Tip of the week: Don't EVER get sick in Irvine!
- Thread starter PeterUK_IHB
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balboarenter_IHB
New member
blackacre-seeker,
You describe yourself as a lay-person, but I would say you are actually more knowledgeable than the average lay-person, at least in the US. Most people want antibiotics from their doctor, even though they probably just have a virus. Taking an antibiotic in the absence of any bacterial infection (or not taking the full dosage when there is an infection) leads to resistant bacteria - simple evolution. That is why older antibiotics are less and less effective, and why there superstrains of staph and tuberculosis (remember the lawyer who caused a health scare by flying to Italy? He had a drug-resistant strain of TB).
Some doctors will take the time to explain the difference between a bacterial infection and a viral one, but many patients don't want to hear it, they just want a prescription. Now the doctor has a hard choice - he can prescribe antibiotics and let the patient feel like the doctor is doing something, or he can tell them it's viral and it will run its course. Judging from the opinions on this board, the latter isn't acceptable. So he prescribes antibiotics, fully knowing that it will do more harm than good. Gah.
Also, I'd love to compare the cost of medical training in Russia compared to the cost of training in the US. In Russia, my very basic google search seems to indicate 6 years of training (no undergraduate education necessary), maybe $7k a year in tuition. In the US, physician training requires:
4 years of undergraduate education ($16k a year at a UC, not including room, board, books)
4 years of medical school education ($25k a year, not including room, board, books)
3 years of residency (salary of maybe $40-45k, as set by a national board, 100 hr work weeks, only one weekend a month where you have both Sat and Sun off)
3-4 additional years of training if you subspecialize or do surgery (at a similar salary as residency)
Doctors in the US typically start their actual career at 30 and older, many with over $200k in student debt. Most primary-care physicians in the US are far from millionaires. Economically, it is not the lucrative job many seem to make it out to be. Certainly surgeons and some specialists can earn in the very high six-figures or more. But your average family care physician or internist isn't earning anywhere near that.
Now, is all that training necessary? Hard to say. I personally have the perception that the quality of medical care available in the US is the best in the world - whether or not it justifies the COST of such medical care in the US is an entirely different topic.
You describe yourself as a lay-person, but I would say you are actually more knowledgeable than the average lay-person, at least in the US. Most people want antibiotics from their doctor, even though they probably just have a virus. Taking an antibiotic in the absence of any bacterial infection (or not taking the full dosage when there is an infection) leads to resistant bacteria - simple evolution. That is why older antibiotics are less and less effective, and why there superstrains of staph and tuberculosis (remember the lawyer who caused a health scare by flying to Italy? He had a drug-resistant strain of TB).
Some doctors will take the time to explain the difference between a bacterial infection and a viral one, but many patients don't want to hear it, they just want a prescription. Now the doctor has a hard choice - he can prescribe antibiotics and let the patient feel like the doctor is doing something, or he can tell them it's viral and it will run its course. Judging from the opinions on this board, the latter isn't acceptable. So he prescribes antibiotics, fully knowing that it will do more harm than good. Gah.
Also, I'd love to compare the cost of medical training in Russia compared to the cost of training in the US. In Russia, my very basic google search seems to indicate 6 years of training (no undergraduate education necessary), maybe $7k a year in tuition. In the US, physician training requires:
4 years of undergraduate education ($16k a year at a UC, not including room, board, books)
4 years of medical school education ($25k a year, not including room, board, books)
3 years of residency (salary of maybe $40-45k, as set by a national board, 100 hr work weeks, only one weekend a month where you have both Sat and Sun off)
3-4 additional years of training if you subspecialize or do surgery (at a similar salary as residency)
Doctors in the US typically start their actual career at 30 and older, many with over $200k in student debt. Most primary-care physicians in the US are far from millionaires. Economically, it is not the lucrative job many seem to make it out to be. Certainly surgeons and some specialists can earn in the very high six-figures or more. But your average family care physician or internist isn't earning anywhere near that.
Now, is all that training necessary? Hard to say. I personally have the perception that the quality of medical care available in the US is the best in the world - whether or not it justifies the COST of such medical care in the US is an entirely different topic.
earthbm_IHB
New member
So is my impression correct that Peter UK got charged so much due to
1) Paying the overinflated bills himself
2) The bills were overinflated because insurance companies only pay a fraction of the face value?
Kind of like paying MSRP for a car, only more so?
By the way, blackacre-seeker is opinionated, but that does not make him objective or always right. Little knoledge is way more dangerous than no knowledge. Antibiotics are not over the counter in Europe (my wife is a farmacist). This is total bull. Reading Merck manual is no substitute for the training that doctors get. It is easy to see what doctors do (write a prescription). It is impossible to see the myriad of nuanced and complex experience and past knowledge that went into making a decision.
Russian healthcare is hit and miss. There are doctors who do what they do because they love it and other opportunities are limited (doctors' qualifications generally don't travel well). But the majority are still human and are motivated by money and since they don't make a lot they are not motivated. Go outside the Moscow ring road and you experience about the same contrast as when you cross into Tijuana. Certainly access to state of the art equipment is at "forget-it" level if you are outside a large (>1m) city. (He is right that lifestyle contributes much to the low life expectancy -- everyone smokes, drinks heavily, and don't forget suicides).
The reason US healcare costs are out of control is referred to as agency problem -- huge disparities in negotiating power, mostly due to buyers unable to make an informed decision. Some state intervention may or may not help solve this.
Incidentally, I tend to avoid doctors to the extent I can, largely because of my information disadvantage and natural scepticism.
1) Paying the overinflated bills himself
2) The bills were overinflated because insurance companies only pay a fraction of the face value?
Kind of like paying MSRP for a car, only more so?
By the way, blackacre-seeker is opinionated, but that does not make him objective or always right. Little knoledge is way more dangerous than no knowledge. Antibiotics are not over the counter in Europe (my wife is a farmacist). This is total bull. Reading Merck manual is no substitute for the training that doctors get. It is easy to see what doctors do (write a prescription). It is impossible to see the myriad of nuanced and complex experience and past knowledge that went into making a decision.
