No Death Panels, Eh?
Moderator: Jesus H Christ
Re: No Death Panels, Eh?
conditions that should be treated holistically and/or homeopathically
conditions that should be treated by shamans and witch doctors
FTFY (you're welcome)
conditions that should be treated by shamans and witch doctors
FTFY (you're welcome)
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"Blessed be the Lord my strength, which teaches my hands to the war, and my fingers to fight."
Re: No Death Panels, Eh?
Someone call me? Wadda ya got? Gout? Diabetes? High blood pressure? Are ya just fat? No problem...let's see yer insurance...what?


Before God was, I am
- Felix
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Re: No Death Panels, Eh?
exactly when did you lose your humanity for your fellow man bud? Nice "christian" attitude you've got there....Tom In VA wrote:Same old boring, junior high bullshit I see.Felix wrote:because their masters have told them
Hey, people who can't afford for themselves a lifestyle that is conducive to healthy living and access to healthy resources should be right up your alley. Darwin, remember ?
The strong survive, the weak struggle, and the weakest perish. That's the way it goes. What are you going religious on us all of a sudden ? And to top that off, the worst possible kind of religious. I knew you would come around some day, but don't come around too much dude. It's still wrong to foist your notions of morals upon those that hold different morals than you. Remember those days, when you despised that ? I do.
of course, the fact that you've butchered what the term "survival of the fittest" means is no great surprise, because you don't know shit about that what you rail so adamantly against.....survival of the fittest doesn't mean the biggest and the baddest survive, it means those that are best adapted to their enviornment survive....a perfect example of working in unison is a pack of wolves.....singularly, no wolf could kill an elk, but when they work in unision, they can and do kill them all the time...a "lone wolf", (e.g. one that doesn't have pack support) doesn't last very long in the wild.....
"the strong survive and weak perish"? wow, I know I've seen that kind of philosophy somewhere, I just can't quite put my finger on where.....
get out, get out while there's still time
Re: No Death Panels, Eh?
Oh the irony. You simply will not accept any argument in opposition to your preferences. The source(s) of that opposition, in your mind, are never legitimate. Yet, here you are presenting the very same bad faith you accuse opponents of Obamacare of displaying. Nice work KYOA, dopey.Felix wrote:see, this is about as disingenuous as it gets......Reps aren't against national healthcare because they're afraid of a few illegals getting through the system, they don't want it because their masters have told them to fight the public option at all costs
BTW - they are legitimate arguments against the public option which is why Obama is going to abandon it.
I don't have a problem with health insurance companies earning profits. Their profit ain't the problem with health care in the US.sure, they'd support a system whereby the government was to subsidize health care costs for low income people, because of course, that would raise the profits of the health care companies to obscene levels....you think they make boatloads of cash right now, just wait.....
And irony has no bounds. First you accuse Republicans of fearmongering and scaring the shit out of people and then turn right around and try to tell us there's a crisis that needs addressin. Seriously, how fucking dumb are you?you know, the Reps who are now screaming that they've got a better plan had 6 years to enact health care legislation back when Bush was president, but they sat with their thumbs stuck up their asses, pretending that there was no crisis....seriously, if you don't think that 70 percent of the personal bankruptcies in this country are attributable to health care related issues is a crisis, then there's simply no reasoning with you
Where do you get this 70% number? No matter, though, since the bankruptcy figure is totally irrelevant to the question of fundamentally altering the health care system. It's like arguing that we need to fundamentally change the health care system because less than 5% of the population is chronically uninsured. Address the problem rather than attempting to Euro-nize our health care system and ration care based on Obama's preferences.
Oh, rationing...can't happen, right?
Yeah, lets go the way of Britain and wait for people to go blind before providing them with effective drugs that prevent blindness.Patients with terminal illnesses are being made to die prematurely under an NHS scheme to help end their lives, leading doctors warn today.
In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.
Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.
Because nationalizing health care never leads to rationing, never leads to unelected and unaccountable bureaucrats determining what citizens may be treated or not treated for.
Morons.
I wonder how LTS square his assertion that Britain provides "full coverage" to all citizens with the fact that the NHS rations care like this? Oh? Stephen Hawking says he was saved by the NHS? God for him. Too bad for the pensioners that must go blind in one eye and then start going blind in the other eye before receiving treatment that could have prveneted the blindness in the first place.
How do people like Felix, LTS, and Obama continue to peddle this crap?
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Re: No Death Panels, Eh?
here's a clue asshat, it doesn't matter how many concessions the Democrats make, the Reps will NEVER sign on to any kind of healthcare reform....you could put a statement in there that anybody giving an illegal alien health services would be banished to Siberia, and the Reps would come back with some other reason as to why they won't support it....they have no interest in Obama reforming health careJMak wrote:
Oh the irony. You simply will not accept any argument in opposition to your preferences. The source(s) of that opposition, in your mind, are never legitimate. Yet, here you are presenting the very same bad faith you accuse opponents of Obamacare of displaying. Nice work KYOA, dopey.
he hasn't abandoned it you imbecile...you've been reading and/or watching the wrong information....lets see what he has to say when congress gets back from their recessBTW - they are legitimate arguments against the public option which is why Obama is going to abandon it.
I don't have a problem with health insurance companies earning profits. Their profit ain't the problem with health care in the US.
