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Dr. Tom Price nominated for HHS Secretary
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Propbulica: [url=https://www.propublica.org/article/preet-bharara-fired-investigating-tom-price-hhs-stock-trading]
[h1]Fired U.S. Attorney Preet Bharara Said to Have Been Investigating HHS Secretary Tom Price[/url][/h1]
Trumps head of the Department of Health and Human Services traded stocks of health-related companies while working on legislation affecting the firms. A source says Bharara was overseeing an investigation. The White House didnt immediately comment. -
Price is on CNN right now defending the Senate healthcare bill. He is so F.O.S I’m surprised he doesn’t explode.
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New healthcare bill is just Obamacare 2.0. It will fail and we will have single payer within 10 years.
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Quote from radi2012
New healthcare bill is just Obamacare 2.0. It will fail and we will have single payer within 10 years.
Yeah – it will.
Both it and Ocare based on a false premise: If you do nothing about the actual costs, and just divide them up differently, everyone will be happy.
NO ONE is talking seriously about reducing utilization, reducing profits to the corporate bad actors (insurance, Big Healthcare (i.e. humana and the like), and Big Pharma. ) Their “solution” is to send the bill to someone else and hide the costs. Even if it means sending the bill to us via our taxes.
Until that happens, it will be the same play with different actors, different lines, and the same outcome.-
You’re exactly right. The politicians are not trying to reduce the cost of healthcare. They are trying to find ways to hide the costs. It will show up in your taxes.
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Physicians are the weakest group of people you will ever meet. They accept whatever cuts the government applies. Doesn’t help when you have radical left physicians who agree that physician compensation is too much. Old farts like Frumi benefited from the glory days of medicine. Now he wants you new graduates to be considered the equivalent of a teacher.
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Quote from Ben Casey
Physicians are the weakest group of people you will ever meet. They accept whatever cuts the government applies. Doesn’t help when you have radical left physicians who agree that physician compensation is too much. Old farts like Frumi benefited from the glory days of medicine. Now he wants you new graduates to be considered the equivalent of a teacher.
Actually I believe teachers are more important than being paid $45k per year. For your information, this “old fart” recalls a time when people had more living wages as opposed to today’s minimum wages that hasn’t kept up with the old minimum. Real wages for the Middle Calls have declined or at best remained stagnant for decades.
As for physicians, you can’t complain of high costs while eliminating yourself from the solution but imposing the cost containment on others. “Anyone but me” is not a solution, everyone’s got an interest in play including patients. The solution of only penalizing patients is not a solution outside of protecting the interests of the affluent and politically influential.
And if physicians are the weakest group as you complain, whose fault is that other than the person reflected in the mirror? I thought “do no harm” to the patient was a primary goal? and if physicians are taking a back seat in the discussion, it is a voluntary back seat.
If you don’t play you can’t complain about the outcome.
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Quote from Frumious
Quote from Ben Casey
Physicians are the weakest group of people you will ever meet. They accept whatever cuts the government applies. Doesn’t help when you have radical left physicians who agree that physician compensation is too much. Old farts like Frumi benefited from the glory days of medicine. Now he wants you new graduates to be considered the equivalent of a teacher.
Actually I believe teachers are more important than being paid $45k per year. For your information, this “old fart” recalls a time when people had more living wages as opposed to today’s minimum wages that hasn’t kept up with the old minimum. Real wages for the Middle Calls have declined or at best remained stagnant for decades.
As for physicians, you can’t complain of high costs while eliminating yourself from the solution but imposing the cost containment on others. “Anyone but me” is not a solution, everyone’s got an interest in play including patients. The solution of only penalizing patients is not a solution outside of protecting the interests of the affluent and politically influential.
And if physicians are the weakest group as you complain, whose fault is that other than the person reflected in the mirror? I thought “do no harm” to the patient was a primary goal? and if physicians are taking a back seat in the discussion, it is a voluntary back seat.
If you don’t play you can’t complain about the outcome.
Really? To reiterate– $6 per chest xray, and you think we are overpaid??? We are not, and neither are most other physicians. Most of them, justly, have the same complaints that we do that their jobs have reached a ridiculous pace where they don’t have the time they should to talk to a patient, read a CT, etc. See recent article on concierge medicine in NY times.
Now, I agree that physicians play a significant role in increasing healthcare costs, but it isn’t because we are overpaid for each case/visit etc. It’s because many physicians have the ability to drive utilization, and make money on things other than direct patient care (e.g. orthopod buying an MRI and scanning everyone, surgical group building a surgery center and operating on everyone, pain management clinics existing, etc).
IMO part of an effective solution to our broken health care system would involve INCREASING pay per case/visit to physicians– in exchange for physicians taking a much more active role in, and responsibility for, limiting overutilization and other unnecessary costs.-
Quote from BHE
Quote from Frumious
Quote from Ben Casey
Physicians are the weakest group of people you will ever meet. They accept whatever cuts the government applies. Doesn’t help when you have radical left physicians who agree that physician compensation is too much. Old farts like Frumi benefited from the glory days of medicine. Now he wants you new graduates to be considered the equivalent of a teacher.
Actually I believe teachers are more important than being paid $45k per year. For your information, this “old fart” recalls a time when people had more living wages as opposed to today’s minimum wages that hasn’t kept up with the old minimum. Real wages for the Middle Calls have declined or at best remained stagnant for decades.
As for physicians, you can’t complain of high costs while eliminating yourself from the solution but imposing the cost containment on others. “Anyone but me” is not a solution, everyone’s got an interest in play including patients. The solution of only penalizing patients is not a solution outside of protecting the interests of the affluent and politically influential.
And if physicians are the weakest group as you complain, whose fault is that other than the person reflected in the mirror? I thought “do no harm” to the patient was a primary goal? and if physicians are taking a back seat in the discussion, it is a voluntary back seat.
If you don’t play you can’t complain about the outcome.
Really? To reiterate– $6 per chest xray, and you think we are overpaid??? We are not, and neither are most other physicians. Most of them, justly, have the same complaints that we do that their jobs have reached a ridiculous pace where they don’t have the time they should to talk to a patient, read a CT, etc. See recent article on concierge medicine in NY times.
Now, I agree that physicians play a significant role in increasing healthcare costs, but it isn’t because we are overpaid for each case/visit etc. It’s because many physicians have the ability to drive utilization, and make money on things other than direct patient care (e.g. orthopod buying an MRI and scanning everyone, surgical group building a surgery center and operating on everyone, pain management clinics existing, etc).
IMO part of an effective solution to our broken health care system would involve INCREASING pay per case/visit to physicians– in exchange for physicians taking a much more active role in, and responsibility for, limiting overutilization and other unnecessary costs.
BTW, where & when exactly did I ever say physicians were overpaid? A Red Herring of an argument.
Why is that always the defensive fall back position?
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Quote from Dr.Sardonicus
Quote from radi2012
New healthcare bill is just Obamacare 2.0. It will fail and we will have single payer within 10 years.
Yeah – it will.
Both it and Ocare based on a false premise: If you do nothing about the actual costs, and just divide them up differently, everyone will be happy.
NO ONE is talking seriously about reducing utilization, reducing profits to the corporate bad actors (insurance, Big Healthcare (i.e. humana and the like), and Big Pharma. ) Their “solution” is to send the bill to someone else and hide the costs. Even if it means sending the bill to us via our taxes.Until that happens, it will be the same play with different actors, different lines, and the same outcome.
The ACA was never meant to solve healthcare costs on the 1st try, it was meant as a “universal healthcare coverage” plan first and foremost. That was the plan when Heritage designed it as the “free market plan” as an alternative to Hillary’s single payer universal plan in the 1990’s. In Massachusetts as implemented by Romney it was not designed or sold as a cure for high costs of healthcare but only as universal coverage. To complain as the ACA as not achieving a faux goal of containing costs is like complaining the Constitution failed it’s goal of being anti-slavery. The anti-slavery part came later in the Constitution as was supposed to happen with cost containing with the ACA.
And let’s face it, if it had been designed as cost containment the howl against it would be magnitudes higher than it is now since cost containment would involve many things like open costs for a start and keeping profits and other costs down by a multitude of ways such as allowing government negotiations, cost comparison, regulations, reimbursement & fee-for-service, etc. similar to the way other countries with universal coverage keep costs down.