Russian healthcare is hit and miss. There are doctors who do what they do because they love it and other opportunities are limited (doctors' qualifications generally don't travel well). But the majority are still human and are motivated by money and since they don't make a lot they are not motivated. Go outside the Moscow ring road and you experience about the same contrast as when you cross into Tijuana. Certainly access to state of the art equipment is at "forget-it" level if you are outside a large (>1m) city. (He is right that lifestyle contributes much to the low life expectancy -- everyone smokes, drinks heavily, and don't forget suicides).
The reason US healcare costs are out of control is referred to as agency problem -- huge disparities in negotiating power, mostly due to buyers unable to make an informed decision. Some state intervention may or may not help solve this.
Incidentally, I tend to avoid doctors to the extent I can, largely because of my information disadvantage and natural scepticism.
momopi_IHB
New member
It's a lot easier for a small urbanized country or territory with reasonable income levels to afford national health insurance scheme. But for larger countries, it's much more difficult due to size, logistics, etc. i.e. much easier to provide government health care in Hong Kong or Taiwan than China or India.
In Taipei, Taiwan, because it's a highly urbanized city with good public transportation with many hospitals, clinics, and parents who insist that their kids become doctors, there is no shortage of medical care facilities and I even saw a dentist that opens until 10pm next to my aunt's condo. The government health care scheme, from what I see, is like a PPO.
In comparison, many of my Canadian friends complain about the long wait to see a doctor. Both countries have national health care scheme, but Canada is the 2nd largest country on this planet and my friends live in BFE locations like Powell River, instead of Toronto or Vancouver. So she had to wait 3 weeks to see a dentist.
The US can easily solve many of its medical care cost issues by imposing more medical liability lawsuit limits, as well as recognizing more foreign medical degrees.
If you're looking to save on non-emergency medical expenses, it's possible to go to another country and pay much less in cash for the treatment. I've recommended several coworkers to combine their vacation trip with a visit to the dentist in East or SE Asia, and helped them save thousands of dollars. Trans-gender patients have been flying to Thailand for decades. There will be some risk, but you get to save a lot of $ in return.
In Taipei, Taiwan, because it's a highly urbanized city with good public transportation with many hospitals, clinics, and parents who insist that their kids become doctors, there is no shortage of medical care facilities and I even saw a dentist that opens until 10pm next to my aunt's condo. The government health care scheme, from what I see, is like a PPO.
In comparison, many of my Canadian friends complain about the long wait to see a doctor. Both countries have national health care scheme, but Canada is the 2nd largest country on this planet and my friends live in BFE locations like Powell River, instead of Toronto or Vancouver. So she had to wait 3 weeks to see a dentist.
The US can easily solve many of its medical care cost issues by imposing more medical liability lawsuit limits, as well as recognizing more foreign medical degrees.
If you're looking to save on non-emergency medical expenses, it's possible to go to another country and pay much less in cash for the treatment. I've recommended several coworkers to combine their vacation trip with a visit to the dentist in East or SE Asia, and helped them save thousands of dollars. Trans-gender patients have been flying to Thailand for decades. There will be some risk, but you get to save a lot of $ in return.
Trooper_IHB
New member
<p>Momopi,</p>
<p>It's interesting that you mention seeking dental care out of the States. I need a dental implant, but don't feel like shelling out 3K to get one. My Mom told me it can be done in Mexico for 1K and that many seniors from AZ go across the border for their dental care.</p>
<p>Does anyone else have any info on this...?</p>
<p>It's interesting that you mention seeking dental care out of the States. I need a dental implant, but don't feel like shelling out 3K to get one. My Mom told me it can be done in Mexico for 1K and that many seniors from AZ go across the border for their dental care.</p>
<p>Does anyone else have any info on this...?</p>
effenheimer_IHB
New member
I've heard the same thing, but I don't know who is trustworthy down there. Perhaps check out a retirement forum? With so many US retirees in MX, there must be some known-reliable medical providers.
Fraychielle_IHB
New member
Lawyerliz
That's an awfully large paintbrush you just painted the physician community with.
Rather than to explain why your post evinced so many defensive reactions from me, I will just say this.
Yes, in the community there are many bad docs. I went to med school, even trained with in residency, with people whom I'd never see myself, have my kids see, or ever refer my friends (and worst enemies? ) to. I hear of stuff that is done in the medical community that is absolutely outrageous and downright incompetance.
However, there are good physicians out there who will spend the time with you to talk, are understanding, offer reassurance or at least their honest appraisal of your clinical situation, and yes, wash their hands both before and after each patient encounter. Oh, and alcohol-wipe their stethoscopes and equipment between patients. Am I one of them? I hope I can aspire to that. However, if you're seeing me as a patient you or your child probably have some serious health issues.
As far as the original reason for this thread, I feel for PeterUK's pain and agree with IrvineAllergyDoc's analysis. I brought my daughter to the same ED not too long ago and ended up paying my copay, $5 (though I got the outrageous bills for the same outrageous fees).
That's an awfully large paintbrush you just painted the physician community with.
Rather than to explain why your post evinced so many defensive reactions from me, I will just say this.
Yes, in the community there are many bad docs. I went to med school, even trained with in residency, with people whom I'd never see myself, have my kids see, or ever refer my friends (and worst enemies? ) to. I hear of stuff that is done in the medical community that is absolutely outrageous and downright incompetance.
However, there are good physicians out there who will spend the time with you to talk, are understanding, offer reassurance or at least their honest appraisal of your clinical situation, and yes, wash their hands both before and after each patient encounter. Oh, and alcohol-wipe their stethoscopes and equipment between patients. Am I one of them? I hope I can aspire to that. However, if you're seeing me as a patient you or your child probably have some serious health issues.
