REPUBLICANS: Please vote for John McCain.

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mhosea
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Post by mhosea »

Bill Glasheen wrote:Where have you been, Mike? The announcement before the announcement before the announcement has been all over the news! :lol: :lol:
Under a rock, apparently. I'm news fasting. Cheaper than xanax. ;)
Mike
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f.Channell
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Post by f.Channell »

Mike,

I'm not running. It's just a rumor. The countries just not ready for mandatory universal Uechi lessons. 8)

Bill, The doctor I know drives a Subaru Forester. An excellent ER doctor.

The healthcare insurance exec I know has a Harley, a 57 Chevy, a giant gas guzling Suburban, And a big gas guzzling pickup. His house is also twice the size of the doctors, so you tell me?
I figure the pickup is to transport all of the money we overpay in healthcare to the bank. Why else would he need one?

F.
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Bill Glasheen
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Post by Bill Glasheen »

Here is salary information for Emergency Medicine, as reported on studentdoc.com

EMERGENCY MEDICINE

Lowest Reported Salary: $160,000
Average Salary: $197,000
Highest Reported Salary: $250,000


If you want the big bucks, you can try...

Neurosurgery

Lowest Reported Salary: $279,650
Average Salary: $438,426
Highest Reported Salary: $713,961

Not too shabby! 8)


Here are median salaries found in health insurance companies around the country.

Image

Physician salaries at health insurance companies average quite a bit higher. Their median salary in that setting is $144,000 (less than what they get in practice). So they're pulling the average and median salaries up a bit in the insurance venue.

'Nuff said.

- Bill
IJ
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Post by IJ »

"Americans are cheap bastards when it comes to their health care. They'll think nothing of dropping half a million for a home and stretch the paments out over 30 years or get interest only loans. But ask them to pay a couple hundred dollar copay for their specialist visit and they go nuts. That's what happens when a 3rd party pays for health care. People are friggin ungrateful. ...One of the biggest reasons for health care inflation in this country is that our ability to cure is growing faster than our GDP"

Sorta. I pay a heck of a lot more than my copay for my health insurance. Perhaps its overall frustration with the system that boils over where things are more tangible... perhaps they can't figure out why talking to someone 15 minutes can run you a few hundred bucks. But more importantly, I think the (accurate) point that your health is worth spending a lot of dough on obscures the tremendous waste that goes on in medicine. At the hospital improvement course I'm taking over 4 months in Salt Lake City, I've learned that your average modern business can't compete with more than 1-2% waste; intermountain healthcare, an influential group in Utah, found many of their processes ran a (fairly common in healthcare) ~25% waste. As examples, they had ~80 variations on treating pneumonia when national guidelines recommended using one of two. They had 4 fold variation in prostate surgery length of stay and operating room times with use of inpatient cystograms varying from 0-100%. They had (usual) lengthy ER wait times and tremendous shift to shift, doctor to doctor, and even intra-doctor variation on ventilator weaning, which ought to be protocol driven and standardized, and a dozen other problems.

They've since become one of the most data driven healthcare organizations in the country, and they analyze their processes carefully, identify faults, standardize things using toyota methods and run continous quality improvement cycles--plan a change, do it, study the effects, and decide on keeping it or not.

One of the more impressive results aside from the multiple millions of dollars they've saved is that Utah healthcare expenditures rose at the rate of general inflation only recently, far below the exponential rising costs of healthcare across the nation.

It's not just that our new drugs (oh, epogen, for example, to raise blood counts without transfusions, or outpatient tuneups with nesiritide for healthfailure) are really expensive--it's that the epogen was being overused to the extent it was causing worse outcomes, and the nesiritide infusions were a drug company dream unsupported by data, while the actual data suggested nesiritide might increase renal failure and death. People have a right to expect more from their healthcare dollars. I'm becoming more and more convinced, and I'm reasonably sure Bill will back me up on this, that the primary reasons are the lack of free market forces (ie, the spending of O.P.M.) and the cowboy (or more nicely put, the craftsman) culture of medicine, where everyone thinks their seat of the pants care, medicine a la Jack Bauer, is optimal and their professional "right."