Blame Big Pharma, yes, but we are part of “Big Healthcare” and many don’t like what would be required to contain costs as can be seen by the arguments about healthcare coverage now ranging from everyone should have affordable healthcare to no one should have it except those who can pay for it out of their own pockets and limiting costs by just cutting funding for healthcare and Medicare regardless of the consequences.
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Quote from Dr.Sardonicus
Quote from radi2012
New healthcare bill is just Obamacare 2.0. It will fail and we will have single payer within 10 years.
Yeah – it will.
Both it and Ocare based on a false premise: If you do nothing about the actual costs, and just divide them up differently, everyone will be happy.
NO ONE is talking seriously about reducing utilization, reducing profits to the corporate bad actors (insurance, Big Healthcare (i.e. humana and the like), and Big Pharma. ) Their “solution” is to send the bill to someone else and hide the costs. Even if it means sending the bill to us via our taxes.Until that happens, it will be the same play with different actors, different lines, and the same outcome.
Exactly.
Lots of improvements can easily be made to our broken health care system, but in pretty much every case there is some player (e.g. equipment manufacturer’s, pharma, insurers, etc) who will take a hit. And they lobby like crazy to avoid that. And it works.
The exact same drugs, the exact same medical hardware, etc, frequently costs 2-3x as much here as in other wealthy countries. Which makes exactly zero sense. And yet it persists.
Wake me up when someone in power is ready to make real change. Right now we are just shuffling back and forth between screwing the rich and screwing the poor.
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Quote from Frumious
Quote from Dr.Sardonicus
Quote from radi2012
New healthcare bill is just Obamacare 2.0. It will fail and we will have single payer within 10 years.
Yeah – it will.
Both it and Ocare based on a false premise: If you do nothing about the actual costs, and just divide them up differently, everyone will be happy.
NO ONE is talking seriously about reducing utilization, reducing profits to the corporate bad actors (insurance, Big Healthcare (i.e. humana and the like), and Big Pharma. ) Their “solution” is to send the bill to someone else and hide the costs. Even if it means sending the bill to us via our taxes.Until that happens, it will be the same play with different actors, different lines, and the same outcome.
The ACA was never meant to solve healthcare costs on the 1st try, it was meant as a “universal healthcare coverage” plan first and foremost. That was the plan when Heritage designed it as the “free market plan” as an alternative to Hillary’s single payer universal plan in the 1990’s. In Massachusetts as implemented by Romney it was not designed or sold as a cure for high costs of healthcare but only as universal coverage. To complain as the ACA as not achieving a faux goal of containing costs is like complaining the Constitution failed it’s goal of being anti-slavery. The anti-slavery part came later in the Constitution as was supposed to happen with cost containing with the ACA.
And let’s face it, if it had been designed as cost containment the howl against it would be magnitudes higher than it is now since cost containment would involve many things like open costs for a start and keeping profits and other costs down by a multitude of ways such as allowing government negotiations, cost comparison, regulations, reimbursement & fee-for-service, etc. similar to the way other countries with universal coverage keep costs down.
Blame Big Pharma, yes, but we are part of “Big Healthcare” and many don’t like what would be required to contain costs as can be seen by the arguments about healthcare coverage now ranging from everyone should have affordable healthcare to no one should have it except those who can pay for it out of their own pockets and limiting costs by just cutting funding for healthcare and Medicare regardless of the consequences.
[size=”5″]WHAT!!!!!!!!!!!!!!????????????????[/size]
Obama promised “bending the curve down” and THOUSANDS less in insurance costs. These claims were used heavily in the promotion of it to try to get it passed.
And – I am not part of big healthcare. Our income has – at the best – been staying stable while productivity has gone up astronomically. WORK WORK WORK. Meanwhile, my hospital has a cash reserve greater than some countries. That’s them – NOT ME.
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Great point. I’m having real
Income cut by 1.5-2.5 percent year after year. Thus, I do agree that I’m not part of the problem of cost containment.-
Single payer will arrive within 10 years. Make sure to save and invest as much as you can for retirement before it comes.
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Quote from radi2012
Single payer will arrive within 10 years. Make sure to save and invest as much as you can for retirement before it comes.
Unless the [b]employer-sponsored[/b] healthcare market falls apart I am skeptical that there will be a true groundswell of support for single payer in the near-mid term.
Most “regular”/ middle class people get access to the healthcare system through that market and for the most part cite satisfaction with it. (Yeah, they would like less out-of-pocket $$ and less bureaucracy but for the most part they’re fine). That employer-sponsored market was a shrinking percentage before the ACA and is still shrinking, but not at the rate people thought. It was the bulk of the market before the ACA and remains the the bulk of the market after. Importantly, the ACA had the least effect (not no effect but the the least) on this market.
I keep hearing this argument that ACA repeal will be so bad that it will lead to single-payer in a hurry.
I just don’t buy it. We go back to the pre-ACA status quo where most people are vaguely satisfied or vaguely dissatisfied with their healthcare, but are doing alright, while ever-increasing numbers of poor, brown, and sick people are completely f*cked.
But we Americans have been for the most part just fine with f*cking over those populations for a long time. I don’t expect that to change quickly.
The GOP has the potential to turn back the clock to essentially the pre-ACA status quo. And barring a radical turn in public opinion and huge breakthrough in partisan politics that status quo will probably hold (with tweeks back to the left and right and left again etc) for a generation or longer.
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Quote from wisdom
Great point. I’m having real
Income cut by 1.5-2.5 percent year after year. Thus, I do agree that I’m not part of the problem of cost containment.Neither does anybody else. But when you add all up the “not me” people who say they [i]aren’t[/i] part of the health care cost problem you get up to nearly 20% of GDP. Hence the massive lobbies, hence the inability for politicians to tackle the root cause of increasing costs
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And yes, Obama did sell the ACA mostly on bending the cost curve and decreasing out-of-pocket for the middle class. That was the necessary politics in order to get the thing passed in Congress. (Just like the GOP is currently selling their bill as “better” care that will “bring down premiums” when it is really mostly just getting rid of ACA taxes on the rich and cutting medicaid and subsidies).
The ACA was really a healthcare access bill. It was a large tax bill and insurance reform meant to redistribute from the rich (and the young) to the poor, the sick and the older by getting those latter groups health insurance.
The disingenuous salesmanship around the passage of the ACA was a big part of the original sin that made it so unpopular. It was never going to live up to the metrics that the Obama administration had stress, while it did a pretty good job (and if it wasn’t hindered by the GOP Congress, GOP Governors, GOP Legislatures, and SCOTUS would be doing an even better job on that front).
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If you want to really take down cost you need to pull revenues/profit out of Pharma , Device manufacturers, hospitals, yes — us providers, and everybody else who has their fingers in the pie of US healthcare. That represents nearly 20% of the US GDP and a number of very, very powerful special interests.The only way to tackle special interests of that magnitude of power is with broad bipartisan legislation. That way the elected politicians take the heat from lobbyists and their whipped constituencies equally on both sides. I see absolutely zero chance of that happening in the US political short term.
…So instead, We will fight about who pays the huge costs . Will it be the Government (either through levying taxes or deficit spending ) or will it be mostly through out-of-pocket expenses by consumers. The relative percentage of each of those is the real fight today .
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Quote from dergon
The only way to tackle special interests of that magnitude of power is with broad bipartisan legislation. That way the elected politicians take the heat from lobbyists and their whipped constituencies equally on both sides. I see absolutely zero chance of that happening in the US political short term.
Great point
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So Sardonicus, you actually believed the ACA would actually make healthcare cheaper than before the ACA? You also believed then that Trump would actually deliver on that explicit promise to make it cheaper?
Uh huh. & you believed that exactly how? I know you are not that naive.
Did Heritage promise cheaper healthcare costs in the 1990’s? Did Romney promise cheaper healthcare? Bottom line is that you always had Romneycare as the actual functioning experiment. It showed costs “in line” as expected, not cheaper.
[link=http://www.factcheck.org/2011/03/romneycare-facts-and-falsehoods/]http://www.factcheck.org/…-facts-and-falsehoods/[/link]
Claim: The law cost more. [link=http://nhjournal.com/2011/02/24/huckabee-romney-should-apologize-for-health-plan/]Huckabee[/link]
Claim: Its bankrupting Massachusetts. [link=http://gop12.thehill.com/2011/01/santorum-romneycare-bankrupting.html]former Pennsylvania Sen. Rick Santorum[/link]
The question is: cost more than what? Well take that to mean, more than was predicted.