As far as the original reason for this thread, I feel for PeterUK's pain and agree with IrvineAllergyDoc's analysis. I brought my daughter to the same ED not too long ago and ended up paying my copay, $5 (though I got the outrageous bills for the same outrageous fees).
lawyerliz_IHB
New member
<p>Sorry, I wrote this long long post, hit the wrong button and lost it.</p>
<p>This was a rant, and I have a nice dr now, but he won't see me when I'm sick. Have to make an appt ahead of time. So, I've gone to that clinic I mentioned. </p>
<p>The whole system is a mess, the worst possible combination of socialize and capitalism, smushed together to make nobody happy. </p>
<p>I think that drs should unionize to oppose obnoxious insurance companies and govt agencies, you'll never get anywhere with them going against them one on one.</p>
<p>There is a close statistical correlation between improved public works and lengthened lifespans. Clean good water, clean air, good food, exercise, less drinking no smoking, lowered pollution, lowered stress. Investments in these have a real impact, especially in developing countries.</p>
<p>I remember reading that the statistical correlation between medicine and lifespan was not nearly so clear.</p>
<p>I think that what I object to is not just the lack of time, but the fact that drs are sooo sure of themselves--when what they do isn't checked with anybody, so nobody really knows what's right except in rare cases where big studies have been done. </p>
<p>I've occasionally told drs I wasn't going to take his/her advice, and was told I was going to die immediately. Still here. Now I just don't tell them.</p>
<p>I have told drs about herbal remedies that have had real science behind them, and got either scoffing, or the drs never heard of what I was talking about. </p>
<p>I try to learn from my clients, and I do!! Even in real estate, with my years of experience sometimes somebody comes up with some good idea that I never thought of. And I tell them so, too. </p>
<p>My hub recently went to the hospital with what looked like old guy heart problems. Turned out it was a bad back. Not so sure that is a blessing. Anyway, long after the bad back thing was 99% sure, the cardo-surgeon guy kept pressing him for an operation. We kept saying no. Anesthesia makes him sick. We kept saying that. Finally, the dr conceded not to do the test. However weaker, less confident people would have been browbeat into taking the test.</p>
<p>And why so defensive? People criticize lawyers all the time. You should hear judges!! Other lawyers! Clients!</p>
<p>Medicine is much harder. We humans made up the game of law. Our bodies are fantastically more complicated, as you know. I understand that the connections in one human brain exceed the number of stars, not in the galaxy, but the whole universe. Drs know more than they used to, but still not much at all. Perhaps like physics or astronomy in 1900. There was a lot of really good physics and astronomy done before then, but now. . . .!</p>
<p>And if we study physics and astronomy for another thousand years as hard as we have for the past hundred. . .well, then we will know something. Medicine? Perhaps more like 10,000 years. </p>
<p>I like to say 90% of everything is crap. Goes for medicine too.</p>
<p>This was a rant, and I have a nice dr now, but he won't see me when I'm sick. Have to make an appt ahead of time. So, I've gone to that clinic I mentioned. </p>
<p>The whole system is a mess, the worst possible combination of socialize and capitalism, smushed together to make nobody happy. </p>
<p>I think that drs should unionize to oppose obnoxious insurance companies and govt agencies, you'll never get anywhere with them going against them one on one.</p>
<p>There is a close statistical correlation between improved public works and lengthened lifespans. Clean good water, clean air, good food, exercise, less drinking no smoking, lowered pollution, lowered stress. Investments in these have a real impact, especially in developing countries.</p>
<p>I remember reading that the statistical correlation between medicine and lifespan was not nearly so clear.</p>
<p>I think that what I object to is not just the lack of time, but the fact that drs are sooo sure of themselves--when what they do isn't checked with anybody, so nobody really knows what's right except in rare cases where big studies have been done. </p>
<p>I've occasionally told drs I wasn't going to take his/her advice, and was told I was going to die immediately. Still here. Now I just don't tell them.</p>
<p>I have told drs about herbal remedies that have had real science behind them, and got either scoffing, or the drs never heard of what I was talking about. </p>
<p>I try to learn from my clients, and I do!! Even in real estate, with my years of experience sometimes somebody comes up with some good idea that I never thought of. And I tell them so, too. </p>
<p>My hub recently went to the hospital with what looked like old guy heart problems. Turned out it was a bad back. Not so sure that is a blessing. Anyway, long after the bad back thing was 99% sure, the cardo-surgeon guy kept pressing him for an operation. We kept saying no. Anesthesia makes him sick. We kept saying that. Finally, the dr conceded not to do the test. However weaker, less confident people would have been browbeat into taking the test.</p>
<p>And why so defensive? People criticize lawyers all the time. You should hear judges!! Other lawyers! Clients!</p>
<p>Medicine is much harder. We humans made up the game of law. Our bodies are fantastically more complicated, as you know. I understand that the connections in one human brain exceed the number of stars, not in the galaxy, but the whole universe. Drs know more than they used to, but still not much at all. Perhaps like physics or astronomy in 1900. There was a lot of really good physics and astronomy done before then, but now. . . .!</p>
<p>And if we study physics and astronomy for another thousand years as hard as we have for the past hundred. . .well, then we will know something. Medicine? Perhaps more like 10,000 years. </p>
<p>I like to say 90% of everything is crap. Goes for medicine too.</p>
Irvine Allergy Dr_IHB
New member
"I like to say 90% of everything is crap. Goes for medicine too."
True, but when it comes to medicine, that 10% may save your life.
This time, I agree with almost everything you've said. The system is a mess, it would be nice for us to unionize (except for the fact that it would be against the law), we aren't really as sure of ourselves as we like to appear to be (because without confidence in our physicians, what would we as patients have left?), the correlation between lifespan and the level of technological advancement in healthcare is not readily apparent, and yes, the human body is fantastically complicated.
That said, when I'm sick, I will trust myself to a person, who I understand is not omniscient nor omnipotent, but instead is someone who has trained long and hard, learned a tremendous amount of information, and hopefully went into the profession because, when you get down to it, we wanted to help people. And I will call that person "Doctor".
True, but when it comes to medicine, that 10% may save your life.
