The PPACA Thread Part III - Let's have a healthy debate!

[DrDemento]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Your dad is a very very very smart man. Wish mine was the same.

Scooby: I was just too young to appreciate much of what he used to say. He also advised me(jokingly) to never get married and never have children. he said doing that means you can take your last dime and put it into the pay phone to call the undertaker. He was one of those super intelligent guy who was well read (3-4 newspapers per day) but the family did not have the money for any sort of college education having him and his 4 bothers. With all my education, I never beat him at Scrabble, never answered more questions correctly on Jeopardy, and he could finish the NY Times Sunday Crossword puzzle in pen within 45 minutes.
I do not think he was all that unusual though. I think that generation (he was born 1914) just was very special in ways that we do not approach.

 

[FlagDUDE08]

Re: The PPACA Thread Part III - Let's have a healthy debate!

One of the sillier tropes in this country today is the hyperventilating and posturing over where the average person went to college. I work with a couple of software developers who attended two years of community college, and they write code that is just as good, or better than the work of some people with a 4-year CS/CpE degree from a flashy 'brand name' school. In fact, I find they are far more practical and receptive to the realities of writing industrial-strength code than the folks who were steeped in 4-5 years of academic theory.

Meanwhile, you get some schools where the students are getting worthless majors that they can't use, end up partying for four years, and get stuck with huge bills they complain about not being able to pay.

 

[joecct]

The total package is marrying a rich girl who can cook. Anything else you can get elsewhere (best advice i ever got from my dad).

The Maine mantra is to marry a nymphomaniac whose father owns a liquor store.

 

[Rover]

Re: The PPACA Thread Part III - Let's have a healthy debate!

but you cannot merely dismiss it out of hand simply because it doesn't conform to what you want to believe is true.

That knock on your door is from the Irony Police. You're about to be charged with Felony Hypocricy!

 

[Rover]

Re: The PPACA Thread Part III - Let's have a healthy debate!

cont'd

PPACA has some good parts do it, and it has some awful parts to it. One cannot really speak about it as a monolithic entity, you really need to parse out what's good from what is terrible.

The concept of insurance exchanges is promising, if you really allowed for unfettered innovation. The lack of variety and the overload of mandates makes the execution of the concept really bad.

The concept of combining a prohibition against pre-existing conditions with open enrollment windows can work well. The way PPACA implemented that concept was totally bass-ackwards.

etc.

The promoters of the law limit their praises to its objectives, the opponents limit their objections to its consequences. How can anyone have a meaningful conversation that way?

And when you point out something reasonable and not what you heard on the Glen Beck show we can have that conversation. Or you guys can remain a laughingstock. Either way works for me.

 

[Kepler]

Re: The PPACA Thread Part III - Let's have a healthy debate!

PPACA has some good parts do it, and it has some awful parts to it.

Slowly they turn, step by step, inch by inch.

The conservative evolution on every social advance:

Year 01: It's laughable!

Year 21: It's evil!

Year 41: It's too soon!

Year 81: It was our idea.

 

[FlagDUDE08]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Slowly they turn, step by step, inch by inch.

The conservative evolution on every social advance:

Year 01: It's laughable!

Year 21: It's evil!

Year 41: It's too soon!

Year 81: It was our idea.

You mean like the Bin Laden thing, you push and push for us to get out, never take the action, but all of a sudden when you get power, you want to do it so you can get the credit? The other side is no different.

 

[FreshFish]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Scooby: I was just too young to appreciate much of what [my father] used to say.

You and Mark Twain!

paraphrase:

"When I was 16, my father was an ignorant dunce. By the time I was 21, I was amazed at how much the old man had learned in five years."

 

[WisconsinWildcard]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Bad medicine is worse than no medicine. I also strongly believe that the most important phrase in medicine is the phrase " I don't know."

Two sentences to live by.

 

[WisconsinWildcard]

Re: The PPACA Thread Part III - Let's have a healthy debate!

My real reason for asking for a citation was because I have heard that said by physicians that they would "leave medicine" but I have not seen the data to back that up.

