Why is Obama saying that our healthcare costs are way too high?

[Anonymous]

Can't we agree that the patient always has the right to ask questions and make suggestions and requests, and drop terms like red-faced stomping and ignorant bullying?

[Anonymous]

Can we also agree if this stupid healthcare initiative somehow gets through that all the liberals will say it's fair that union employees are exempt from their benefits being taxed.

[Anonymous]

Anonymous wrote:Can't we agree that the patient always has the right to ask questions and make suggestions and requests, and drop terms like red-faced stomping and ignorant bullying?

Yes to the first part, no to the second. I wrote the original red faced stomping post and I meant it. I have been an advocate for several people at end of life, including my mother and father. I know what good advocacy is. But a lot of people do something else - ignorant bullying and red faced stomping around. I'm sorry, but there is a difference between the two, and if you can't see it you are part of the problem.

[Anonymous]

Anonymous wrote:I'm sorry, but there is a difference between the two, and if you can't see it you are part of the problem.

That there is a difference is exactly the point I was making. I interpreted your terms as characterizing patient self-advocacy in general. Not being a doctor, I can't say how much of it goes overboard; my suspicion is that there is a lot more blind obedience than stubborn demands.

BTW, your final comment seems gratuitous. I take a bit of umbrage at being told that not seeing things as you do makes me "part of the problem". Just a bit, though, so don't sweat it.

[Anonymous]

I agree.

[Anonymous]

I work with people and I do encounter red-faced bullies. However, I would much rather they err on the side of partnering with me than 'blind subservience'. I believe patients should actively participate in their care, not accept blinding pain as 'normal' and pursue treatment until effective. As a patient, I have never brought a whiff of litigation into the consulting room - but I have been persistent on my behalf and my family's. I am glad that you were on behalf of your parents--thank god--that seems the ethical course of action to me. I think your comments about the majority of patients who self-advocate being "red-faced bullies" feeds dangerously into myths of hysteria and hypochondria about patients. Do these conditions exist? Of course. But that they exist should not be used to dismiss valid patient concerns. Just like I need to weed through many factors to work well with my clients, that is also part of the doctor's art--to collect information, including from the patient, and ensure the best care. If they do that, I also think there should be caps on litigation.

[Anonymous]

To add on--by 'caps on litigation' I am still out on how to do this. I just acknowledge that litigation is a big issue in medicine right now and it needs to be examined so that egregious abuses are punished, but not so ethical practices.

[Anonymous]

My real concern about universal health care is that all of the issues being argued above - pain management, patient advocacy, end-of-life care, etc. should all be issues addressed solely between the patient and his/her doctor. The federal government has no right, constitutional or otherwise, to be involved in such situations. As Independence day approaches, it is important to remember that our founding fathers never intended for the instrumentality of the government that they so carefully devised to be used against us in such controlling ways.

[Anonymous]

Anonymous wrote:My real concern about universal health care is that all of the issues being argued above - pain management, patient advocacy, end-of-life care, etc. should all be issues addressed solely between the patient and his/her doctor. The federal government has no right, constitutional or otherwise, to be involved in such situations. As Independence day approaches, it is important to remember that our founding fathers never intended for the instrumentality of the government that they so carefully devised to be used against us in such controlling ways.

My first reaction to the comment about the founding fathers was that it was silly because the founding fathers surely never thought about issues involving health insurance one way or the other. But then I want back and checked the tenth amendment: "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people." So perhaps you're right. Can someone supply the counter-argument -- interstate commerce, perhaps?

[Anonymous]

I think that we need to limit malpractice. First, patients should have to put up some money to sue. Second, both malpractice and permanent damage should have to be present. Limits should be strict on pain and suffering.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My real concern about universal health care is that all of the issues being argued above - pain management, patient advocacy, end-of-life care, etc. should all be issues addressed solely between the patient and his/her doctor. The federal government has no right, constitutional or otherwise, to be involved in such situations. As Independence day approaches, it is important to remember that our founding fathers never intended for the instrumentality of the government that they so carefully devised to be used against us in such controlling ways.

My first reaction to the comment about the founding fathers was that it was silly because the founding fathers surely never thought about issues involving health insurance one way or the other. But then I want back and checked the tenth amendment: "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people." So perhaps you're right. Can someone supply the counter-argument -- interstate commerce, perhaps?

Well, as long as the government still allows you the option of buying private plans I don't see how there would be an issue for the founding fathers. Then they are not forcing any decisions on you. If there are enough customers willing to pay escalating premiums for private insurance then the free market will provide it.