This time, I agree with almost everything you've said. The system is a mess, it would be nice for us to unionize (except for the fact that it would be against the law), we aren't really as sure of ourselves as we like to appear to be (because without confidence in our physicians, what would we as patients have left?), the correlation between lifespan and the level of technological advancement in healthcare is not readily apparent, and yes, the human body is fantastically complicated.
That said, when I'm sick, I will trust myself to a person, who I understand is not omniscient nor omnipotent, but instead is someone who has trained long and hard, learned a tremendous amount of information, and hopefully went into the profession because, when you get down to it, we wanted to help people. And I will call that person "Doctor".
blackacre-seeker_IHB
New member
to earthbm:
"By the way, blackacre-seeker is opinionated, but that does not make him objective or always right. Little knoledge is way more dangerous than no knowledge. Antibiotics are not over the counter in Europe (my wife is a farmacist). This is total bull."
As I said previously, while in Paris, France (and that is Europe, last time I checked) I personally went to the drugstore and bought antibiotics without a doctor's prescription. I might still have a receipt, if you need any evidence. Oh, and by the way, it is "pharmacist," since we are being petty. Is your wife a pharmacist in Europe? If not, how would she know what is going on there?
Are you from Russia/ever been there and used Russian healthcare system? If not, then you can speculate as much as you wish, but I speak from my personal experience with Russian healthcare, which has been great.
to balboa renter: I actually agree with most of what you said, and it is correct that the cost of tuition is not that high in Russia (don't forget, however, to think in terms of average income there and average tuition, otherwise, comparison to U.S. tuition is not useful. Average salary (excluding Moscow) is around $300-500 dollars a month, so your best bet is a scholarship). Anyhow, being a lawyer myself and having this huge student loan debt, I guess I am supposed to sympathize with doctors. But somehow I can't. My dentist just bought 2.5 mil mansion in Riverside (in addition to his other properties), and I am pretty sure I paid for a part of it.
On a general note, it is interesting to see how most people who defend doctors are doctors themselves (Irvine Allergy Dr, Fraychielle). There is some fault of my own here, but this thread really should not be about whether or not all doctors are motivated by profit and so on. As I said, I do know some great docs here who are behaving like doctors, not businessmen. The more interesting debate is about why the healthcare costs are so outrageously high here and what can be done about that and I believe that is what PeterUK intended for this thread to be).
And personal attacks are just for those who have no legitimate arguments to bring to the table.
"By the way, blackacre-seeker is opinionated, but that does not make him objective or always right. Little knoledge is way more dangerous than no knowledge. Antibiotics are not over the counter in Europe (my wife is a farmacist). This is total bull."
As I said previously, while in Paris, France (and that is Europe, last time I checked) I personally went to the drugstore and bought antibiotics without a doctor's prescription. I might still have a receipt, if you need any evidence. Oh, and by the way, it is "pharmacist," since we are being petty. Is your wife a pharmacist in Europe? If not, how would she know what is going on there?
Are you from Russia/ever been there and used Russian healthcare system? If not, then you can speculate as much as you wish, but I speak from my personal experience with Russian healthcare, which has been great.
to balboa renter: I actually agree with most of what you said, and it is correct that the cost of tuition is not that high in Russia (don't forget, however, to think in terms of average income there and average tuition, otherwise, comparison to U.S. tuition is not useful. Average salary (excluding Moscow) is around $300-500 dollars a month, so your best bet is a scholarship). Anyhow, being a lawyer myself and having this huge student loan debt, I guess I am supposed to sympathize with doctors. But somehow I can't. My dentist just bought 2.5 mil mansion in Riverside (in addition to his other properties), and I am pretty sure I paid for a part of it.
On a general note, it is interesting to see how most people who defend doctors are doctors themselves (Irvine Allergy Dr, Fraychielle). There is some fault of my own here, but this thread really should not be about whether or not all doctors are motivated by profit and so on. As I said, I do know some great docs here who are behaving like doctors, not businessmen. The more interesting debate is about why the healthcare costs are so outrageously high here and what can be done about that and I believe that is what PeterUK intended for this thread to be).
And personal attacks are just for those who have no legitimate arguments to bring to the table.
zovall_IHB
New member
"The more interesting debate is about why the healthcare costs are so outrageously high here and what can be done about that"
balboarenter_IHB
New member
"I think that what I object to is not just the lack of time, but the fact that drs are sooo sure of themselves--when what they do isn't checked with anybody, so nobody really knows what's right except in rare cases where big studies have been done."
That is a very good point. There are quite a lot of arrogant doctors out there. Part of it might be innate, part of it might be a product of the system. After all, who wants to go to a doctor that doesn't sound confident in his diagnoses and orders? If a doctor by nature second-guesses all of his decisions, especially in a specialty that deals with a lot of death (ie cancer), he'd go crazy with worry and sorrow. There's a balance that needs to be achieved.
At my wife's hospital, they have weekly meetings where doctors from different specialties will go over a particular patient's diagnosis and orders in order to see if any improvements can be made in his or her treatment. I'd like to see that implemented in every hospital and clinic, but I'm guessing that isn't always standard practice, unfortunately.
That is a very good point. There are quite a lot of arrogant doctors out there. Part of it might be innate, part of it might be a product of the system. After all, who wants to go to a doctor that doesn't sound confident in his diagnoses and orders? If a doctor by nature second-guesses all of his decisions, especially in a specialty that deals with a lot of death (ie cancer), he'd go crazy with worry and sorrow. There's a balance that needs to be achieved.