I think the argument can be made that small private practice is all but dead. As others have said, the trend is for much larger practices or hospital groups as they are much easier to handle the bureaucracy and take the load off of the physicians. However, I do not think I have seen anything that convinced me that more people have left practicing medicine that otherwise would have. Instead, I think the case can be made that most adapted the way they practice in some way (which is really required throughout a career).

I find it very interesting talking to different generations of physicians. Every generation has had to adapt in some way and I am pretty confident they all had their gripes about the "paucity" of the new physicians education. Some of the older generation absolutely hate electronic medical records but I cannot fathom working efficiently without them. I have worked on paper and although it has its merits (brevity is encouraged), I am not sure I could manage a patient's care as well as with the EMR.

My generation will not know to run their own blood work like residents of generations past. We can use our time doing other things in the morning/seeing more patients but I try to keep the thought of me running my own blood work to make me contemplate if a test is truly necessary.

 

[FreshFish]

Re: The PPACA Thread Part III - Let's have a healthy debate!

My generation will not know to run their own blood work like residents of generations past. We can use our time doing other things in the morning/seeing more patients but I try to keep the thought of me running my own blood work to make me contemplate if a test is truly necessary.

One of the most offensive things Obama has said about the practice of medicine is that he thinks doctors order additional unnecessary tests in order to pad their bottom line. Either he does not understand how that process works, or he is tacitly accusing doctors of taking kickbacks.

 

[Kepler]

Re: The PPACA Thread Part III - Let's have a healthy debate!

You mean like the Bin Laden thing, you push and push for us to get out, never take the action, but all of a sudden when you get power, you want to do it so you can get the credit? The other side is no different.

As in the other thread, your "pox on both houses" mask is slipping. However I can honestly say you've lost me with this post. The most I can get out of it is it appears to be a grammatically correct English sentence.

 

[Kepler]

Re: The PPACA Thread Part III - Let's have a healthy debate!

One of the most offensive things Obama has said about the practice of medicine is that he thinks doctors order additional unnecessary tests in order to pad their bottom line. Either he does not understand how that process works, or he is tacitly accusing doctors of taking kickbacks.

Source?

 

[unofan]

One of the most offensive things Obama has said about the practice of medicine is that he thinks doctors order additional unnecessary tests in order to pad their bottom line. Either he does not understand how that process works, or he is tacitly accusing doctors of taking kickbacks.

Some clearly do, just as some lawyers do extra work just to pad their fees, mechanics push for unnecessary repairs to pad their fees, etc.

Any profession who is paid by service rather than outcome will have some members of the profession who scam the system.

Or are you saying there is absolutely no health care fraud going on?

 

[FlagDUDE08]

Re: The PPACA Thread Part III - Let's have a healthy debate!

My real reason for asking for a citation was because I have heard that said by physicians that they would "leave medicine" but I have not seen the data to back that up.

I think the argument can be made that small private practice is all but dead. As others have said, the trend is for much larger practices or hospital groups as they are much easier to handle the bureaucracy and take the load off of the physicians. However, I do not think I have seen anything that convinced me that more people have left practicing medicine that otherwise would have. Instead, I think the case can be made that most adapted the way they practice in some way (which is really required throughout a career).

I find it very interesting talking to different generations of physicians. Every generation has had to adapt in some way and I am pretty confident they all had their gripes about the "paucity" of the new physicians education. Some of the older generation absolutely hate electronic medical records but I cannot fathom working efficiently without them. I have worked on paper and although it has its merits (brevity is encouraged), I am not sure I could manage a patient's care as well as with the EMR.

My generation will not know to run their own blood work like residents of generations past. We can use our time doing other things in the morning/seeing more patients but I try to keep the thought of me running my own blood work to make me contemplate if a test is truly necessary.

For some people, they would rather the small practice over practicing at all. Big fish in a small pond, support small, not be a slave to the man, whatever you want to call it, it's the same concept. There are still family doctors out there (accepting a crate of tomatoes, a duck, and so on), but the sue happy generation ruins that, as it just takes one grumpy city slicker to bankrupt that doctor.