You're a fucking idiot....there profits have increased an average of 486% between the years 2000 to 2008...I have no problem with companies making a profit, but this kind of profit margin borders on robbery.....
um, this idiotic "non-response" makes no sense.....the republicans are fearmongering....Palin and her death panels remark has been echoed by every far right Rep in the land....if this isn't fear mongering, then what exactly what would you call it.....and if you don't think that spending 20% of every dollar in this country on something related to health care is a crisis, you're an even bigger idiot than I thought.....And irony has no bounds. First you accuse Republicans of fearmongering and scaring the shit out of people and then turn right around and try to tell us there's a crisis that needs addressin. Seriously, how fucking dumb are you?
I posted the link dumbshit, take a look a few posts up and you'll see itWhere do you get this 70% number?
No matter, though, since the bankruptcy figure is totally irrelevant to the question of fundamentally altering the health care system.
So let me see if I can follow your logic here....in 2007, 68% of all of the bankruptcies in this country were related to some type of health care related issue, and you say it doesn't matter....who do you think is picking up the tab for those write-offs the creditors are on the hook for....you and me dude, in the form of higher prices, higher premiums
Seriously, as much as I'd love for you to experience it first hand, I hope that you never suffer any type of catastrophic illness in your family....you'll see (like I have first hand) just how quickly medical bills can evaporate everything your parents and grandparents have worked to acheive.....ever seen what the costs for treating someone with brain cancer for two years?
I have....I fucking hope beyond all hope you never do......
get out, get out while there's still time
Re: No Death Panels, Eh?
Riight, once again, demonstrating that you possess as much bad faith as you allege the Republicans are exercising. I like how you take criticism of Obamacare as a broad resistance/opposition to health care reform generally. But that's the life of an intellectual dishonest douche like you, Felix.Felix wrote:here's a clue asshat, it doesn't matter how many concessions the Democrats make, the Reps will NEVER sign on to any kind of healthcare reform....you could put a statement in there that anybody giving an illegal alien health services would be banished to Siberia, and the Reps would come back with some other reason as to why they won't support it....they have no interest in Obama reforming health care
Yeah, lets see. Besides, I didn't say he had abandoned it. I speculated that he is going to abandon it.he hasn't abandoned it you imbecile...you've been reading and/or watching the wrong information....lets see what he has to say when congress gets back from their recess
It's really none of your business. Nonetheless, you were probably opposed to the government returning tax payments to actual taxpayers when the government was collecting excessive tax revenue, right?You're a fucking idiot....there profits have increased an average of 486% between the years 2000 to 2008...I have no problem with companies making a profit, but this kind of profit margin borders on robbery....

The Republicans are the ones fearmongering, yet here you are pitching this major crisis that should have been addressed over the last several years...but it's the Republicans who are fearmongering, right? LMAO!um, this idiotic "non-response" makes no sense.....the republicans are fearmongering....Palin and her death panels remark has been echoed by every far right Rep in the land....if this isn't fear mongering, then what exactly what would you call it.....and if you don't think that spending 20% of every dollar in this country on something related to health care is a crisis, you're an even bigger idiot than I thought.....
And, no, Palin's death panel comments have not been echoed by every Republican. In fact, the editors of such far-right publications as National Review and The Weekly Standard criticized Palin for those remarks.
I don't see a link, I see you citing a 62% number and acknowledging that was a 2007 number and speculating that it's higher in 2008. But no link.I posted the link dumbshit, take a look a few posts up and you'll see it
Man, you could fuck up a peanut butter and jelly sandwich, you know that?So let me see if I can follow your logic here....in 2007, 68% of all of the bankruptcies in this country were related to some type of health care related issue, and you say it doesn't matter....who do you think is picking up the tab for those write-offs the creditors are on the hook for....you and me dude, in the form of higher prices, higher premiums
I said that such bankrupticies are not a relevant issue in this debate to fundamentally restructure the nation's health care system. The problem with the health care system aint that people are going bankrupt from medical bills. And, in any case, what is being proposed doesn't address that issue at all.
I don't see how that justifies taxing me beause I have a good benefit plan or nationalizing the health care system or pilings trillions more in additional debt. Those individual circumstances are just that - individual. Address the problem, Felix. These reform proposals don't address the problem(s).Seriously, as much as I'd love for you to experience it first hand, I hope that you never suffer any type of catastrophic illness in your family....you'll see (like I have first hand) just how quickly medical bills can evaporate everything your parents and grandparents have worked to acheive.....ever seen what the costs for treating someone with brain cancer for two years?
Re: No Death Panels, Eh?
There is no single "the" problem. And if you don't think that this is a problem then you've really got your head up your ass.JMak wrote: The problem with the health care system aint that people are going bankrupt from medical bills.
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Re: No Death Panels, Eh?