Maybe they'd be willing to spend lexus dollars to get a lexus, but they aren't willing to pay for a lexus and get an escort, that's all I'm saying....
--Ian
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Bill Glasheen
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Post by Bill Glasheen »

To some extent, you're preaching to the choir, Ian. My profession is all about helping health care professionals make data-driven decisions. It's about both efficiency and complying to known evidence-based guidelines.

And Intermountain Healthcare has been a bit of a star in this realm for over a decade. They tend to be on the leading edge in many interesting managed care issues.

There are caveats, however.
Ian wrote:
They've since become one of the most data driven healthcare organizations in the country, and they analyze their processes carefully, identify faults, standardize things using toyota methods and run continous quality improvement cycles--plan a change, do it, study the effects, and decide on keeping it or not.

One of the more impressive results aside from the multiple millions of dollars they've saved is that Utah healthcare expenditures rose at the rate of general inflation only recently, far below the exponential rising costs of healthcare across the nation.
What you are implying isn't quite the case.

There ARE myriad inefficiencies in the health care system, and there is money to be saved. There are improvements which can be made which also can improve health care outcomes.

However...

If there's one thing that the managed care revolution has shown, it's that it hasn't yet reigned in the underlying drivers of health care inflation. Over a dozen years ago, a physician executive I worked with shared a thought with me which has proven to be true again and again. Process improvements can create discontinuities in the health care cost trends. But once the system settles again, the same rate of cost increase lingers.

Our population is aging. Medicine is getting better at keeping older people healthy for a lot longer. These treatments cost. Then these individuals hit another (different) morbidity wall at a later age, and the end-of-life cost spending resumes.

One rather amusing study shows how letting people smoke actually saves the government quite a bit of money because they die earlier and cost social security and Medicare much less. Go figure...

There also is rising consumerism driven partially by direct-to-consumer advertising, partly by the information age, and partly by regional oversupplies in certain health care specialties.

And then there's the fragmentation of our system which is both its best and its worst characteristic. In the interest of competition, the left hand sometimes doesn't know what the right hand is doing.

Any politician who tells you they have a simple solution to our problems is feeding you the typical politician BS. This is a growing, evolving problem which will morph into many bite-size efforts and myriad battles. Unless there's a bit of a Manhattan Project on health care, we'll see these issues linger for years.

Even in the best of circumstances, there will be some dissatisfaction with the solutions.

- Bill
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Post by IJ »

I think the temporary stabilization in costs you're referring to is the plateau that HMO's created, and then lost the gains on, because people decided they hated gatekeepers and everything less than the full court press, and rebelled. I'm not referring to any IHC efforts to revisit that strategy, but rather to improve the care that was delivered. When they ramped up their pneumonia protocol, not only did they reduce costs, which was the primary aim, by standardizing things and focusing on what was most important they also reduced the length of stay for the admitted patients--who were sicker because they'd stopped admitting some of the less sick patients! Better care can cost less, aging population or no.

So yeah, people are living longer, they're more complicated, our system is fragmented, etc. We can expect to pay more for better drugs, for example, aspirin is great, and if you switch to plavix in some circumstances you can prevent an event in 1/200 or so people a year that take it. But it costs a lot more. People will have to decide if they want that, and they'll have to feel it more directly than just a copay. Otherwise they'll always want EVERYTHING and the BEST because of the lack of understanding about declining return on investment and too much of a good thing.
--Ian
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NEB
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Post by NEB »

Well, for what its worth, doctors SHOULD make more money than the median salery paid to insurance employees. Not that they should bilk the public, but 60 bones a year doesn't get it done. (My dad is a pediatrician and never saw anyting near $250,000.)

As far as Bill Clinton and the balanced budget is concerned. If you mean to say that the republican congress's responsible handling of public money is what quelled Clinton's wild spending tendencies and led to a balanced budget, that'd be the day. Its more likey the difference of opinions and policy that just stifiled any real "progress".

How come every Republican president leads the country into record deficits?