At my wife's hospital, they have weekly meetings where doctors from different specialties will go over a particular patient's diagnosis and orders in order to see if any improvements can be made in his or her treatment. I'd like to see that implemented in every hospital and clinic, but I'm guessing that isn't always standard practice, unfortunately.
jwbrown77_IHB
New member
I'll throw a frag grenade in this topic. Krugman:
<nyt_headline type=" " version="1.0"> Big Table Fantasies</nyt_headline>
<nyt_byline type=" " version="1.0"></nyt_byline>
By <a title="More Articles by Paul Krugman" href="http://topics.nytimes.com/top/opinion/editorialsandoped/oped/columnists/paulkrugman/index.html?inline=nyt-per">PAUL KRUGMAN</a>
Published: December 17, 2007
<nyt_text> </nyt_text>
<p>Broadly speaking, the serious contenders for the Democratic nomination are offering similar policy proposals — the dispute over health care mandates notwithstanding. But there are large differences among the candidates in their beliefs about what it will take to turn a progressive agenda into reality. </p>
<a class="jumpLink" href="http://www.nytimes.com/2007/12/17/opinion/17krugman.html?_r=1&hp&oref=login#secondParagraph">Skip to next paragraph</a>
<img width="190" height="201" border="0" alt="" src="http://graphics8.nytimes.com/images/2006/04/02/opinion/ts-krugman-190.jpg" />
<p class="caption"> Paul Krugman. </p>
<a href="http://topics.nytimes.com/top/opinion/editorialsandoped/oped/columnists/paulkrugman/index.html" class="more">Go to Columnist Page »</a>
<a href="http://krugman.blogs.nytimes.com/" class="more">Blog: The Conscience of a Liberal</a>
<a href="http://www.blogrunner.com/snapshot/D/4/0/big_table_fantasies/" class="more">Blogrunner: Reactions From Around the Web</a>
<a name="secondParagraph"></a>
<p>At one extreme, Barack Obama insists that the problem with America is that our politics are so “bitter and partisan,” and insists that he can get things done by ushering in a “different kind of politics.” </p>
<p>At the opposite extreme, John Edwards blames the power of the wealthy and corporate interests for our problems, and says, in effect, that America needs another F.D.R. — a polarizing figure, the object of much hatred from the right, who nonetheless succeeded in making big changes. </p>
<p>Over the last few days Mr. Obama and Mr. Edwards have been conducting a long-range argument over health care that gets right to this issue. And I have to say that Mr. Obama comes off looking, well, naïve. </p>
<p>The argument began during the Democratic debate, when the moderator — Carolyn Washburn, the editor of The Des Moines Register — suggested that Mr. Edwards shouldn’t be so harsh on the wealthy and special interests, because “the same groups are often responsible for getting things done in Washington.”</p>
<p>Mr. Edwards replied, “Some people argue that we’re going to sit at a table with these people and they’re going to voluntarily give their power away. I think it is a complete fantasy; it will never happen.”</p>
<p>This was pretty clearly a swipe at Mr. Obama, who has repeatedly said that health reform should be negotiated at a “big table” that would include insurance companies and drug companies. </p>
<p>On Saturday Mr. Obama responded, this time criticizing Mr. Edwards by name. He declared that “We want to reduce the power of drug companies and insurance companies and so forth, but the notion that they will have no say-so at all in anything is just not realistic.” </p>
<p>Hmm. Do Obama supporters who celebrate his hoped-for ability to bring us together realize that “us” includes the insurance and drug lobbies?</p>
<p>O.K., more seriously, it’s actually Mr. Obama who’s being unrealistic here, believing that the insurance and drug industries — which are, in large part, the cause of our health care problems — will be willing to play a constructive role in health reform. The fact is that there’s no way to reduce the gross wastefulness of our health system without also reducing the profits of the industries that generate the waste. </p>
<p>As a result, drug and insurance companies — backed by the conservative movement as a whole — will be implacably opposed to any significant reforms. And what would Mr. Obama do then? “I’ll get on television and say Harry and Louise are lying,” he says. I’m sure the lobbyists are terrified.</p>
<p>As health care goes, so goes the rest of the progressive agenda. Anyone who thinks that the next president can achieve real change without bitter confrontation is living in a fantasy world.</p>
<p>Which brings me to a big worry about Mr. Obama: in an important sense, he has in effect become the anti-change candidate. </p>
<p>There’s a strong populist tide running in America right now. For example, a recent Democracy Corps survey of voter discontent found that the most commonly chosen phrase explaining what’s wrong with the country was “Big businesses get whatever they want in Washington.” </p>
<p>And there’s every reason to believe that the Democrats can win big next year if they run with that populist tide. The latest evidence came from focus groups run by both Fox News and CNN during last week’s Democratic debate: both declared Mr. Edwards the clear winner. </p>
<p>But the news media recoil from populist appeals. The Des Moines Register, which endorsed Mr. Edwards in 2004, rejected him this time on the grounds that his “harsh anti-corporate rhetoric would make it difficult to work with the business community to forge change.”</p>
<p>And while The Register endorsed Hillary Clinton, the prime beneficiary of media distaste for populism has clearly been Mr. Obama, with his message of reconciliation. According to a recent survey by the Project for Excellence in Journalism, Mr. Obama’s coverage has been far more favorable than that of any other candidate. </p>
<p>So what happens if Mr. Obama is the nominee?</p>
<p>He will probably win — but not as big as a candidate who ran on a more populist platform. Let’s be blunt: pundits who say that what voters really want is a candidate who makes them feel good, that they want an end to harsh partisanship, are projecting their own desires onto the public. </p>
<p>And nothing Mr. Obama has said suggests that he appreciates the bitterness of the battles he will have to fight if he does become president, and tries to get anything done. </p>
<nyt_headline type=" " version="1.0"> Big Table Fantasies</nyt_headline>
<nyt_byline type=" " version="1.0"></nyt_byline>
By <a title="More Articles by Paul Krugman" href="http://topics.nytimes.com/top/opinion/editorialsandoped/oped/columnists/paulkrugman/index.html?inline=nyt-per">PAUL KRUGMAN</a>
Published: December 17, 2007
<nyt_text> </nyt_text>
<p>Broadly speaking, the serious contenders for the Democratic nomination are offering similar policy proposals — the dispute over health care mandates notwithstanding. But there are large differences among the candidates in their beliefs about what it will take to turn a progressive agenda into reality. </p>
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<p>At one extreme, Barack Obama insists that the problem with America is that our politics are so “bitter and partisan,” and insists that he can get things done by ushering in a “different kind of politics.” </p>