JMak wrote: I don't see how that justifies taxing me beause I have a good benefit plan or nationalizing the health care system or pilings trillions more in additional debt. Those individual circumstances are just that - individual. Address the problem, Felix. These reform proposals don't address the problem(s).
seriously, you THINK you have a good plan (as did my mother) but when it came right down to it, it wasn't nearly as comprehensive as you might think....that's the problem, you're being deceived into thinking everything is hunky dory until such time that it comes time to pay the piper and you find out that what you thought you had really isn't what you actually have.....
my mother at one time was taking a monthly chemotherapy shot that cost almost a $1,000 a pop, and you know how much her United Health Care insurance paid for it? Fucking zippity do dah.....and of course, it wasn't covered under Medicare......so, while a specific instance, it's not isolated-not by a long fucking shot......hence, the vast numbers of personal bankruptcies attributable to healthcare related issues...
but seriously, if you think our health care system is fine and you have no problem with companies averaging a 49%/annum increase in their profits, then that's okay by me....
get out, get out while there's still time
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Re: No Death Panels, Eh?
here's your "reasonable and responsible" dialogue
http://crooksandliars.com/logan-murphy/ ... -down-whee
wow, townhallers shouting down a wheelchair bound women suffering from autoimmune diseases as it being 'her fault"
yep, if that isn't the definition of "reasonable and responsible" then what is?
http://crooksandliars.com/logan-murphy/ ... -down-whee
wow, townhallers shouting down a wheelchair bound women suffering from autoimmune diseases as it being 'her fault"
yep, if that isn't the definition of "reasonable and responsible" then what is?
get out, get out while there's still time
Re: No Death Panels, Eh?
Doesn't the term "autoimmune" pretty much imply that it's your own fault?
Re: No Death Panels, Eh?

WacoFan wrote:Flying any airplane that you can hear the radio over the roaring radial engine is just ghey anyway.... Of course, Cirri are the Miata of airplanes..
Re: No Death Panels, Eh?
Well, first, I know precisely what my plan covers. I took great care in reviewing the policy and all additional riders before enrolling. If I want I can purchase additional coverage but choose not to.Felix wrote:seriously, you THINK you have a good plan (as did my mother) but when it came right down to it, it wasn't nearly as comprehensive as you might think....that's the problem, you're being deceived into thinking everything is hunky dory until such time that it comes time to pay the piper and you find out that what you thought you had really isn't what you actually have.....
Second, neither I or anyone else is being deceived. Read your damned policy. Your emergency is not all of a sudden my obligation to cover. The only deception here are people like you attempting to argue that it's someone else's fault when a person gets sick and then finds out their insurance doesn't cover it.
Yeah, I know and that sucks. However, that's not a problem being addressed by the specific proposals and principles being presented by Obama and the Democrats. And I don't see how these instances warrant fundamentally altering 1/6th of the nation's economy.my mother at one time was taking a monthly chemotherapy shot that cost almost a $1,000 a pop, and you know how much her United Health Care insurance paid for it? Fucking zippity do dah.....and of course, it wasn't covered under Medicare......so, while a specific instance, it's not isolated-not by a long fucking shot......hence, the vast numbers of personal bankruptcies attributable to healthcare related issues...
And there's the dishonesty and bad faith, again.but seriously, if you think our health care system is fine and you have no problem with companies averaging a 49%/annum increase in their profits, then that's okay by me....
I never suggested that I was fine with the current state of the health care system. Yet, you insist that I am.
Do you have an ounce of good faith in you?
Answer: no.
- Felix
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Re: No Death Panels, Eh?
Oh so you're for healthcare reform, just not if the Democrats are suggesting it....JMak wrote: And there's the dishonesty and bad faith, again.
I never suggested that I was fine with the current state of the health care system. Yet, you insist that I am.
Do you have an ounce of good faith in you?
Answer: no.
okay hoss, lets here your lollipops and candy apple version of what you think health care reform should look like
or are you like the rest of the tard conservatives that say "we want healthcare reform, we've always wanted health care reform-pay no attention to the fact that we could have addressed it years ago before it became the monster that it is now, but in spirit we've always wanted to reform health care-we don't have any idea of how to do it, but we just know we don't want what Obama is proposing"
about as disingenuous as it gets bud
get out, get out while there's still time
Re: No Death Panels, Eh?
mvscal wrote:Cuda wrote:Niiiiice liberal...Man's Finger Bitten Off in Scuffle at Health Care Rally
THOUSAND OAKS -- A 65-year-old man had his finger bitten off Wednesday evening at a health care rally in Thousand Oaks, according to the Ventura County Sheriff's Department.
http://www.ktla.com/news/landing/ktla-f ... 5717.story
Well, the the ignorant old codger was lucky enough to be covered by Medicare:
A witness from the scene says a man was walking through the anti-reform group to get to the pro-reform side when he got into an altercation with the 65-year-old, who opposes health care reform.
The injured anti-reform man walked to Los Robles hospital to have the finger reattached.
He had Medicare.
A blogger who witnessed the fight from the pro-reform side says that the finger-biter was provoked:
The man in the orange shirt hit the pro-reform guy (I'm going to call him PR Guy just to keep the players straight). Hard. ... He punched him in the face, knocked him to the ground and into that thruway. ... He got up, tried to get back up on the curb, but Orange Shirt guy was in his face. Finger in his face, PR Guy standing, steps up to the curb, and there's a scuffle. Orange shirt seemed to have PR Guy in a hold, but again, I was across the street, so won't state that as absolute fact. Next thing I see is PR Guy's hat being tossed into the street, both yelling at one another, then Orange shirt walks away, PR Guy picks up hat and crosses to our side.
When he gets to our side, he tells a story in one sentence: "He punched me hard, straight in the face, so I bit his finger off."
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Re: No Death Panels, Eh?
There seems to be conflicting reports on just who provoked this. I did a quick search and found at least 1 different description of the events which means the media did a bang-up job finding someone not involved in either protest. :doh:LTS TRN 2 wrote:
Well, the the ignorant old codger was lucky enough to be covered by Medicare:
A witness from the scene says a man was walking through the anti-reform group to get to the pro-reform side when he got into an altercation with the 65-year-old, who opposes health care reform.