Unfortunately, theres no Congressional Budget Office in Massachusetts that can give us a solid look at spending projections specifically attributable to the law. Experts we spoke to said the Taxpayers Foundation was the best source for this, and the foundation says state spending is in line with what it expected.
It certainly takes money to create a subsidy program and expand Medicaid coverage. But is the Massachusetts law bankrupting the state? The foundation says no. In May 2009 it put out a report called [link=http://www.masstaxpayers.org/sites/masstaxpayers.org/files/Health%20care-NT.pdf]The Myth of Uncontrolled Costs[/link], which concluded that the net added cost to Massachusetts taxpayers was $353 million in 2010, or roughly 1.2 percent of the state budget. (The total cost of reform spending, beyond what Massachusetts was already paying for uncompensated care before the law, was $707 million, with federal dollars covering half of that.)
The state Executive Office of Health and Human Services [link=http://www.nejm.org/doi/full/10.1056/NEJMp0909295]estimated[/link] that Massachusetts needed $172 million more from the general fund in 2009 than it spent in 2006 to cover reform. But the 2009 budget also used an unspecified number of federal stimulus dollars.
Costs for the subsidies did grow more than was expected at first. More people signed up for subsidized insurance more quickly than officials predicted there was a point when there was great concern that the state had vastly underestimated the number of the uninsured. Costs at the beginning rose dramatically and much faster than people assumed, Widmer of the Taxpayers Foundation says. But enrollment in the subsidized plans leveled off. It reached 176,000 in mid-2008 and is down somewhat, to 154,000, after the state reduced coverage for legal immigrants (illegal immigrants were never covered).
To pay for the law, the state increased the cigarette tax, and had some money coming in through individual and employer penalties. It also continued a safety net surcharge on insurers and hospitals (which had been assessed before the law), and, as mentioned, it spends general funds.
Murphy, Romneys secretary of HHS, says that the subsidized program has worked out fairly fine, and as expected. I still think that the state sends too much to hospitals and community health centers for people who say that theyre not insured, he says. But overall, from a state budgeting perspective, anybody who makes any type of comment that this is busting the bank, this is a runaway train, this is a failure, flat-out doesnt know what theyre talking about. Simple as that.
Regardless of how Obama promised the fact is that the ACA made the slope of increasing costs decrease.
Look back in the Off Topic forum & you will find many a discussion between me and Mistrad where he complained that the ACA would not make healthcare cheaper than before the ACA & I argued that making it cheaper was not the goal, universal care was. And Romneycare was the role model.
And lowering costs before universal care would actually make it harder to accomplish universal care since the new argument would have been that adding more people onto the insurance rolls would increase costs again and “we” couldn’t afford to do that. So universal coverage had to come first.
And to be fair, how did Republican actions actually make healthcare more expensive & unavailable in many rural states? But they get no credit for their sabotage but Obama gets all the blame?
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[img]http://assets.pewresearch.org/wp-content/uploads/sites/12/2017/06/23144346/FT_17.06.23_healthcare_640px.png[/img]
Just recent Pew polling on single payer. Yes, it’s shifting leftward, but there would have to get to bigger support across the political spectrum to be put in place. … Nowhere near there yet.-
Where on that chart is personal responsibility?
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Quote from radi2012
Where on that chart is personal responsibility?
“Personal responsibility?”
Let’s see, a patient comes into the ER & before treatment someone will determine whether the patient showed sufficient “personal responsibility?”
How does that work exactly? A “Death Panel?” Seriously.
How about the Congressman Scalise? Isn’t he an example of “stuff happens” that is outside of one’s control?-
How did this migrate from the Off-Topic area?
I’ll share the same comments and questions I’ve posted for years about all this, in no particular order.
[ol][*]Single payer works in small, homogeneous European (socialist) nations. It won’t work here. Americans won’t tolerate the waiting and inherent rationing involved. [*]Physician salaries make up about 7% of the healthcare bill. Making us work [i]for free[/i] wouldn’t change much of anything, but since we are the face of healthcare, we are targeted.[*]Obamacare was designed to fail and force us into single payer. It contained several promises that could not possibly have been fulfilled (and DON’T try to spin those promises as has been done before. Everyone knows what Obama meant by “If you like your doctor…” and “Premiums will fall $2,500.”)[*]The majority of the population has been led to believe by the Socialist leaning media that single payer means they get Cadillac care for free, paid for by rich people.[*]If we wish to cover [i]everyone[/i], we have to make tough decisions because funds are not unlimited. i.e., does the 68 year-old derelict get a liver transplant for his self-induced cirrhosis? [*]Is healthcare a right or a privilege? [*]Our drug prices are higher because we are subsidizing those nations that cap them. [*]Nobody goes from the U.S. to Canada for specialized health care. Or to jump the line. [*]Medical tourism to India or Mexico should have taken off if the care was equal to ours.[*]The uninsured are covered by physicians and hospitals who eat the cost of their care.[*]The current (mild) support for Obamacare simply reflects the public’s indoctrination that they are actually getting something out of it, ignoring the higher premiums, sky-high deductibles, insurance companies exiting the exchanges, poor coverage, and a host of other problems. [*]The current system as it stand is unsustainable, and if Congress had any cojones, it would dismantle the entire system, Medicare, Medicaid, even Social Security, and start over. But the public would revolt if they thought their precious entitlements might possibly come in at one cent less than they already get. [/ol]-
It was never posted in Off Topics. The subject matter is both professional related as well as extremely political.
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Dalai,
1.”Americans wouldn’t tolerate waiting period?”
Based on what and for what? Many Americans wait now for various reasons. Yes, many Americans are used to fast food ideas & immediate gratification regardless of anything but this is all speculation with no real data being used. And I have relatives in European countries who don’t object to any so-called waiting period. Canadians complaining they want the American system over their own?
I don’t think so.
2.Yes, physicians are the “front line” and aren’t necessarily a major cause for the high cost if limited to certain facts and paying them $0.00 was no one’s “solution” to anything outside of empty hyperbole.
But are you arguing that physicians contribute nothing causing the high cost of healthcare in America? True if $7 per chest image is the only criteria. But then is the argument that the amount of chest X-rays was ever a major factor to the high cost of healthcare?
There are many reasons for the high cost of healthcare & arguing that no physicians contribute to the high cost at all, ever simply cannot be true for a variety of reasons, honest and not so honest.
3.Obamacare was designed to fail the way the Heritage Plan was designed to fail as Romneycare was designed to fail. Meaning it would fail if sabotaged for political reasons. Saying it was designed to fail is political hyperbole again.
4. The public doesn’t have a clue the real cost of healthcare but many do believe it is essentially “free.” But that is definitely NOT caused by socialists anywhere but by many Capitalists in the business of medicine. Ask many executives who have Cadillac plans what the cost is & what do you think they’ll tell you? likely many will know it is expensive but most won’t really know anything of real value. “It’s free! My employer pays for it.”
If you want people too know it’s true value have them declare the value on tax forms as a benefit, not for taxing purposes just so the number is before their eyes. But then the reality is they will likely blame 2 actors, insurance companies and physicians.
ALL costs should be open to all participants at all times, only then will people know the value and cost.
5. Why would a 68 y/o derelict get a liver transplant under universal health? Would one get one now? Yes, truth is if they have a Cadillac Plan. And would Medicare pay for a liver transplant? Yes but how easy is it and are liver transplants for 68 year old derelicts the reason for the high cost of healthcare in America in the 1st place?
I doubt that.
1st problem is the use of hyperbole when arguing healthcare alternate facts. These are not the problems causing all the problems with healthcare, whether it’s availability or cost.
6. My opinion is that healthcare is a right. But all rights have limits nonetheless.
7. Our drug prices are high for a myriad of reasons. See upcoming trial on Monday of Martin Shkreli for a single example.
8. Going to Canada for medical procedure is another example of a nothing illustrating nothing. How is your example supposed to explain anything about anything?
People do however go to Canada for drugs.
9. No one said Mexico or India’s medical care was equal to America’s that I’m aware of. Can you provide examples please.
10. Many hospitals risk going bankrupt as they were pre-ACA if the AHCA and the Senate version passes do to non-reimbursed costs so to say it is absorbed is not accurate especially in light of hospitals and insurance companies ensuring that insurance costs more just to cover these uninsured patients and treatments and procedures.