<p>At the opposite extreme, John Edwards blames the power of the wealthy and corporate interests for our problems, and says, in effect, that America needs another F.D.R. — a polarizing figure, the object of much hatred from the right, who nonetheless succeeded in making big changes. </p>
<p>Over the last few days Mr. Obama and Mr. Edwards have been conducting a long-range argument over health care that gets right to this issue. And I have to say that Mr. Obama comes off looking, well, naïve. </p>
<p>The argument began during the Democratic debate, when the moderator — Carolyn Washburn, the editor of The Des Moines Register — suggested that Mr. Edwards shouldn’t be so harsh on the wealthy and special interests, because “the same groups are often responsible for getting things done in Washington.”</p>
<p>Mr. Edwards replied, “Some people argue that we’re going to sit at a table with these people and they’re going to voluntarily give their power away. I think it is a complete fantasy; it will never happen.”</p>
<p>This was pretty clearly a swipe at Mr. Obama, who has repeatedly said that health reform should be negotiated at a “big table” that would include insurance companies and drug companies. </p>
<p>On Saturday Mr. Obama responded, this time criticizing Mr. Edwards by name. He declared that “We want to reduce the power of drug companies and insurance companies and so forth, but the notion that they will have no say-so at all in anything is just not realistic.” </p>
<p>Hmm. Do Obama supporters who celebrate his hoped-for ability to bring us together realize that “us” includes the insurance and drug lobbies?</p>
<p>O.K., more seriously, it’s actually Mr. Obama who’s being unrealistic here, believing that the insurance and drug industries — which are, in large part, the cause of our health care problems — will be willing to play a constructive role in health reform. The fact is that there’s no way to reduce the gross wastefulness of our health system without also reducing the profits of the industries that generate the waste. </p>
<p>As a result, drug and insurance companies — backed by the conservative movement as a whole — will be implacably opposed to any significant reforms. And what would Mr. Obama do then? “I’ll get on television and say Harry and Louise are lying,” he says. I’m sure the lobbyists are terrified.</p>
<p>As health care goes, so goes the rest of the progressive agenda. Anyone who thinks that the next president can achieve real change without bitter confrontation is living in a fantasy world.</p>
<p>Which brings me to a big worry about Mr. Obama: in an important sense, he has in effect become the anti-change candidate. </p>
<p>There’s a strong populist tide running in America right now. For example, a recent Democracy Corps survey of voter discontent found that the most commonly chosen phrase explaining what’s wrong with the country was “Big businesses get whatever they want in Washington.” </p>
<p>And there’s every reason to believe that the Democrats can win big next year if they run with that populist tide. The latest evidence came from focus groups run by both Fox News and CNN during last week’s Democratic debate: both declared Mr. Edwards the clear winner. </p>
<p>But the news media recoil from populist appeals. The Des Moines Register, which endorsed Mr. Edwards in 2004, rejected him this time on the grounds that his “harsh anti-corporate rhetoric would make it difficult to work with the business community to forge change.”</p>
<p>And while The Register endorsed Hillary Clinton, the prime beneficiary of media distaste for populism has clearly been Mr. Obama, with his message of reconciliation. According to a recent survey by the Project for Excellence in Journalism, Mr. Obama’s coverage has been far more favorable than that of any other candidate. </p>
<p>So what happens if Mr. Obama is the nominee?</p>
<p>He will probably win — but not as big as a candidate who ran on a more populist platform. Let’s be blunt: pundits who say that what voters really want is a candidate who makes them feel good, that they want an end to harsh partisanship, are projecting their own desires onto the public. </p>
<p>And nothing Mr. Obama has said suggests that he appreciates the bitterness of the battles he will have to fight if he does become president, and tries to get anything done. </p>
Fraychielle_IHB
New member
I Agree. There needs to be a change in the health care system. Massive. And it may be painful for Mr. US Taxpayer, but it's either that or national collapse.
"There is some fault of my own here, but this thread really should not be about whether or not all doctors are motivated by profit and so on. As I said, I do know some great docs here who are behaving like doctors, not businessmen."
Again, I direct you back to AllergyDoc's note. It doesn't matter how many patients I see - I get paid the same amount. I'm not a businessman. I have a general idea, but not a specific one, of how much money the division gets for every dollar it bills for. I just document that I saw the patient by using progress notes. The docs that perform procedures (catheterizations, surgeons, etc) may have a conflict of interest (ie they may get paid for each surgical procedure they do) but the ones I refer to (and by the way, we don't get any $$ for sending referrals - maybe a Christmas calendar) are very judicious in whom they operate on.
If you really want to direct your anger at someone (or something) refer to the insurance companies and the hospitals because the companies are devoted to paying out as little as possible and the hospitals are devoted to trying to squeeze each last cent by billing those insurance companies as much as possible. Why else is health care consuming an increasing proportion of our country's GDP year after year? They're businesses, corporations, trying to make a buck. And right now, there are two ways - charge more, or save more. Take your pick.
The country's health care system is broken. Soon it will be broke. And everyone will suffer.
----
"On a general note, it is interesting to see how most people who defend doctors are doctors themselves (Irvine Allergy Dr, Fraychielle)."
Note how we aren't defending ALL doctors, or "doctor" in general. I get annoyed when people lump good physicians in with a general glom of the self-aggrandizing "House of God" physician stereotype.
Included within this statement is the assumption that I, myself am a good physician - I acknowledge that. I really do do my best to spend time with patients and make sure that they (or their parents) understand the intricacies of their illness, or the diagnostic process. Many patients come to my specialty almost as a last resort and they are seeking answers for why their children are developmentally delayed, autistic, have seizures and they have been to many, many physicians who have given them no answers or conflicting answers. They need to have someone who is willing to spend the time with them and walk them through the process, tell them it's not their fault, explain the meaning of that esoteric test, and tell the truth that (currently) many of those who come to me seeking answers, I can do my best, but often not find answers.