The injured anti-reform man walked to Los Robles hospital to have the finger reattached.
He had Medicare.
A blogger who witnessed the fight from the pro-reform side says that the finger-biter was provoked:
The man in the orange shirt hit the pro-reform guy (I'm going to call him PR Guy just to keep the players straight). Hard. ... He punched him in the face, knocked him to the ground and into that thruway. ... He got up, tried to get back up on the curb, but Orange Shirt guy was in his face. Finger in his face, PR Guy standing, steps up to the curb, and there's a scuffle. Orange shirt seemed to have PR Guy in a hold, but again, I was across the street, so won't state that as absolute fact. Next thing I see is PR Guy's hat being tossed into the street, both yelling at one another, then Orange shirt walks away, PR Guy picks up hat and crosses to our side.
When he gets to our side, he tells a story in one sentence: "He punched me hard, straight in the face, so I bit his finger off."
Re: No Death Panels, Eh?
You're really reaching there. Far, a far reach, one of despair.Felix wrote: exactly when did you lose your humanity for your fellow man bud? Nice "christian" attitude you've got there....
of course, the fact that you've butchered what the term "survival of the fittest" means is no great surprise, because you don't know shit about that what you rail so adamantly against.....survival of the fittest doesn't mean the biggest and the baddest survive, it means those that are best adapted to their enviornment survive....a perfect example of working in unison is a pack of wolves.....singularly, no wolf could kill an elk, but when they work in unision, they can and do kill them all the time...a "lone wolf", (e.g. one that doesn't have pack support) doesn't last very long in the wild.....
"the strong survive and weak perish"? wow, I know I've seen that kind of philosophy somewhere, I just can't quite put my finger on where.....
In nature it means that those that can eat, fuck and procreate before they die, allow the species to survive and genetic traits passed on. That's it, bud. Please find for me, anywhere, my railings against Darwinism. I'll be waiting, for a long time too.
You want to assist your fellow man ? Get up off your dead ass and do it. Many people do. Many people upon whom you look down and judge. Quit voting for people who STEAL from their fellow man to sit in high office, get jobs for their friends, and NOT PRODUCE ANYTHING WORTH A DAMN - and GET OFF YOUR ASS AND HELP.
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Re: No Death Panels, Eh?
How did Howard Beale get Tom's password?Tom In VA wrote:You're really reaching there. Far, a far reach, one of despair.
In nature it means that those that can eat, fuck and procreate before they die, allow the species to survive and genetic traits passed on. That's it, bud. Please find for me, anywhere, my railings against Darwinism. I'll be waiting, for a long time too.
You want to assist your fellow man ? Get up off your dead ass and do it. Many people do. Many people upon whom you look down and judge. Quit voting for people who STEAL from their fellow man to sit in high office, get jobs for their friends, and NOT PRODUCE ANYTHING WORTH A DAMN - and GET OFF YOUR ASS AND HELP.
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Re: No Death Panels, Eh?
Interesting read for this thread's combatants:
http://www.slate.com/id/2227082
The Fix Is In
The hidden public-private cartel that sets health care prices.
By Darshak Sanghavi
Posted Wednesday, Sept. 2, 2009, at 12:13 PM ET
Doctors in an operating roomLiving in Massachusetts should, by all indicators, mean having access to good health care. Following the landmark passage of a health insurance mandate in 2006, the state today enjoys the nation's lowest percentage of uninsured citizens. Major cities like Boston have the nation's highest numbers of doctors per capita and anchor some of the world's largest and most prestigious medical centers. And Massachusetts isn't stingy—it spends more on health care per person than any other state. Yet, as a remarkable NPR documentary reported last year, patients calling Massachusetts General Hospital—ranked the fifth best in the nation by U.S. News and World Report—were informed that Harvard's massive academic hospital was no longer accepting new patients needing primary care. And that problem isn't limited to Massachusetts General—it's occurring throughout the state. Despite near-universal insurance, oodles of doctors, reams of cash, and no dearth of bright minds, the average person in Massachusetts can't find a new primary care doctor. To have any hope of meaningful national health reform, therefore, we must address the perverse financial incentives that created and continue to inflame this problem.
The root of the shortage can be traced to 1985, when a Harvard economist named William Hsiao developed a scale to measure the relative value of every single one of the thousands of services provided by doctors, a job later compared to measuring "the exact amount of anger in the world." For example, Hsiao's team deemed that a hysterectomy required 3.8 times more mental effort and 4.47 times more technical skill than a psychotherapy session. In 1992, Medicare formally adopted Hsiao's concept; private insurers followed suit. Today, this relative value-based system sets the prices—and therefore drives the priorities of American medicine.
Here's how it works. Doctors do a job—like placing a coronary artery stent, reading an EKG, or spending an hour examining and diagnosing a patient with a complex problem like insomnia—and earn something called "relative value units." In 2009, according to Medicare, the stent guy scores about 24 units for his relatively quick procedure, the EKG person gets 0.5 units for the 10 seconds his job requires, and the poor internist gets only 2.5 units for his hour of time. Figuring a doctor's total take per task is straightforward: Medicare adds up a doctor's total RVUs, multiplies the total by a fixed amount (roughly $40 right now), and writes the check.