11. The ACA was a 1st draft and always was a work in progress. By the same token are you arguing that all the Republican efforts to undermine the ACA were actually supposed to help the ACA with deductibles and co-pays?
I say if the Republicans were not a deliberate obstacle to the success of the ACA it would work better, as it has proven to work in Massachusetts as Romneycare.
12. The current system is unsustainable mainly because of Republicans efforts and propaganda to undermine the ACA. As Massachusetts proved, it is very sustainable.
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Yes the current system is sustainable as long as physicians accept Medicaid reimbursement rates. I was at a dinner in Jersey over the weekend with mostly surgeons and surgical subspecialists. I couldn’t find one who participates with Medicaid or Medicare. Their response: ” why would I?”
So unless you are willing to pass legislation forcing doctors to participate, the system will not be sustainable.-
That answer answers nothing in itself. It is equivalent to preferring a job for a lower salary, all things being equal. Or paying more for services or goods just because you can.
Is that argument that Medicare doesn’t pay enough to cover the real costs of service or just that you can get paid more from private insurance reimbursement?
I think it has a lot to do with the high paying customer. Just as much as anyone would take the higher paying job, all things being equal.
And so saying that your friends prefer private insurance over Medicare demonstrates physicians’ contribution to the higher cost of healthcare in America. Specifically, profits and lifestyle.
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Medicare reimbursement for laparoscopic cholecystectomy is around $660.
So the answer is NO medicare doesn’t pay enough to cover costs. -
I think cost reduction has to be part of getting to universal coverage. They need to go hand in hand, not universal coverage THEN reduce costs. It’s not reasonable to say to well off people, yes medications/hospital stays/medical devices etc cost much more here than in other wealthy countries, but we expect you to pay that price for those that can’t afford it, and we aren’t going to do what’s necessary to reduce the costs.
That’s like saying, ok, we have a nutrition problem with the poor. The solution is going to be that those below the poverty line get to eat out at the restaurant of their choice every night, drinks included, and it will be paid for by a new tax on the wealthy. Then you get a proliferation of Michelin starred restaurants, everyone eats out every night, and there is a massive restaurant lobby that blocks any attempt to cut back on this.
That’s why I said it’s either screwing the rich or screwing the poor, depending on who is in power.
Fix the cost problem, which requires Congress to stand up to lobbyists, and get to universal coverage that way. But the costs have to be fixed. Otherwise this isn’t a wealth transfer from the 1% to the poor, it’s mostly a wealth transfer from the 1% to big pharma/big insurance etc.
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Quote from Frumious
Quote from radi2012
Where on that chart is personal responsibility?
“Personal responsibility?”
Let’s see, a patient comes into the ER & before treatment someone will determine whether the patient showed sufficient “personal responsibility?”
How does that work exactly? A “Death Panel?” Seriously.
How about the Congressman Scalise? Isn’t he an example of “stuff happens” that is outside of one’s control?
Can we all agree that there are parts of personal health that you can control and maintain such as diet, exercise, and avoiding risk (smoking, alcohol, drugs, high risk behavior, etc). That’s what I mean by personal responsibility. A large part of human disease is lifestyle related. For the parts we cannot control, yes I agree that there should be a safety net. But currently our “healthcare” system does not reward health or healthy habits. We are doing it all wrong.-
Quote from radi2012
Can we all agree that there are parts of personal health that you can control and maintain such as diet, exercise, and avoiding risk (smoking, alcohol, drugs, high risk behavior, etc). That’s what I mean by personal responsibility. A large part of human disease is lifestyle related. For the parts we cannot control, yes I agree that there should be a safety net. But currently our “healthcare” system does not reward health or healthy habits. We are doing it all wrong.
Sure. We can agree. But …. and it’s a big “but” …
Can we also all agree that people who are poorer and of minority communities have a more difficult time, often through no fault of their own, in finding a way to a healthy lifestyle. Poverty correlates with addiction, obesity, and other social issues that lead to poor health.
We can not be willing as a society to condemn and penalize those people without first being willing to address the issues that lead their communities to be disproportionately less healthy.
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Quote from radi2012
Where on that chart is personal responsibility?
I’m not sure exactly what you mean. But in the context of the link above …
It’s out on the far right (both politically and graphically) represented by the 5% of Americans who think the government should not be involved in health care.
In the context of healthcare policy people who shout “personal responsibility” are saying that people should take care of themselves physically, make sure that they have the coverage they need/want, and live with the consequences of those two without turning to the government. Sounds great …
But what that means in practice is the support of policy that strips funding from safety net programs and putting up mean-spirited road blocks to prevent access to those programs in a way that disproportionately negatively affects the weakest, poorest and sickest Americans. Exhibit A: The AHCA and “Better Care”.
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The program was opposed from conception so it was impossible to address costs.
And the AHCA and the Senate version addresses nothing complained about such as costs either. It is nothing but a tax cut program & Medicare defunding program disguised as a healthcare program. Deny healthcare & there will be savings.
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Quote from Frumious
The program was opposed from conception so it was impossible to address costs.
And the AHCA and the Senate version addresses nothing complained about such as costs either. It is nothing but a tax cut program & Medicare defunding program disguised as a healthcare program. Deny healthcare & there will be savings.
I’m not defending the AHCA. I’m criticizing health care costs in the US. And until that gets addressed we won’t have a solution. And passing those ridiculous costs on to the 1% is not a reasonable solution. Could be an irresistible force (need to address unsustainable costs)/immovable object (industry lobbying) situation.
Interestingly, there is an article on cnn.com today on just this issue:
[link=http://www.cnn.com/2017/06/26/opinions/us-health-care-prices-rosenthal-opinion/index.html]http://www.cnn.com/2017/0…hal-opinion/index.html[/link]
Read that– not a single outrageous example (and they are indeed outrageous) is of a doctor’s fee for seeing a patient, performing a procedure, etc.
If you addressed costs you could have universal coverage for quite a bit less than we spend on healthcare today. Costs must be addressed. There is no reasonable solution without that. Congress just lacks to will to do so.
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Big Pharm/Hospital/Insurance lobbies are too powerful to make politicians (particularly GOP politicians) want to address costs. Even Obama/Hillary weren’t ready to embrace single payer yet. This could change in 10 years depending on how many poor people get fed up enough to actually vote.
In the meantime, will we be going back to the pre ACA days, where hospitals had to merge to prevent financial collapse because of all the poor showing up to the ED without coverage?
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Quote from hey
Big Pharm/Hospital/Insurance lobbies are too powerful to make politicians (particularly GOP politicians) want to address costs. Even Obama/Hillary weren’t ready to embrace single payer yet. This could change in 10 years depending on how many poor people get fed up enough to actually vote.
In the meantime, will we be going back to the pre ACA days, where hospitals had to merge to prevent financial collapse because of all the poor showing up to the ED without coverage?
Your second paragraph is completely inaccurate. Hospital mergers are at an all-time high post-ACA.
[image]https://hbr.org/resources/images/article_assets/2016/10/R1612F_DAFNY_HOSPITALMERGERS.png[/image]-
Quote from drmcree
Quote from hey
Big Pharm/Hospital/Insurance lobbies are too powerful to make politicians (particularly GOP politicians) want to address costs. Even Obama/Hillary weren’t ready to embrace single payer yet. This could change in 10 years depending on how many poor people get fed up enough to actually vote.
In the meantime, will we be going back to the pre ACA days, where hospitals had to merge to prevent financial collapse because of all the poor showing up to the ED without coverage?
Your second paragraph is completely inaccurate. Hospital mergers are at an all-time high post-ACA.
Yes but by the same token, defunding Medicare & Medicaid will close many hospitals and increase layoffs and unemployment in rural communities where hospitals provide significant care and employment and preventative programs.
So the concern about rural communities and “affordable” insurance for these states and communities was in fact, a lie, as the AHCA and the Senate version basically throw these concerns away as they were only political fodder. The only real concern ny the GOP is tax cuts and defunding government and programs regardless of the harm it creates and increases.
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How would you address costs? Who is at fault? Patients? Administrators? Insurance companies? But not physicians at all? How about unnecessary procedures done for little reason other than billing? Certainly not done for the patient’s benefit.
Never heard of that ever happening?