IMHO, they're all bad, on both sides of the aisle.

nb
"Well, let's get to the rat killing..."
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Bill Glasheen
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Post by Bill Glasheen »

I hear you on the Pediatricians. I could look it up, but... They are one of the lowest paid medical specialties. It is what it is. You do it for the love of kids.
NEB wrote:
As far as Bill Clinton and the balanced budget is concerned. If you mean to say that the republican congress's responsible handling of public money is what quelled Clinton's wild spending tendencies and led to a balanced budget, that'd be the day. Its more likey the difference of opinions and policy that just stifiled any real "progress".

How come every Republican president leads the country into record deficits?
You are sort of getting what my theory is.

Democrats are generally fiscal liberals, and Republicans fiscal conservatives. Liberals have faith in government, and conservatives want to minimize it.

It's generally the case that whatever party gets in the White House, the other party eventually will control Congress. That's historically how it has worked.

What I found to be a fascinating combination is having a "Contract with America" Republican Congress with a Democratic president. We balanced budgets mostly because Congress wouldn't pass any liberal agenda programs, and Clinton vetoed the Republican programs he didn't like. At the end of the day, spending was reigned in.

I will give Clinton credit for undoing some of the Great Society programs which taxed our citizens and destroyed our lower class. If a Republican had done that, he would have been called heartless. A Democrat could do that though without getting tarred and feathered by the usual suspects in the liberal side of the media. (NY Times, Washington Post, LA Times, etc.)

Now... What about a Democratic Congress and a Republican president? It doesn't seem to work too well in terms of keeping a budget in balance. GW doesn't veto much. He's trying not to so he can "unite" rather than "divide" when pursuing his agendas. And so a lot of pork spending is generated in a more liberal Congress, and makes it through the White House. And then there's the wartime economy. As they said about LBJ's time, you can't have guns and butter at the same time. Something has to give.

That's my theory anyhow - in case you're wondering. There are many, many caveats to it. Some argue that Bush HAD to spend a lot on military initiatives and armaments (as did Reagan) because previous Democratic administrations let the military and certain global terrorism issues go south. Etc., etc.

All good subjects to argue about. 8)

- Bill
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Post by Valkenar »

Bill Glasheen wrote: Liberals have faith in government, and conservatives want to minimize it.
There are plenty of us liberals who don't have faith in government. And not just in the specific (of course we don't have faith in *this* administration) but also in the general. Personally, I think that while the government is usually wasteful, it can still be better than the alternatives sometimes.

It's nearly impossible to pin down the cause of a deficit to one or two factors. There's way to much going on to say the democratic president + republic congress = surplus. One thing is for sure though, unilaterally starting idiotic wars is a pretty efficient way to rack up debt in a hurry.

As for the upcoming election, I think it's pretty much hopeless of the democrats. Neither Hillary nor Obama can really win and it doesn't seem likely for anyone else to win the primaries. Honestly after the last election I find it impossible to have the slightest faith in the American voter.
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Post by benzocaine »

As for the upcoming election, I think it's pretty much hopeless of the democrats. Neither Hillary nor Obama can really win and it doesn't seem likely for anyone else to win the primaries. Honestly after the last election I find it impossible to have the slightest faith in the American voter.
On the bright side, we won't have someone trying to ban personal firearms, usher in universal healthcare, or pull us out of Iraq too quickly.

As much as it sucksforair we are stuck with Iraq for a while, otherwise we will lose all credability in the world arena :(
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mhosea
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Post by mhosea »

NEB wrote: How come every Republican president leads the country into record deficits?
My knowledge of American presidental and congressional history is not that detailed, but in this case I think there are three main factors.

1. The surplus at the end of Clinton's tenure was going to evaporate no matter what, tax cut or no tax cut. Anybody who was paying attention to the economic signals knew that the Y2K buildup and dotcom boom was over. I found the discussion of what to do with the surplus amusing at best.