It's clear that Medicare and all major insurers place far more relative value on fancy procedures like stents, EKGs, skin biopsies, CT scans, and bowel clean-outs than they do on actual face-to-face time with patients. Procedures, they have decreed, require more mental effort and skill than seeing actual people. The implications are obvious. Just visit any hospital: The dermatology, radiology, and cardiology centers that depend on high-volume, relatively quick procedures have gleaming new facilities, while the primary care and psychiatry clinics languish, since they earn their keep from poorly compensated face-to-face time with patients. And, obviously, specialists make more money than primary care doctors. (Even trainees grasp this; recently, only a single graduating internist out of a class of 50 residents at Massachusetts General Hospital planned to become a primary care doctor.)
Fundamentally, the entire payment model of American health care drives medical centers, doctors, and hospital managers to push for more fancy procedures at the expense of primary care doctors. How'd we get here? Since 1992, Medicare has depended almost entirely on the American Medical Association for guidance on how relative values should be set. In a devastating critique published in the Annals of Internal Medicine, scholars from the Urban Institute and the University of California-San Francisco explained that Medicare uncritically accepted 95 percent of the AMA's recommendations, which are formulated by the group's Relative Value Scale Update Committee, or RUC.
Of the committee's 29 members, 23 are appointed from subspecialties like cardiology and dermatology. Just three represent primary care, even though half of all Medicare dollars are spent on face-to-face encounters. Their meetings are closed to uninvited observers. Unsurprisingly, over time, the relative values of various procedures far outpaced face-to-face "evaluation and management." In 2000, for example, the RUC recommended relative value increases in 469 specialty procedure codes but made no change in codes related to evaluation and management—which are used by primary care doctors for outpatient visits for physicals, back pain, headaches, and so on.
This price-fixing process explains why people can't find primary care doctors in Massachusetts. By law, Medicare's costs are capped so what one doctor gains, another loses. (Medicare has long "rationed" care in this manner.) To meet budget targets, Medicare doesn't alter the relative valuations of different medical services; instead, it simply cuts the multiplier (say, from $40 to $38 per RVU), which just worsens the disparity between specialists and primary care doctors.
Over time, the big-money specialists dominating the AMA have demanded more and more "relative value" for their procedures. Medicare has rolled over and complied, which has drained revenue from the little-money workhorses—primary care doctors. More than any peculiarity of American medicine, these procedure-mad incentives have corrupted our health care system.
The funny thing is, paying more for medical care that's more valuable does makes sense. That's how capitalism should work. Unfortunately, ever since William Hsiao created the system in 1985, the collusive market valuation of medical services considered only the doctor (paying for his or her mental effort and stress, for example). The system completely fails to consider the value to the person actually getting the service. If we did, for example, angioplasties for stable chest pain would never be worth so much more than outpatient visits to lower cholesterol and blood pressure, which are just as effective.
Who speaks for patients? The 36-employee Medicare Payment Advisory Committee serves as Congress' adviser on Medicare policy but lacks the authority and funding to counter the AMA's lobbying. For years, MedPAC has sensibly argued that Americans shouldn't outsource medical pricing to a private interest group. Because properly valuing medical services is a public good, we should invest tax dollars in comparative effectiveness studies and a stronger public agency to fight for patients.
That terrifies powerful special interest groups like physician specialty societies and drug companies. In the mid-1990s, the medical device maker Medtronic sued to block a sound federal report showing spinal fusions didn't help back pain, and Republicans gutted the responsible agency. The Medicare-approved relative value for the pointless surgery remained largely unchanged and the gravy train chugged along. When Barack Obama recently proposed expanding MedPAC and reducing some of the AMA's influence, the interest groups again fought back ferociously to defend the status quo—and christened MedPAC a "death panel."
And while nobody's been looking, they pulled the plug on primary care doctors.
http://www.slate.com/id/2227082
The Fix Is In
The hidden public-private cartel that sets health care prices.
By Darshak Sanghavi
Posted Wednesday, Sept. 2, 2009, at 12:13 PM ET
Doctors in an operating roomLiving in Massachusetts should, by all indicators, mean having access to good health care. Following the landmark passage of a health insurance mandate in 2006, the state today enjoys the nation's lowest percentage of uninsured citizens. Major cities like Boston have the nation's highest numbers of doctors per capita and anchor some of the world's largest and most prestigious medical centers. And Massachusetts isn't stingy—it spends more on health care per person than any other state. Yet, as a remarkable NPR documentary reported last year, patients calling Massachusetts General Hospital—ranked the fifth best in the nation by U.S. News and World Report—were informed that Harvard's massive academic hospital was no longer accepting new patients needing primary care. And that problem isn't limited to Massachusetts General—it's occurring throughout the state. Despite near-universal insurance, oodles of doctors, reams of cash, and no dearth of bright minds, the average person in Massachusetts can't find a new primary care doctor. To have any hope of meaningful national health reform, therefore, we must address the perverse financial incentives that created and continue to inflame this problem.
The root of the shortage can be traced to 1985, when a Harvard economist named William Hsiao developed a scale to measure the relative value of every single one of the thousands of services provided by doctors, a job later compared to measuring "the exact amount of anger in the world." For example, Hsiao's team deemed that a hysterectomy required 3.8 times more mental effort and 4.47 times more technical skill than a psychotherapy session. In 1992, Medicare formally adopted Hsiao's concept; private insurers followed suit. Today, this relative value-based system sets the prices—and therefore drives the priorities of American medicine.
