towards that. why would we add to the problem by starting a new insurance company? the pharmaceutical question is very different. the problems have largely been mitigated by the availability of $4 generics at wal mart and now everywhere.. if we could legislate against convincing people that they need brand name drugs (with no greater efficacy) through direct to consumer drug advertising and let medical professionals decide what drugs are appropriate, we'd make real progress. even without that, there's no reason or need to start a liberal pharma movement.

this drug was targeted at premenopausal women as much as postmenopausal just as viagra is used recreationally (pprobably for placebo effects) by millions of men without erectile dysfunction. if you don't understand this then you won't "get" her piece.

you might want to tell that to the 10's of millions who took male viagra, cialis and levitra last year (and their manufacturers). you seem not to grasp the subtle anatomic and physiologic differences between the sexes. paglia just mentioned androgyny to make a point, she wasn't being literal.