As for ridiculous costs, European countries are able to do it albeit at about 1/2 the cost for American healthcare and everyone pays their share one way or another.-
Then why are they all insolvent too, Frumi?
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Quote from Frumious
How would you address costs? Who is at fault? Patients? Administrators? Insurance companies? But not physicians at all? How about unnecessary procedures done for little reason other than billing? Certainly not done for the patient’s benefit.
Never heard of that ever happening?
As for ridiculous costs, European countries are able to do it albeit at about 1/2 the cost for American healthcare and everyone pays their share one way or another.
This seems to be fizzling into a typically unproductive internet discussion unfortunately, and if you have a point you don’t seem to be making it clearly or directly (or at least I’m not seeing it), but I’ll try to clarify my points before signing off:
[b]1. “How about unnecessary procedures done for little reason other than billing? Certainly not done for the patient’s benefit. [/b][b]Never heard of that ever happening? “[/b]
Absolutely, and I already mentioned that above (” e.g. orthopod buying an MRI and scanning everyone, surgical group building a surgery center and operating on everyone, pain management clinics existing, etc.”). By all means this should be addressed, forcefully. Here are two suggestions: (1) put teeth into Stark laws, so they work like they were supposed to (2) stop paying for things not shown to work. Any procedure/drug etc should either have been shown to be effective, be so new that that evidence is still being gathered, or not be reimbursed.
2.[b] “As for ridiculous costs, European countries are able to do it albeit at about 1/2 the cost for American healthcare and everyone pays their share one way or another. “[/b]
You are completely missing the point. Europeans don’t pay the ridiculous costs for drugs, medical devices, hospital stays, etc that we do. Read the CNN article– none of those examples would happen in most European countries. Why did the epipen cost $600/pair here and $100/pair in France, or $70/pair in Britain? Examples like that are a dime a dozen (however, if sold by pharma in US they are $100/dozen and you have to buy two dozen). Why does the exact same hip prosthesis cost several times more here than in other western countries? How would Europeans handle it if tomorrow they had to pay the same for drugs etc that we do in the US? Give the US the same costs the Europeans have and you could have universal coverage while actually SAVING money. Now that’s a proposal that both parties could get behind. That’s why costs and coverage should be part of the same discussion.
So, here are my points:
[b]1. Costs in the US, per unit (whether that be for medications, hospital stays, medical devices) are far too high, and that has to be addressed.[/b] And no, in general I don’t think costs physicians are paid PER PROCEDURE are anywhere close to too high. There are plenty of bad incentives that all too many physicians take advantage of, and that should absolutely be stopped. But in terms of things being ludicrously overpriced, it is almost never physician compensation.
[b]2. Without addressing costs, it is not reasonable to force taxpayers to pay for universal coverage.[/b] As I said above, when you think about it this way, this isn’t a transfer from rich to poor, a large part of it is a transfer from wealthy people to health care corporations, simply because Americans are paying so much more than everyone else for the same products.
[b]3. We should have universal coverage. But cost reduction needs to be part of it.[/b] Saying “that can’t happen” isn’t a solution, it’s just stating the problem. It needs to happen. As long as it doesn’t happen we will continue to be in the same mess.
[b]4. Some ideas for reducing costs:[/b] (1) medicare not only can, but MUST negotiate prices for medications, medical devices, etc. We are the largest health care market in the world. We should have the best prices among wealthy nations, not the worst. (2) Universal coverage, and everyone has a PCP. Then incentivize people to see their PCP instead of going to the ER for non-emergent conditions. ER care is 7-9x as expensive as care from a PCP for the same non-emergent conditions. People use/abuse the ER simply because of convenience, but it comes at a staggering cost, which for the most part they aren’t paying and is instead passed on to everyone else. (3) Stark law etc stuff I mentioned above.
So, 3 basic components of cost reduction:
1. Lower costs for meds/equipment/hospital stays etc so they are in line with other wealthy countries. Fix the abuses of the patent system as well (well documented on line).
2. Put a system in place to drive non-emergent care back to PCPs and away from ERs, which has been a disaster in multiple ways.
3. Put strong systems in place to reduce physicians increasing costs by performing/ordering things that are of little to no benefit to the patient.
4. Oh yeah– remembering the crazy graph of # administrators vs physicians in the US– take a good look at administrative costs too. I haven’t looked at that, but looks like a tremendous amount of waste.-
I don’t see anything in your post I disagree with but I do have some point to add.Regarding European drug costs, their governments do regulation, something that is expected of them. And they are allowed to negotiate pricing with companies, something Congress has forbidden government to do apparently in the name of protecting Big Pharma profits. So already the US Government is already crippled thanks to Congress regarding pricing.
Costs “per procedure” are all over the map from one place to another. Even 2 hospitals in the same neighborhood can have wildly varied pricing for the identical procedure.
Worst of all the customer/patient can’t know the cost until the procedure is done unless the hospital/provider has a cash price list.
Hospital CEO’s & VP’s, etc are paid very high wages. Is it justified? I’m not sure. But an example is Florida Governor whose earlier career was in HCA, was paid a fortune to leave & left behind the highest fine ever at the time of cheating Medicare. All while ranting about public hospitals “stealing” taxpayer money. But I’m loathe to preach they get paid too much overall. It’s in the same category of complaining about people’s wages, like physicians. Like teachers.
All the things required to address the problems involve government and regulations and making the system open for cost comparison and competition. none of that exists today. I am not talking “free market” as that has given us the problems of today, but a regulated, rule-based, law-abiding open system that pays well to all participants while providing excellent care at cheaper costs than today’s costs.
I think it is definitely possible. Other countries do it & Americans are not more stupid than people in other countries. We’ve done many things better in the past, suddenly we are incompetent by comparison?
I don’t think so. That’s an excuse to do nothing.
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Quote from Frumious
All the things required to address the problems involve government and regulations and making the system open for cost comparison and competition. none of that exists today. I am not talking “free market” as that has given us the problems of today, but a regulated, rule-based, law-abiding open system that pays well to all participants while providing excellent care at cheaper costs than today’s costs.
I think it is definitely possible. Other countries do it & Americans are not more stupid than people in other countries. We’ve done many things better in the past, suddenly we are incompetent by comparison?
I don’t think so. That’s an excuse to do nothing.
This topic has been dealt with ad nauseum on the Off Topic board…perhaps not this very thread. Don’t be so concrete.
I created a point by point response to your point-by-point answer and then my computer ate it. You IT folks have powers I can only imagine…
My basic premise, with which you fundamentally disagree, is that America is DIFFERENT than Europe…we have a much larger and much more heterogeneous population. Americans are far more independent-minded, do not appreciate queueing up for anything but the next iPhone, and won’t tolerate the down-side of single payer. That, and the fact that with all its foibles, US medicine is the best in the world. You don’t see Arab sheiks going to Canada for their treatment; they come HERE. And if cost were the only problem, medical tourism to India or Mexico would have been adopted lock, stock, and barrel by the insurers. But the CARE IS NOT THE SAME. American exceptionalism. I know you don’t like it.
As far as this being a free-market problem…hardly. Even dearly departed kpack/eradicator (he rightly decided to have a life instead of wallowing in the muck here) agrees with me. Because of government regulations, medicine in the US is anything BUT a free-market exercise. LET the free market work and see what happens.
Frankly, if I were cynical enough, I would clamor for single payer myself, just so those of you for whom it is the end-all-to-end-all could see how bad it will be. Go have a look at your local VA. Ask the vets how they are enjoying their single payer experience. Pray that they aren’t armed when you confront them.
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Somehow in WWII for example people actually did queue up and cooperated in many other ways in a collective effort to help the war effort.
We’ve moved beyond that now? Is that an improvement?-
Ridiculous example. Try again.
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How much of that “wait lines” in Europe and Canada just total mythology political grist? How much of that “no waiting lines in US” is just total mythology political grist?
[link=https://www.nytimes.com/2014/07/06/sunday-review/long-waits-for-doctors-appointments-have-become-the-norm.html]https://www.nytimes.com/2…e-become-the-norm.html[/link]
Yet there is emerging evidence that lengthy waits to get a doctors appointment have become the norm in many parts of American medicine, particularly for general doctors but also for specialists. And that includes patients with private insurance as well as those with Medicaid or Medicare.