Anyway, I digress.
The world of the doctor is an odd one. Beginning in college, with all the premed science classes and everyone competing for that coveted med school interview.
Then, 4 years of medical school memorizing hundreds, if not thousands, of diagnoses, medications, side effects, interactions, muscles, nerves, etc. You then get thrown into the hospital and introduced to mind-numbing 30 hour shifts (when I was in med school it was 36 or up, often every 3 days).
You interview and achieve the status of resident, where you are constantly working mind-numbing overnight shifts at a pay level less than that of a minimum-wage by-the-hour employee to take care of 10, 20, 30 inpatients at a time.
I think the people who understand the mind of a physician best have to either be a physician themselves, a spouse of a physician, or somehow involved in pharmacy, nursing, or some aspect of patient care. Perhaps that explains the mystique of Chicago Hope, or House, or ER. Perhaps that's why people think physicians are all in this hush-hush society where we protect our own (we don't).
And finally, I guess I didn't want to go through 4 years of college, 4 years of medical school, and 6 years of residency and fellowship to be told that physicians suck, are horrible, uncaring, stubborn megalomaniacs reveling in their control over their patients' lives and deaths. I went into medicine to care for people, and despite the efforts of that nasty physician training system to iron out the compassion in me, I am grateful to say that it's still there. And I'm happy where I am, daily with the chance to take care of kids in need.
"There is some fault of my own here, but this thread really should not be about whether or not all doctors are motivated by profit and so on. As I said, I do know some great docs here who are behaving like doctors, not businessmen."
Again, I direct you back to AllergyDoc's note. It doesn't matter how many patients I see - I get paid the same amount. I'm not a businessman. I have a general idea, but not a specific one, of how much money the division gets for every dollar it bills for. I just document that I saw the patient by using progress notes. The docs that perform procedures (catheterizations, surgeons, etc) may have a conflict of interest (ie they may get paid for each surgical procedure they do) but the ones I refer to (and by the way, we don't get any $$ for sending referrals - maybe a Christmas calendar) are very judicious in whom they operate on.
If you really want to direct your anger at someone (or something) refer to the insurance companies and the hospitals because the companies are devoted to paying out as little as possible and the hospitals are devoted to trying to squeeze each last cent by billing those insurance companies as much as possible. Why else is health care consuming an increasing proportion of our country's GDP year after year? They're businesses, corporations, trying to make a buck. And right now, there are two ways - charge more, or save more. Take your pick.
The country's health care system is broken. Soon it will be broke. And everyone will suffer.
----
"On a general note, it is interesting to see how most people who defend doctors are doctors themselves (Irvine Allergy Dr, Fraychielle)."
Note how we aren't defending ALL doctors, or "doctor" in general. I get annoyed when people lump good physicians in with a general glom of the self-aggrandizing "House of God" physician stereotype.
Included within this statement is the assumption that I, myself am a good physician - I acknowledge that. I really do do my best to spend time with patients and make sure that they (or their parents) understand the intricacies of their illness, or the diagnostic process. Many patients come to my specialty almost as a last resort and they are seeking answers for why their children are developmentally delayed, autistic, have seizures and they have been to many, many physicians who have given them no answers or conflicting answers. They need to have someone who is willing to spend the time with them and walk them through the process, tell them it's not their fault, explain the meaning of that esoteric test, and tell the truth that (currently) many of those who come to me seeking answers, I can do my best, but often not find answers.
Anyway, I digress.
The world of the doctor is an odd one. Beginning in college, with all the premed science classes and everyone competing for that coveted med school interview.
Then, 4 years of medical school memorizing hundreds, if not thousands, of diagnoses, medications, side effects, interactions, muscles, nerves, etc. You then get thrown into the hospital and introduced to mind-numbing 30 hour shifts (when I was in med school it was 36 or up, often every 3 days).
You interview and achieve the status of resident, where you are constantly working mind-numbing overnight shifts at a pay level less than that of a minimum-wage by-the-hour employee to take care of 10, 20, 30 inpatients at a time.
I think the people who understand the mind of a physician best have to either be a physician themselves, a spouse of a physician, or somehow involved in pharmacy, nursing, or some aspect of patient care. Perhaps that explains the mystique of Chicago Hope, or House, or ER. Perhaps that's why people think physicians are all in this hush-hush society where we protect our own (we don't).
And finally, I guess I didn't want to go through 4 years of college, 4 years of medical school, and 6 years of residency and fellowship to be told that physicians suck, are horrible, uncaring, stubborn megalomaniacs reveling in their control over their patients' lives and deaths. I went into medicine to care for people, and despite the efforts of that nasty physician training system to iron out the compassion in me, I am grateful to say that it's still there. And I'm happy where I am, daily with the chance to take care of kids in need.
No_Such_Reality_IHB
New member
<p>Our medical system is broken because it is focused on minimizing symptoms and not preventing illness. That is slowly changing with some of the HMO/PPOs but largely Doctors and Patients are quick to go for the simple solution and prescribe the latest pushed drug, or worse, request the latest pushed drug.</p>
<p>There is a very simple prescription that IMHO would solve 90% of people's problems:</p>
<p>1. quit eating crap and eat and drink in moderation. Let's face it, you know what is crap.</p>
<p>2. get some excersize regularly.</p>
<p>3. get your body fat ratio under control</p>
<p>4. chill out and quit running yourself ragged trying to do everything, be everything or have everything.</p>
<p> </p>
<p>I've been trying and failing a while. Keep trying though. And as most Doctors know, compliance is really the reason most therapy programs don't work.</p>
<p>Hence, the pharma companies give us Viagra, which we use in droves so we can do what we want to do when we've done everything that will prevent us from doing what we want to do without changing any of the damage we've incur because of it.</p>
<p> </p>
<p> </p>
<p> </p>
<p>There is a very simple prescription that IMHO would solve 90% of people's problems:</p>
<p>1. quit eating crap and eat and drink in moderation. Let's face it, you know what is crap.</p>
<p>2. get some excersize regularly.</p>
<p>3. get your body fat ratio under control</p>
<p>4. chill out and quit running yourself ragged trying to do everything, be everything or have everything.</p>
<p> </p>
<p>I've been trying and failing a while. Keep trying though. And as most Doctors know, compliance is really the reason most therapy programs don't work.</p>
<p>Hence, the pharma companies give us Viagra, which we use in droves so we can do what we want to do when we've done everything that will prevent us from doing what we want to do without changing any of the damage we've incur because of it.</p>
<p> </p>
<p> </p>
<p> </p>
Fraychielle_IHB
New member
NSR: so true.