Here's how it works. Doctors do a job—like placing a coronary artery stent, reading an EKG, or spending an hour examining and diagnosing a patient with a complex problem like insomnia—and earn something called "relative value units." In 2009, according to Medicare, the stent guy scores about 24 units for his relatively quick procedure, the EKG person gets 0.5 units for the 10 seconds his job requires, and the poor internist gets only 2.5 units for his hour of time. Figuring a doctor's total take per task is straightforward: Medicare adds up a doctor's total RVUs, multiplies the total by a fixed amount (roughly $40 right now), and writes the check.
It's clear that Medicare and all major insurers place far more relative value on fancy procedures like stents, EKGs, skin biopsies, CT scans, and bowel clean-outs than they do on actual face-to-face time with patients. Procedures, they have decreed, require more mental effort and skill than seeing actual people. The implications are obvious. Just visit any hospital: The dermatology, radiology, and cardiology centers that depend on high-volume, relatively quick procedures have gleaming new facilities, while the primary care and psychiatry clinics languish, since they earn their keep from poorly compensated face-to-face time with patients. And, obviously, specialists make more money than primary care doctors. (Even trainees grasp this; recently, only a single graduating internist out of a class of 50 residents at Massachusetts General Hospital planned to become a primary care doctor.)
Fundamentally, the entire payment model of American health care drives medical centers, doctors, and hospital managers to push for more fancy procedures at the expense of primary care doctors. How'd we get here? Since 1992, Medicare has depended almost entirely on the American Medical Association for guidance on how relative values should be set. In a devastating critique published in the Annals of Internal Medicine, scholars from the Urban Institute and the University of California-San Francisco explained that Medicare uncritically accepted 95 percent of the AMA's recommendations, which are formulated by the group's Relative Value Scale Update Committee, or RUC.
Of the committee's 29 members, 23 are appointed from subspecialties like cardiology and dermatology. Just three represent primary care, even though half of all Medicare dollars are spent on face-to-face encounters. Their meetings are closed to uninvited observers. Unsurprisingly, over time, the relative values of various procedures far outpaced face-to-face "evaluation and management." In 2000, for example, the RUC recommended relative value increases in 469 specialty procedure codes but made no change in codes related to evaluation and management—which are used by primary care doctors for outpatient visits for physicals, back pain, headaches, and so on.
This price-fixing process explains why people can't find primary care doctors in Massachusetts. By law, Medicare's costs are capped so what one doctor gains, another loses. (Medicare has long "rationed" care in this manner.) To meet budget targets, Medicare doesn't alter the relative valuations of different medical services; instead, it simply cuts the multiplier (say, from $40 to $38 per RVU), which just worsens the disparity between specialists and primary care doctors.
Over time, the big-money specialists dominating the AMA have demanded more and more "relative value" for their procedures. Medicare has rolled over and complied, which has drained revenue from the little-money workhorses—primary care doctors. More than any peculiarity of American medicine, these procedure-mad incentives have corrupted our health care system.
The funny thing is, paying more for medical care that's more valuable does makes sense. That's how capitalism should work. Unfortunately, ever since William Hsiao created the system in 1985, the collusive market valuation of medical services considered only the doctor (paying for his or her mental effort and stress, for example). The system completely fails to consider the value to the person actually getting the service. If we did, for example, angioplasties for stable chest pain would never be worth so much more than outpatient visits to lower cholesterol and blood pressure, which are just as effective.
Who speaks for patients? The 36-employee Medicare Payment Advisory Committee serves as Congress' adviser on Medicare policy but lacks the authority and funding to counter the AMA's lobbying. For years, MedPAC has sensibly argued that Americans shouldn't outsource medical pricing to a private interest group. Because properly valuing medical services is a public good, we should invest tax dollars in comparative effectiveness studies and a stronger public agency to fight for patients.
That terrifies powerful special interest groups like physician specialty societies and drug companies. In the mid-1990s, the medical device maker Medtronic sued to block a sound federal report showing spinal fusions didn't help back pain, and Republicans gutted the responsible agency. The Medicare-approved relative value for the pointless surgery remained largely unchanged and the gravy train chugged along. When Barack Obama recently proposed expanding MedPAC and reducing some of the AMA's influence, the interest groups again fought back ferociously to defend the status quo—and christened MedPAC a "death panel."
And while nobody's been looking, they pulled the plug on primary care doctors.
Re: No Death Panels, Eh?
Ucant I never thought I'd be calling you a Communist.
Communist.
Communist.
- ucantdoitdoggieSTyle2
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Re: No Death Panels, Eh?
Don't take my odd interest in "sexy topics" like RVU metrics (*yawn*) as a political stance, bro. 

Re: No Death Panels, Eh?
Right on, doggie. The river of evidence will drown the fatuous phonies here who reflexively hiss, parse, and niggle their fake arguments and dismissals. Unfortunately, the evidence you present is daunting in its own right--but let's clean out the rats first, eh? :wink:
Before God was, I am
Re: No Death Panels, Eh?