Merritt Hawkins, a physician staffing firm, found long waits last year when it [link=http://www.merritthawkins.com/2014-survey/patientwaittime.aspx]polled[/link] five types of doctors offices about several types of nonemergency appointments including heart checkups, visits for knee pain and routine gynecologic exams. The waits varied greatly by market and specialty. For example, patients waited an average of 29 days nationally to see a dermatologist for a skin exam, 66 days to have a physical in Boston and 32 days for a heart evaluation by a cardiologist in Washington.The Commonwealth Fund, a New York-based foundation that focuses on health care, [link=http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2013/Nov/1717_Thomson_intl_profiles_hlt_care_sys_2013_v2.pdf]compared[/link] wait times in the United States to those in 10 other countries last year. We were smug and we had the impression that the United States had no wait times but it turns out thats not true, said Robin Osborn, a researcher for the foundation. Its the primary care where were really behind, with many people waiting six days or more to get an appointment when they were sick or needed care.
Older article.
[link=http://www.aarp.org/politics-society/government-elections/info-03-2012/myths-canada-health-care.html]http://www.aarp.org/polit…anada-health-care.html[/link]
Myth #1: Canadians are flocking to the United States to get medical care.
Myth #2: Doctors in Canada are flocking to the United States to practice.
Maybe the Canadian rads can answer this one.
Myth #3: Canada rations health care; thats why hip replacements and cataract surgeries happen faster in the United States.
Myth #4: Canada has long wait times because it has a single-payer system.
Myth #5: Canada rations health care; the United States doesnt.
This ones a little bit tricky. The truth is, Canada may ration by making people wait for some things, but here in the United States we also ration by cost.
I would like to see some data showing that Americans don’t have to wait, not they would refuse to wait. There is no data showing that, is there? My experience is that I have to make appointments that might be days away to see my doctor. Some appointments are out there a month away.
And the bottom line is neither the AHCA or the Senate version addresses any of these issues. It removes people from insurance rolls and care and Medicare/Medicaid. so the issue of “waiting periods” is a red herring as far as Congress addressing it now is concerned since they would be Waiting for Godot.
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So since Obamacare has partially ruined our system, we should just go ahead and completely destroy it? Great.
And the AARP wants single payer even more than the AMA, which wants it even more than Frumious does. Which is why I’ll never join either organization.
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Aunt Minnie article–over 260 billion claims initially denied
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Interesting timing on another article from CNN on this issue. Headline: American can save $1 trillion and get better health care. And he’s right.
[link=http://www.cnn.com/2017/06/27/opinions/fixing-americas-health-care-sachs/index.html]http://www.cnn.com/2017/0…-care-sachs/index.html[/link]
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Everyone is sooooo pessimistic on this Forum. Nothing can be done, we will be bankrupt, the politicians marginalize us, everyone blames us, we can’t afford it, it’s the patients’ own faults, etc, etc, etc.
Amazing American ever amounted to anything with all this pessimism, the “can’t do” country.
Something can be done. Else you have to argue that of all the countries in the world who actually have done something to keep costs below ours by a substantial margin AND provided excellent care, at least equal to or better than ours, only we can’t seem to get it done?
As for controlling costs before implementing universal care, I fully disagree as there would be a reduced imperative to provide universal care as the argument would be that providing universal care would increase costs back up. But most importantly, it is the “value” of healthcare that is lacking or needs improvement. Value as defined by what a patient actually purchases related to cost. Do we really want to argue that we should be selling a less valued product at a cheaper price to a limited market rather than selling a higher valued product to a larger market?
[link=http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/#]http://www.commonwealthfu…7/july/mirror-mirror/#[/link]
The United States spends far more on health care than other high-income countries, with spending levels that rose continuously over the past three decades (Exhibit 1). Yet the U.S. population has poorer health than other countries. [link=http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/]1[/link] Life expectancy, after improving for several decades, worsened in recent years for some populations, aggravated by the opioid crisis. [link=http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/]2[/link] In addition, as the baby boom population ages, more people in the U.S.and all over the worldare living with age-related disabilities and chronic disease, placing pressure on health care systems to respond.
Timely and accessible health care could mitigate many of these challenges, but the U.S. health care system falls short, failing to deliver indicated services reliably to all who could benefit. [link=http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/]3[/link] In particular, poor access to primary care has contributed to inadequate prevention and management of chronic diseases, delayed diagnoses, incomplete adherence to treatments, wasteful overuse of drugs and technologies, and coordination and safety problems.
Based on a broadly inclusive set of performance metrics, we find that U.S. health care system performance ranks last among 11 high-income countries. The countrys performance shortcomings cross several domains of care including Access, Administrative Efficiency, Equity, and Health Care Outcomes. Only within the domain of Care Process is U.S. performance close to the 11-country average. These results are troubling because the U.S. has the highest per capita health expenditures of any country and devotes a larger percentage of its GDP to health care than any other country.
The U.S. health care system is unique in several respects. Most striking: it is the only high-income country lacking universal health insurance coverage. The U.S. has taken an important step to expand coverage through the Affordable Care Act. As a 2017 Commonwealth Fund report showed, the ACA has catalyzed widespread and historic gains in access to care across the U.S. [link=http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/]4[/link]More than 20 million Americans gained insurance coverage. Additional actions could extend insurance coverage to those who lack it. Furthermore, Americans with coverage often face far higher deductibles and out-of-pocket costs than citizens of other countries, whose systems offer more financial protection. [link=http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/]5[/link]Incomplete and fragmented insurance coverage may account for the relatively poor performance of the U.S. on health care outcomes, affordability, administrative efficiency, and equity.
For example, the U.S. performs poorly in administrative efficiency mainly because of doctors and patients reporting wasting time on billing and insurance claims. Other countries that rely on private health insurers, like the Netherlands, minimize some of these problems by standardizing basic benefit packages, which can both reduce administrative burden for providers and ensure that patients face predictable copayments.
The U.K. stands out as a top performer in most categories except for health care outcomes, where it ranks with the U.S. near the bottom. In contrast to the U.S., over the past decade the U.K. saw a larger decline in mortality amenable to health care (i.e., a greater improvement in the measure) than the other countries studied. (The U.S. has had the smallest decline, or lowest level of improvement.)
The high level of inequity in the U.S. health care system intensifies the problem. For the first time in decades, midlife mortality for less-educated Americans is rapidly increasing.
In conclusion, the performance of the U.S. health care system ranks last compared to other high-income countries. Exhibit 5 shows how the U.S. health system is a substantial outlier when it comes to achieving value.
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Fruminous, excellent post. Other countries do seem to do it better sans free market mumbo jumbo.
“Do we really want to argue that we should be selling a less valued product at a cheaper price to a limited market rather than selling a higher valued product to a larger market? ”
What do you mean by this?
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Quote from radi2012
Can we all agree that there are parts of personal health that you can control and maintain such as diet, exercise, and avoiding risk (smoking, alcohol, drugs, high risk behavior, etc). That’s what I mean by personal responsibility. A large part of human disease is lifestyle related. For the parts we cannot control, yes I agree that there should be a safety net. But currently our “healthcare” system does not reward health or healthy habits. We are doing it all wrong.
As dergon says, “Yes, but…”
Yes, there are a lot on non-compliant patients out there. But 2 questions, are they a majority or a significant minority who “willfully” ignore medical advice and treatment and are their own worst enemies? And are they a major part of the reason American healthcare costs more than anywhere else in the world? you mean no other country has our problems of “lifestyle” diseases which is why they costs are about 1/2 of ours?
I think “no” to both of those questions. And will the defunding of Medicare/Medicaid and the repeal of any decent healthcare regulations such as the ACA, where is preventative care and advice and treatment that would help address just those problems? -
Sachs is a Professor of Economics at Columbia. He is not a physician. Academicians are good at pontificating and telling others how to spend money. Just so you know.