[Anonymous]

The taxes to pay for the government plan would be forced on people

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My real concern about universal health care is that all of the issues being argued above - pain management, patient advocacy, end-of-life care, etc. should all be issues addressed solely between the patient and his/her doctor. The federal government has no right, constitutional or otherwise, to be involved in such situations. As Independence day approaches, it is important to remember that our founding fathers never intended for the instrumentality of the government that they so carefully devised to be used against us in such controlling ways.

My first reaction to the comment about the founding fathers was that it was silly because the founding fathers surely never thought about issues involving health insurance one way or the other. But then I want back and checked the tenth amendment: "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people." So perhaps you're right. Can someone supply the counter-argument -- interstate commerce, perhaps?

Well, as long as the government still allows you the option of buying private plans I don't see how there would be an issue for the founding fathers. Then they are not forcing any decisions on you. If there are enough customers willing to pay escalating premiums for private insurance then the free market will provide it.

Do you understand that the government plan will force most companies to drop the private plans? Why would a company continue to fund a private plan if they can join on the government one? So, if you like the plan that you have now, you will most likely lost it and be forced into the government plan. We've already started saving to buy supplemental insurance because I don't want the government to decide whether my family lives or dies.

[Anonymous]

"I do not understand this logic. My doctor does not make a profit by ordering tests for me, since 90% of these tests are performed by other vendors. I am in an HMO, so he doesn't even get paid more if I visit him more. The same goes for the lab that does my bloodwork -- they are on a retainer and do not get paid per a test. The hospital where my doctor works is run by a non-profit. Yes, there are for profit aspects to healthcare, but I don't see a huge conspiracy.

There have been lots of studies on this and defensive healthcare is very expensive. "

Not true. One of the expense issues is that doctors are only reimbursed by most all insurance if you come into the office. For patients with chronic conditions, a phone consultant could work just as well with the doctor prescribing medication or giving a refferal if needed. Until the insurance companies recognize this as a cost the doctor will keep bringing you to the office which then carries higher overhead costs. Its false to assume that a non profit medical organization is not driven by market costs. The NP still has a a large overhead budget with high salaries to cover. NPs can sometimes be worse if they are not well managed or if they are trying to cover shortfalls in other areas from serving populations not covered by Medicare or insurance.

Defensive medicine is actually a small percentage though completely overblown by the medical profession. There was an interesting report comparing health outcomes and health costs between areas with a high density of specialists and areas with a low density of specialists. The areas with the most doctors including alot of specialists had very high rates of referrals and patients seeing 4-5 doctors. Patients with the same health profiles in areas that had fewer doctors obtained the majority of their care from their primary physcian. The health outcomes were much higher for the group seeing fewer doctors. In metro areas with alot of doctors the constant referrals may be more habit than need and while the doctor may tell themselve they are doing it defensively this is probably more a rationalization than reality.

For the do nothing crowd, try comparing how much health care costs have risen in the past 5-10 years against the average income/wage increase. The insurance and healthcare you think you have and like today will not be around in 5 years anyway. There are a good number of people out there who believe they are well insured and safe but are one job loss or one medical incident away from bankruptcy.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My real concern about universal health care is that all of the issues being argued above - pain management, patient advocacy, end-of-life care, etc. should all be issues addressed solely between the patient and his/her doctor. The federal government has no right, constitutional or otherwise, to be involved in such situations. As Independence day approaches, it is important to remember that our founding fathers never intended for the instrumentality of the government that they so carefully devised to be used against us in such controlling ways.

My first reaction to the comment about the founding fathers was that it was silly because the founding fathers surely never thought about issues involving health insurance one way or the other. But then I want back and checked the tenth amendment: "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people." So perhaps you're right. Can someone supply the counter-argument -- interstate commerce, perhaps?

Well, as long as the government still allows you the option of buying private plans I don't see how there would be an issue for the founding fathers. Then they are not forcing any decisions on you. If there are enough customers willing to pay escalating premiums for private insurance then the free market will provide it.

Do you understand that the government plan will force most companies to drop the private plans? Why would a company continue to fund a private plan if they can join on the government one? So, if you like the plan that you have now, you will most likely lost it and be forced into the government plan. We've already started saving to buy supplemental insurance because I don't want the government to decide whether my family lives or dies.

Well, since my employer dropped our health insurance plan, I sure wish Obama would offer me a sweet deal right about now. Companies are ALREADY dropping their private plans.