Sadly, everything's getting consolidated these days, and the PPACA itself is no exception, as people were too lazy to shop around for what they want, or to go to it if it isn't available in their area, so they get mommy and daddy government to force a one-size-fits-most system on the entire country with no alternative. Take a look at legal immigrants; they're setting a prime example of what a citizen base should be doing. Their former country doesn't give them what they want, so they head to greener pastures to get what they want, and accept all of the side effects that come with the territory.

 

[DrDemento]

Re: The PPACA Thread Part III - Let's have a healthy debate!

My real reason for asking for a citation was because I have heard that said by physicians that they would "leave medicine" but I have not seen the data to back that up.

I think the argument can be made that small private practice is all but dead. As others have said, the trend is for much larger practices or hospital groups as they are much easier to handle the bureaucracy and take the load off of the physicians. However, I do not think I have seen anything that convinced me that more people have left practicing medicine that otherwise would have. Instead, I think the case can be made that most adapted the way they practice in some way (which is really required throughout a career).

I find it very interesting talking to different generations of physicians. Every generation has had to adapt in some way and I am pretty confident they all had their gripes about the "paucity" of the new physicians education. Some of the older generation absolutely hate electronic medical records but I cannot fathom working efficiently without them. I have worked on paper and although it has its merits (brevity is encouraged), I am not sure I could manage a patient's care as well as with the EMR.

My generation will not know to run their own blood work like residents of generations past. We can use our time doing other things in the morning/seeing more patients but I try to keep the thought of me running my own blood work to make me contemplate if a test is truly necessary.

Nicely stated. I tend to believe that the reason physicians do not leave the practice of medicine, or often even retire at an advancing age, is simply that most of us do not know how to do anything else. My medical education was so skewed towards just learning medicine. We had zero business training, zero training in dealing with insurance and zero training in dealing with the government. Granted that was a long time ago, but physicians from my era really knew little else than medicine. I have had to self teach myself anything else necessary to survive in this world. My investment and accountant friends have told me very often that doctors are the worst businessmen and the least knowledgeable investors they see.(yet most of them would never admit it since it is very hard for most doctors to ever admit they do not know anything)
I have not seen many leave the field(but I must admit some have left earlier than one would have expected) but I have seen many alter how they practice.

 

[DrDemento]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Some clearly do, just as some lawyers do extra work just to pad their fees, mechanics push for unnecessary repairs to pad their fees, etc.

Any profession who is paid by service rather than outcome will have some members of the profession who scam the system.

Or are you saying there is absolutely no health care fraud going on?

Agree 100%. I also wonder how much disability fraud there is going on by regular folks who receive stipends often for life when they could be actually quite physically and mentally productive?

 

[FlagDUDE08]

Re: The PPACA Thread Part III - Let's have a healthy debate!

One of the most offensive things Obama has said about the practice of medicine is that he thinks doctors order additional unnecessary tests in order to pad their bottom line. Either he does not understand how that process works, or he is tacitly accusing doctors of taking kickbacks.

For some, this is the case, especially if they receive a government subsidy, and try to use it up in order to make sure they get the same amount in the next year. However, many of the tests are not necessarily relevant, but used as protection against a lawsuit. For example, when a woman goes in, they'll almost immediately give her a pregnancy test.

 

[ScoobyDoo]

Re: The PPACA Thread Part III - Let's have a healthy debate!

For some, this is the case, especially if they receive a government subsidy, and try to use it up in order to make sure they get the same amount in the next year. However, many of the tests are not necessarily relevant, but used as protection against a lawsuit. For example, when a woman goes in, they'll almost immediately give her a pregnancy test.

The answer to that question is why if there is such of volume of tests the costs of the test never go down. Testing should be a good thing and it should be encouraged. We need to get to the point where the costs of testing is minimal.

 

[FlagDUDE08]

Re: The PPACA Thread Part III - Let's have a healthy debate!

The answer to that question is why if there is such of volume of tests the costs of the test never go down. Testing should be a good thing and it should be encouraged. We need to get to the point where the costs of testing is minimal.

Is the demand for the test changing, or is the demand elasticity for the test changing? If the idea for the suppliers of the test is to maximize revenue, and the demand elasticity diminishes (i.e. making the product so essential that you have a low chance of being able to function without it, similar to gasoline), there is no incentive to lower your price point in order to get more "customers", because you will get them anyway.