Here is his ten point plan:
[blockquote][ol][*][i]First, move to capitation for Medicare, Medicaid and the tax-exempt private health insurance plans. Under capitation, hospitals and physician groups receive an annual “global budget” based on their patient population, not reimbursement on a fee-for-service basis. [/i] [ol][*][b]Capitation[/b]? Seriously? Along with the “value” garbage, this is simply a SCAM which arbitrarily cuts payment, no matter how much or how little service is rendered. [/ol] [*][i]Second, limit the compensation of hospital CEOs and top managers. The pay of not-for-profit hospital CEOs and top managers, for example, could be capped at $1 million per year. [/i] [ol][*]This is not how the market works, even though I tend to agree these people make a lot more than they should. Would you get the very best and brightest in these positions with a cap? [/ol] [*][i]Third, require Medicare and other public providers to negotiate drug prices on a rational basis, taking account of research and development incentives and the manufacturing costs of the medicines.[/i] [ol][*]Can’t argue with that, but who decides what’s “rational”? [/ol] [*][i]Fourth, use emergency power to override patents (such as compulsory licensing of patent-protected drugs) to set maximum prices on drugs for public health emergencies (such as for HIV and hepatitis C). [/i] [ol][*]See above; who decides what’s an “emergency”? [/ol] [*][i]Fifth, radically simplify regulatory procedures for bringing quality generic drugs to the market, including through importation, by simplifying Food and Drug Administration procedures. [/i] [ol][*]I tend to agree, but safeguards for faulty formulations need to be there. [/ol] [*][i]Sixth, facilitate “task shifting” from doctors to lower-cost health workers for routine procedures, especially when new computer applications can support the decision process.[/i] [ol][*]Ruh Roh…Is that really what you want? [/ol] [*][i]Seven, in all public and private plans, cap the annual payment of deductibles and cost-sharing by households to a limited fraction of household income, [link=http://www.commonwealthfund.org/publications/fund-reports/2017/may/international-profiles]as is done in many high-income countries. [/link][/i] [ol][*]That is supposed to happen now…but the situation was made far, far worse by ObamaCare. Deductibles and premiums skyrocketed. [/ol] [*][i]Eight, use part of the annual saving of $1 trillion to expand home visits for community-based health care to combat the epidemics of obesity, opioids, mental illness and others. [/i] [ol][*]His $1T is a complete guess, or a false promise, or simply an out and out lie (see “you can keep your doctor” and “everyone gets $2500 reduction on premiums.” [/ol] [*][i]Nine, rein in the advertising and other marketing by the pharmaceutical and fast-food industries that has created, alone among the high-income world, a nation of addiction and obesity. [/i] [ol][*]Anyone remember free speech? But I really don’t think high-end chemo drugs should be advertised as they are. Might cut some advertising costs, but probably won’t change much of anything. [/ol] [*][i]Ten, offer a public plan to meet these conditions to compete with private plans. Medicare for all is one such possibility.[/i] [ol][*]Which you all hope will metastasize into full single payer. [/ol] [/ol]
[/blockquote] Cut to the chase. Our system is broken. Republicans want to double down on the broken system as they are so very petrified of losing votes by actually fixing the problem. Democrats, Liberals, Leftists…want single payer, which they envision as full Cadillac full option care, paid for by rich people.
I personally think the whole damn thing needs to be scrapped and revamped. No Obamacare, no TrumpCare, no Medicare, no Medicaid. Start over. Decide what the ultimate goal is, and then work toward that. I still think the private sector has the best chance to provide care, but with government oversight. Basically, sell or just give everyone a high-deductible catastrophic care plan, administered by private companies, Blues, etc. Should cost $100/person/year, or $30 Billion. Then you have the right to buy increased coverage. If you don’t, you pay the difference for necessary care out of pocket, or better an HSA. For those who can’t afford either of these, care provided by physicians, hospitals, etc., becomes a line-item deduction off their income tax, but the patient must sign a declaration of poverty, with yuuuge penalties for false information.
This would work, and work well, but of course it doesn’t have the same cachet of free care paid for by the wealthy, and so it won’t happen. Too bad, really.-
Trumpcare or no care would invite back abuse such as we saw across States in the 1970’s as many institutions were grossly underfunded. Or no care at all as we saw only recently before the ACA.
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Hard to agree or disagree without some examples.
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Quote from Frumious
Trumpcare or no care would invite back abuse such as we saw across States in the 1970’s as many institutions were grossly underfunded. Or no care at all as we saw only recently before the ACA.
I saw no abuses in the 70’s. I would maintain that there were none, until you can give me examples otherwise.
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Actually, in the 70’s – what I saw of care was this:
My parents had work-sponsored insurance. It was not that expensive.
I could see my doctor that day if I needed to. Sometimes, in the 50’s and 60’s my parents needed to take me in for an illness, and I would go right to my doctors office, even in the evening. I remember going one night at about 11 pm with a strep throat. He lived next door. He would meet us, look at me, and decide what needed to be done and then do it.
I have the bill from my birth on my desk. (Mom framed it for me some years ago) That would be 1951. here is the rundown
room rate – $10.60 a day
delivery service – $18.00 (odd phrase -sounds like a pizza)
Phone calls $0.20 per call
“circum” (we know what that is – I waive my hippa rights) = $2.50
total bill – $127.70
Blue cross payment $127.70
net due – 0.00
No mention of the doctors fee.
Incidentally, she spent 7 days in the hospital after an uneventful deliveryfor perspective, as I recall Dad’s pay was around $150 per week as a low level manager – so roughly a low level manager’s pay for a week.
Now? – well – you all know what it is like now.
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Search for Moss Senate subcommittee in 1975.
[link=http://www.nytimes.com/1975/01/22/archives/moss-heads-senate-unit-on-nursinghome-care.html]http://www.nytimes.com/19…-nursinghome-care.html[/link]
[link=http://www.nytimes.com/1975/01/16/archives/senate-panel-to-act-alone-in-nursinghome-hearing.html]http://www.nytimes.com/19…rsinghome-hearing.html[/link]
[link=http://shea.senate.ca.gov/sites/shea.senate.ca.gov/files/NURSING_HOME_MOSS_TESTMONY.DOC]http://shea.senate.ca.gov…HOME_MOSS_TESTMONY.DOC[/link]
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“Its now largely forgotten, but a wave of institutional abuse swept through long-term care facilities in the 1970s. In that decade, there were abuse scandals and investigations in California, Connecticut, Illinois, Kansas, Michigan, Minnesota, New Jersey, New York, Ohio, Pennsylvania, Texas and Wisconsin. Reflecting on some of the evidence brought before his Senate subcommittee in 1975, Senator Frank Moss, Democrat of Utah, wrote that what he had heard was something like a Dickens novel.”
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Nursing home abuse goes on today. Why are you focusing on that very narrow area? Horrid though it is, is THIS the “abuse” you were talking about?
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Speaking of abuse, THIS is the abuse you invite by aping your beloved Europeans:
[link=http://www.dailymail.co.uk/news/article-4644268/Charlie-Gard-s-parents-lose-final-appeal.html]http://www.dailymail.co.u…lose-final-appeal.html[/link]
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And by the way…
[link=https://www.theguardian.com/society/2013/sep/12/hospital-death-rates-england-higher-us?CMP=share_btn_tw]https://www.theguardian.c…er-us?CMP=share_btn_tw[/link]
So THIS is what you want?
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Quote from Frumious
“Its now largely forgotten, but a wave of institutional abuse swept through long-term care facilities in the 1970s. In that decade, there were abuse scandals and investigations in California, Connecticut, Illinois, Kansas, Michigan, Minnesota, New Jersey, New York, Ohio, Pennsylvania, Texas and Wisconsin. Reflecting on some of the evidence brought before his Senate subcommittee in 1975, Senator Frank Moss, Democrat of Utah, wrote that what he had heard was something like a Dickens novel.”
This really has nothing to do with hospital care or general medical care.
“abuses” – in my mind this would mean something more like the self-referral scandal of the 19902 – 2000s and the scandal that is hospital overcharging now.
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OK, but not sure why or how you separate “abuses” from what the Senate subcommittee was investigating then. And Daiai is correct in that abuses still exist but in my point of view the concern today is less about correcting “abuses” or the system in general than just making patients responsible for discovering, correcting and paying for them themselves, those patients who are the least able to correct abuses.
The AHCA and the Senate version have nothing to do with correcting or repairing anything, whether self-referrals or overcharges or insurance and healthcare availability and affordability.
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Add the ACA to that list and I might actually agree.
We need to get back to whatever the goal of all this is. Or was. Or should be.
The continued placing of bandaids upon duct tape upon gauze upon bandaid of the current system is nothing more than a ruse to fool the unwashed into thinking they’re getting something from their beloved government. While I think the AHCA is a step back from the ACA abyss, it is far from perfect. As I said above (and you haven’t yet commented about) the whole darn thing needs to be sacked and redone.