I took a class back in college where the thesis was, the reason why many Americans suffer from obesity, high cholesterol, diabetes, etc. etc. etc. is the same reason why Universal Health Care is well-nigh impossible in the US.
Indeed I conjecture it may be the same reason we are nose high in credit crap.
<strong>The general focus of the average US citizen is individuality. </strong>
<em>I want things my way. Now. </em>
<em>
I would like instant gratification.</em> The things I can't afford I'll get now by putting things on a credit card and paying the minimum for the rest of my life.
I want to eat that portobello mushroom $6 burger because it tastes good and I don't care what it does to my coronaries. I'll deal with that, when it happens.
I don't care if diabetes will make me blind, go on dialysis (on the Medicare buck), and lose both of my legs below the knees because it's not going to happen to me, and if it does, oh well, I'll deal with that when it happens.
I don't want Universal Health Care because it means my tax rate will go from 33% to 50% and I'll be damned if I have to pay more of my paycheck out to Uncle Sam.
And since politicians want to stay in office, no one will stick their neck out to suggest UHC because it will be highly unpopular amongst their constituents that their representative suggested a 50% income tax.
Now if someone can suggest how to keep the income tax rate the same, and guarantee health care to all, then I'm all for them.
I took a class back in college where the thesis was, the reason why many Americans suffer from obesity, high cholesterol, diabetes, etc. etc. etc. is the same reason why Universal Health Care is well-nigh impossible in the US.
Indeed I conjecture it may be the same reason we are nose high in credit crap.
<strong>The general focus of the average US citizen is individuality. </strong>
<em>I want things my way. Now. </em>
<em>
I would like instant gratification.</em> The things I can't afford I'll get now by putting things on a credit card and paying the minimum for the rest of my life.
I want to eat that portobello mushroom $6 burger because it tastes good and I don't care what it does to my coronaries. I'll deal with that, when it happens.
I don't care if diabetes will make me blind, go on dialysis (on the Medicare buck), and lose both of my legs below the knees because it's not going to happen to me, and if it does, oh well, I'll deal with that when it happens.
I don't want Universal Health Care because it means my tax rate will go from 33% to 50% and I'll be damned if I have to pay more of my paycheck out to Uncle Sam.
And since politicians want to stay in office, no one will stick their neck out to suggest UHC because it will be highly unpopular amongst their constituents that their representative suggested a 50% income tax.
Now if someone can suggest how to keep the income tax rate the same, and guarantee health care to all, then I'm all for them.
blackacre-seeker_IHB
New member
Fraychielle: well, how about cutting unnecessary spending and using the money saved to let's say, funding low-cost healthcare insurance for everybody?
Some of the budget categories (from year 2008 fiscal budget) that really aren't necessary:
1. "Operations in the Global War on Terror by providing an additional $93.4 (!) billion in supplemental funds for 2007 and $141.7 billion (!) for 2008, including funds to accelerate efforts to train and equip Iraqi and Afghan Security Forces" (emphasis added). OK, so we divide 141.7 billion by the current U.S. population (over 303 million, let's just round it up to 304 million), and we get almost $490 per person per year! That would be enough to fund 50% of annual cost of a basic health insurance (a young fairly healthy person can obtain a PPO insurance for about $700-1000 a year). Of course I am generalizing and approximating, but it is still a stunning number, $490 a year, for every single human being in the U.S.
2. Average senator's salary is around 100-160K a year. Question: how many senators are actually very wealthy and don't need this salary to be independent of interest gropus and to support themselves? Let's make it a 0.
I can go on forever with this list, but you get my point: there is no need for tax rate increase if we just cut on spending...
Some of the budget categories (from year 2008 fiscal budget) that really aren't necessary:
1. "Operations in the Global War on Terror by providing an additional $93.4 (!) billion in supplemental funds for 2007 and $141.7 billion (!) for 2008, including funds to accelerate efforts to train and equip Iraqi and Afghan Security Forces" (emphasis added). OK, so we divide 141.7 billion by the current U.S. population (over 303 million, let's just round it up to 304 million), and we get almost $490 per person per year! That would be enough to fund 50% of annual cost of a basic health insurance (a young fairly healthy person can obtain a PPO insurance for about $700-1000 a year). Of course I am generalizing and approximating, but it is still a stunning number, $490 a year, for every single human being in the U.S.
2. Average senator's salary is around 100-160K a year. Question: how many senators are actually very wealthy and don't need this salary to be independent of interest gropus and to support themselves? Let's make it a 0.
I can go on forever with this list, but you get my point: there is no need for tax rate increase if we just cut on spending...
earthbm_IHB
New member
blackacre, I am from Russia. My wife is a pharmacist in Italy. European Union prescription drug rules are the same in every country (the exceptions are Andorra and San Marino, tiny states that are not part of the EU, doing brisk business selling prescription drugs, viagra mostly, over the counter).
you can have any sort of opinion on the war in Iraq, money is not a meaningful argument when put into context of $14trillion US GDP (supplemental budget for 2008 is 1% of that).
you can have any sort of opinion on the war in Iraq, money is not a meaningful argument when put into context of $14trillion US GDP (supplemental budget for 2008 is 1% of that).
biscuitninja_IHB
New member
<p>Backacre... Don't get me started. I have been preaching this for almost a decade now.... I see it only getting worse with the younger generation.</p>
<p>-bix</p>
<p>-bix</p>