2. The war in Iraq gives new meaning to Sagan's signature phrase "Billions and billions".

3. President wanted to be a "uniter", and so refused to use his veto power. Actually, I think Bush never intended to be a fiscal conservative. Everybody just assumed. The matter was unclear in Texas, perhaps because of the relative weakness of the Texas governorship and because he presided over a relatively affluent time (as did Clinton). His idea of conservatism didn't include small government, apparently, although it did include lower taxes. Some would say that this a recipe for a deficit, but I have little patience for applying 3rd-grade math to a system as complex as the US economy. Suffice it to say that Bush is very much an "a la carte" conservative. If you are a fiscal conservative and a social liberal, he's not really your man.

I think congress also suffered somewhat from this phenomenon of trying to come across as "compassionate conservatives" as if this would raise their approval ratings with liberals and solidify their power.
Mike
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Bill Glasheen
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Post by Bill Glasheen »

I find truth in many of the comments above.

There is however one comment worth bringing out.
Valkenar wrote:
I find it impossible to have the slightest faith in the American voter.
This comment says more to me about the person who made it than it does about the American voter.

The more you travel, the more you "get" how diverse the beliefs are in this country. Additionally one learns how what works in Mytown may be either irrelevant or even problematic in Yourtown.

We have a very powerful East Coast and urban/suburban bias in most media outlets. It's as if whole sections of the country don't exist at all. It's no wonder that both politicians and media wonks can get a distorted view of what matters and what works from place to place.

- Bill
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Post by Valkenar »

Bill Glasheen wrote: The more you travel, the more you "get" how diverse the beliefs are in this country. Additionally one learns how what works in Mytown may be either irrelevant or even problematic in Yourtown.
I get it more than you think.

This isn't a question of what works vs what doesn't work. English as an official language can work here and not there. So could strict emissions standards, healthcare, gun control, welfare, tax rates, and a million other policy issues. Despite what you may think I'm very happy to accept people voting for things that I don't approve of. But within reason.

Immoral, unjustified war? Sorry, unacceptable. A shocking number of people *still* are swallowing the party line and somehow believe that Sadaam was responsible for 9/11. A shocking number of people just swallow and regurgitate every lie about that whole situation because deep down they like it when America goes to war and shows the world how tough it is. Not much I can do but shake my head.

Government-sponsored discrimination? Sorry, that's just hideously unethical. Don't ask don't tell is utter bs. It's like having a don't ask don't tell policy for Judaism. Constitutional amendment against gay marriage? Awesome, let's just write "God hates gays" into the constitution. That's what this is really about, isn't it? I'm sorry but bigotry doesn't "work" anywhere.

There's plenty of other stuff to dislike Bush in particular about, like the fact that he pretty much exclusively appointed foxes to guard the hen-houses. But if you don't care about hen-houses like environmental agencies and such than I can at least understand not caring, though it's still a pretty sleazy approach to back-door undercutting those programs.

Really, I just never realized how small-minded, intolerant and gullible people are. I mean, certainly I knew that *some* people are, but I honestly never expected that there were enough of them to re-elect such an absolutely terrible president. The first time was bad, but at least people had the excuse that they were surprised.
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mhosea
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Post by mhosea »

Valkenar wrote:but I honestly never expected that there were enough of them to re-elect such an absolutely terrible president. The first time was bad, but at least people had the excuse that they were surprised.
It never occurs to you that Gore or Kerry could have been worse and that many Americans could have been choosing between the perceived, if not actual, lesser of two evils?
Mike
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Post by Bill Glasheen »

I voted for Gore because I was voting for gridlock. I liked the fact that we had the dynamic tension between these two branches of government.

I most definitely did not vote for Gore per se. I'm not a Clinton fan either, but voted for him because he's a smart man and he made for wonderful material for the late night comedians. 8) Anyhow... Comparatively speaking, Gore's an intellectual lightweight. He can be thankful that his SNL appearance made us all forget what a terrible candidate he was.

I have very little respect for Kerry as well. But I might have voted for him (just for a change) until he chose Edwards as a VP. Edwards didn't even win his own state, Justin. And he didn't win the state of his birth as well. That's almost unheard of. What does that tell you? Who would know him better?
Valkenar wrote:
I just never realized how small-minded, intolerant and gullible people are.
I refrained the first time, Justin. But second time? We think a lot of our center of the universe, don't we?

(I'm being gentle, Justin. ;))

- Bill
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