Every Friday, a group of Lyndon LaRouche nutbags set up a picket line at my local post office. This week is was STOP OBAMA'S HEALTH CARE PLAN. On my way out after checking my PO box, one of the little old lady nutjobs shoved some LaRouche literature in my direction and hollered "HELP STOP OBAMA'S EVIL PLAN" " Why would I want to do that?" I replied, " I'm a communist". "Because he's a NAZI!" , she says. "He's no NAZI", I said, "Look how many Jews he's got in his administration". " Yes he is" she insisted, "He's a NAZI, and he wants to kill communists". "Pffft" I said, " tomayto, tomahto- deep down, we're all comrades". At that, she thought better about trying to convert me and moved along to harrass some fat beaner lady getting out of a mini van.Mikey wrote:Ucant I never thought I'd be calling you a Communist.
Communist.
WacoFan wrote:Flying any airplane that you can hear the radio over the roaring radial engine is just ghey anyway.... Of course, Cirri are the Miata of airplanes..
Re: No Death Panels, Eh?
My neighborhood is so boring.
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Re: No Death Panels, Eh?
again, you're ignorance of evolution and evolutionary theory is mind numbing....calling it Darwinism speaks volumes about just how out of touch you are on the subject....Tom In VA wrote:
In nature it means that those that can eat, fuck and procreate before they die, allow the species to survive and genetic traits passed on. That's it, bud. Please find for me, anywhere, my railings against Darwinism. I'll be waiting, for a long time too.
you did know that Darwin wasn't the first one to theorize on evolution don't you? ever heard of a guy by the name of Alfred Russel Wallace? Google his name and see what you come up with.
and you do know that science has made huge massive advances in evolutionary theory in the 150+ years since Darwin published On the Origin of the Species don't you?
science has never been and never will be married to pronouncements that were made centuries ago....contrary to what you might think, science advances and the theory of evolution is no exception
Guess what, Darwin had a lot of shit wrong, but given the limitations he had back then (like not having any understanding about shit like DNA, RNA and the fossil record), his writings were remarkable....jeez bud, scientists have mapped the human genome, which in and of itself is one of the most remarkable scientific breakthroughs I'll probably ever see in my lifetime...but you know what, 50 years from now that will probably seem like child's play compared to where science will be by then
see if you can get yourself just a tad more up to date on the strides made in refining evolutionary theory and get back to me when you can get a grasp on exactly what "survival of the fittest" means in evolutionary theory...
btw, do you commonly refer to the theory of gravity as Newtonianism? if not, then quit calling the theory of evolution "Darwinism"
get out, get out while there's still time
Re: No Death Panels, Eh?
Darwin wants you to stop sucking his cock, feeldix
WacoFan wrote:Flying any airplane that you can hear the radio over the roaring radial engine is just ghey anyway.... Of course, Cirri are the Miata of airplanes..
Re: No Death Panels, Eh?
Thanks for the tutorial Dr. Felix.Felix wrote: again, you're ignorance of evolution and evolutionary theory is mind numbing....calling it Darwinism speaks volumes about just how out of touch you are on the subject....
you did know that Darwin wasn't the first one to theorize on evolution don't you? ever heard of a guy by the name of Alfred Russel Wallace? Google his name and see what you come up with.
and you do know that science has made huge massive advances in evolutionary theory in the 150+ years since Darwin published On the Origin of the Species don't you?
science has never been and never will be married to pronouncements that were made centuries ago....contrary to what you might think, science advances and the theory of evolution is no exception
Guess what, Darwin had a lot of shit wrong, but given the limitations he had back then (like not having any understanding about shit like DNA, RNA and the fossil record), his writings were remarkable....jeez bud, scientists have mapped the human genome, which in and of itself is one of the most remarkable scientific breakthroughs I'll probably ever see in my lifetime...but you know what, 50 years from now that will probably seem like child's play compared to where science will be by then
see if you can get yourself just a tad more up to date on the strides made in refining evolutionary theory and get back to me when you can get a grasp on exactly what "survival of the fittest" means in evolutionary theory...
btw, do you commonly refer to the theory of gravity as Newtonianism? if not, then quit calling the theory of evolution "Darwinism"

I understand things a bit more, you're evidence that douches have adapted and fucked -- err ... "mapped their genome".
- Felix
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Re: No Death Panels, Eh?
great comeback hoss.....look it's not my fault that you're so behind the curve on what you claim to "know"....do some research and reading and you'll be up to speed in about 5 to 6 years...Tom In VA wrote:
Thanks for the tutorial Dr. Felix.![]()
I understand things a bit more, you're evidence that douches have adapted and fucked -- err ... "mapped their genome".
here's a good place to start
http://ncseweb.org/media/voices/society-study-evolution
look to the left side and you'll find plenty of reading material....or you can choose to hold on to your primitive (e.g. 150 year-old) understanding of evolution
get out, get out while there's still time
Re: No Death Panels, Eh?
Dude, this post isn't to discuss the finer points of evolution. I'm sure you're better read on the topic than me. Is anything I said about "evolution" false ? Not really.Felix wrote:-
Either way, what's that got to do with Obamacare choosing who gets to live or die as opposed to peoples own choices and expenditure of the fruits of their labor ?
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Re: No Death Panels, Eh?
Obamacare doesn't choose who gets to live or die.
Calm down and find a new place to get your world info. Your current sources are failing you.
Calm down and find a new place to get your world info. Your current sources are failing you.
why is my neighborhood on fire
Re: No Death Panels, Eh?
Someone care to remind me which Amendment grants the fed the power to start up an insurance company?
Because I can show you the one that says it can't.
Get rid of Medicare, repeal the HMO Act of 1973, and get the government THE FUCK out of our business, and watch those insurance premiums plummet.
Wait... that would take balls, which the sheeple of this country are severely lacking, and instead make claims on that which belongs to others to promote their own self interest, which in most circles is known as "theft."
Because I can show you the one that says it can't.
Get rid of Medicare, repeal the HMO Act of 1973, and get the government THE FUCK out of our business, and watch those insurance premiums plummet.
Wait... that would take balls, which the sheeple of this country are severely lacking, and instead make claims on that which belongs to others to promote their own self interest, which in most circles is known as "theft."
I got 99 problems but the 'vid ain't one
Re: No Death Panels, Eh?
Bizzarofelice wrote:Obamacare doesn't choose who gets to live or die.
Calm down and find a new place to get your world info. Your current sources are failing you.
Not an ounce of reference to rationing ?
Not the seeds of a system that could evolve into the Federal Government having that power ?
Whew, okay, I'm cool with it. Thanks Bace, I trust you.
Re: No Death Panels, Eh?
"Welfare of the people" man, "welfare of the people".Dinsdale wrote:Someone care to remind me which Amendment grants the fed the power to start up an insurance company?
That will be the answer you hear. The Tenth Amendment.
So be careful. Then of course you'll get the "If you can interpret the 2nd Amendment to actually mean individuals have the right to defend themselves - against the government too - then we can interpret the 10th to mean , cradle to grave care by the Government. "
Re: No Death Panels, Eh?
And the ancient Greeks considered taxation a basic requirement for defining yourself as a democratic, modern and civilised society. The only examples that I can think - societies without a form of taxation - are primitive, or unrecovered from war.Dinsdale wrote: Wait... that would take balls, which the sheeple of this country are severely lacking, and instead make claims on that which belongs to others to promote their own self interest, which in most circles is known as "theft."
Best start thinking of things on a foundation level, you've moved off into 'Lord of the Flies' territory. Economics has it's own set of rules, rationalising them through the lens of a single constitution seems a bit limiting.
Re: No Death Panels, Eh?
I don't think that's the answer to the question Phibes. Nobody is contesting "taxation", that is in the Constitution.
The question is, how much and for what purpose ?
There are scholars that and lawyers that earn a living debating that and trying to discern that. We just hope they'll eventually come forward and become legislators and judges one day.
The question is, how much and for what purpose ?
There are scholars that and lawyers that earn a living debating that and trying to discern that. We just hope they'll eventually come forward and become legislators and judges one day.
Re: No Death Panels, Eh?
Definitely not answering any questions :o, just questioning the approach. The concept of taxation as theft is a grand one, it deals in an absolute - it doesn't allow for nuance, or exceptions - so you can attack it at a root level.
Re: No Death Panels, Eh?
No mention of torte reform?Dinsdale wrote:
Get rid of Medicare, repeal the HMO Act of 1973, and get the government THE FUCK out of our business, and watch those insurance premiums plummet.
Hmmm.... seems the cost of insurance - malpractice that is, should find it's way into this debate as well.
While we're at it perhaps add why there's no negotiated cost on lifesaving drugs - Felix Mom is a great example.
The current system is fucked up - from both sides.
You don't have to be Red or Blue to see it.
Re: No Death Panels, Eh?
KC Scott wrote: No mention of torte reform?
Hmmm.... seems the cost of insurance - malpractice that is, should find it's way into this debate as well.
Which Amendment is that again?
Wanna know the one that says that ain't the feds' job, either? It's right there in the BoR.
Stupid fucking reply dude, in response to what's obviously a "limited fed" take.
Light coming on yet?
If stupid motherfuckers would... oh, say... educate their ignorant asses, and maybe look at... oh, say... facts and figures... you know, that quantifiable stuff... they might figure out at which point in American history that health care costs started skyrocketing.
Oh... that would require some research and actually learning something... nevermind.
I'll give you a hint -- the fed removed competition from the market place, and fucked with the supply/demand curve in a big way.
Simple fucking Economics 101.
I'm starting to get a little fucking pissed off at the motherfuckers trying to overthrow what's left of my country. If only John Wilkes Booth had done his good deed a little earlier.
I got 99 problems but the 'vid ain't one
Re: No Death Panels, Eh?
Dinsdale wrote:If only John Wilkes Booth had done his good deed a little earlier.

Heavens to Betsy!
Re: No Death Panels, Eh?
It's on Dins - the Constitution as sole arbiter argument is banal.
I just added a couple more points that needed to be added to this discussion - yours just happened to be the quote I picked
I just added a couple more points that needed to be added to this discussion - yours just happened to be the quote I picked
Re: No Death Panels, Eh?
Dinsdale wrote:KC Scott wrote: No mention of torte reform?
Hmmm.... seems the cost of insurance - malpractice that is, should find it's way into this debate as well.
I'll give you a hint -- the lunatic Christer GOP hacks like Phil Gramm removed essential regulation from the market place, and fucked with the world economy in a big way.
Simple Ayn Rand demented Economics 101.
I'm looking forward to Michael Moore's new film, "Capitalism: A Love Story. (If only Squeaky Fromme and John Hinkley had done their good deeds a little earlier! :wink:
Now I see what's beneath your inane rant, Dins, and I've fixed it for you.
Before God was, I am