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No, I am opposed to your list of “the whole damned thing” be redone. The chaos it would cause not to mention the harm to people is unacceptable.
If your roof leaks you don’t need to tear down the house to fix the roof, just fix the roof. You don’t like the house? OK, but you have family living there & need to figure out where to put them while you demolish the place & then rebuild.
There is nothing that cannot be fixed in the present system. Using the house example, Congress would be arguing and deciding your family lives perfectly well on the empty lot full of debris.
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You probably don’t see how you just declared to the world how much you LOVE BIG BROTHER.
I never once said anything that could have been taken as: “Cut off all programs, kill everyone’s Grandma’s, and when half of the po’ folk have gone to the Great Politburo in the Sky, then, and only then, do we implement the new program.” No. Any rational person would realize that the old programs are phased out and the new phased in. But when one is addicted to the government entitlement dole, the slightest hint of its possible loss sends the bowels into an uproar.
The system is broken badly. Everyone knows it. And it needs to be replaced. The roof is kaput with coverage in one corner. Those who can live in a different house altogether. But your terror justifies the deplorable behavior of the Republican-controlled Congress who cannot accomplish much of anything for fear of triggering the addicted. -
DoctorDalai said:
I personally think the whole damn thing needs to be scrapped and revamped. No Obamacare, no TrumpCare, no Medicare, no Medicaid. Start over.
Not sure what’s not clear about your statement.
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Any rational person would understand that there has to be a transition, not a cut-off. But you are so utterly terrified of the government not taking care of you 24/7, you might not see that. So allow me to restate it for the record:
[blockquote] I personally think the whole damn thing needs to be scrapped and revamped. No Obamacare, no TrumpCare, no Medicare, no Medicaid. Start over. But of course the old programs must be continued until the new programs are implemented, with adequate temporal overlap, so as not to bring harm, emotional or physical, to those who are dependent upon the government for their healthcare.
[/blockquote]
Better?
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So transition from what to what over what period? & is the plan supposed to improve things? Exactly what does the Republican plan improve & for whom?
& what of the poor, elderly, children & disabled? So they deserve your contempt because they have nowhere to go other than government insurance?
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Fundamentally what issue or issues are you & the Republican plan concerned about & trying to solve with the Republican proposal?
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“Decide what the ultimate goal is, and then work toward that.”
What is the ultimate goal DoctorDalai? Spend X amount of dollars and get Y amount of health? This is an extremely complicated problem in itself. Who spends who’s money? Who measures the outcome health? Who determines what gets done? What is just?
“Do you think it possible for a man who does not know how to measure when a multitude of others equally ignorant assure him that he is four cubits tall [426e] not to suppose this to be the fact about himself? Why no, he said, I don’t think that. Then don’t be harsh with them. For surely such fellows are the most charming spectacle in the world when they enact and amend such laws as we just now described and are perpetually expecting to find a way of putting an end to frauds in business and in the other matters of which I was speaking because they can’t see that they are in very truth trying to cut off a Hydra’s head. [427a] Indeed, he said, that is exactly what they are doing. I, then, said I, should not have supposed that the true lawgiver ought to work out matters of that kind in the laws and the constitution either of an ill-governed or a well-governed statein the one because they are useless and accomplish nothing, in the other because some of them anybody could discover and others will result spontaneously from the pursuits already described. [427b]
-Plato on Legislation in the the Republic
“I still think the private sector has the best chance to provide care, but with government oversight.”
Isn’t that what we are doing now? How well is that working out for us?
“Basically, sell or just give everyone a high-deductible catastrophic care plan, administered by private companies, Blues, etc.”
This too has already been done. Works great only for healthy people who don’t use healthcare services.
“For those who can’t afford either of these, care provided by physicians, hospitals, etc., becomes a line-item deduction off their income tax, but the patient must sign a declaration of poverty, with yuuuge penalties for false information.”
I assume you mean a tax credit for free care dollar for dollar? A deduction off of other income would only compensate for 35-40% of the uncompensated care. How is this different from medicaid?
Don’t quit your day job DoctorDalai.
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Don’t follow your arguments, they seem all about negatives, just points to make just to be contrary, not constructive.
You arguments are non sequiturs. The point is that we can and should do something about an imperfect system, not make it worse & dump on the very people who need it most. -
It should be clear, I think, that universal coverage of some sort is coming and coming pretty quickly at this point.
Why? The Republicans vowed to get rid of Obamacare, but had to leave in the provision that people can’t be denied coverage for preexisting conditions. I don’t wan to take the time to spell out the argument, but once you have that you have a shoddy version of universal coverage and I think a more complete and better thought out version is inevitable.
Not saying single payer (which would be very hard to achieve here), but clearly now you basically have both parties supporting the notion that health insurance is a right.
Expect lots more change, and lots of battles from stakeholders. Healthcare lobbyists are going to do extremely well in the next few years. Wish there were a way to buy futures in health care lobbying …
Physicians definitely need great leadership and to present a united front in times of change like this.-
BHE pretty much has it correct, I think. Healthcare is a right? Well, no, but we all seem to agree everyone should have it. But NEITHER the ACA nor the AHCA (nor Medicaid nor Medicare) will do. These are complex monstrosities, bogged down in their own bureaucracy, that help some people at a very high overall cost.
I proposed a simpler plan that would work, but since it doesn’t screw rich folks, it won’t fly.
Frumious nicely illustrates why we can’t have any progress on this. Note his utter panic at the thought of a transition. Congress, particularly the Republicans, who want to keep their power without keeping their promises, won’t tweak such people for fear of losing a vote. And so we’re stuck.-
And where do we find this simpler plan?
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“Panic” from me or extremist hostility calling people insults when you don’t get your way?
If you can’t persuade by argument maybe you are totally wrong Dalai.
Universal healthcare can be done. My opinion is that it is and should be considered a right. What that means and how far that goes can be up for discussion. It does not mean a 90 y/o unreformed alcoholic receiving a liver transplant to use hyperbole in an example.
Europe as on regional example, has multiple examples of a mixture of private and public payers, not just a single payer, but government has tight regulations for all. Europe has many examples of open costs to the patient and does not see overuse of the system, a “free” system. Europe also has single payers. Europe also has private insurance that one can purchase for add-ons to care above the basic on provided by or defined by government and regulations.
It is not impossible or unaffordable. And no need to create alternative facts to argue against it. It is doable. American used to be the “can-do” country.
Let’s make America great again by being “can-do” and no longer the “can’t possibly do that” country. We are like the old GE joke, “You might find a better product but you’ll never find a more expensive product.”
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I propose that the use of the term “make America great again ” be abolished on this site.
America has never been any greater or less great during it’s history. Every period of perceived greatness economically has been just that — superficial perception
and let’s not forget that it’s being used my erdogan jr here on a daily basis.-
Done & agreed.
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Gee, Frumious…took you a whole week to come up with those zingers. You’re slowing down in your old age! 😉
I’ve shown no “extremist hostility” toward you, so don’t try that Liberal game with me. I HAVE pointed out your complete discombobulation at the suggestion that the government dole might possibly be interrupted. Your posts. You own it. Stop blaming others.
“Universal health care can be done”! Sure. We already spend more than other nations, for better or worse. So you propose spending even MORE, probably MUCH MORE, to [i]possibly [/i]up the average, and achieve mediocre care? Not buying it. Sorry.
Discussions like this drove a LOT of us off the Off-topic board. Time to move this thread over there.-
Do you have a point to make about healthcare? I didn’t see it.
The only reason topics like this are labeled “political” & too hot to discuss intelligently is the need for people like you to hurl diatribes instead of discussing facts. Not to mention that is your MO considering your reactions on other topics like AI.
Since everyone posting on this forum presumably works in healthcare & possibly knows something about the subject, there is no reason why it can’t be on the Gen’l Radiology section, one presumes rads know something about healthcare so it should not be verboten or scare people too much to discuss like an adult.
If it’s moved to Off Topics, fine, but it’s the extremists that cause posters to be afraid to discuss things that have some disagreement like adults. And considering the OP was about Tom Price, it started as political, but so what. Somewhere between diatribes there are intelligent conversations.-
If I were vindictive, I would pray for single payer to come here so you could see just how bad it would be. But I’m too nice for that.
I just LOVE it when you howl at me for doing PRECISELY the things you do constantly.
I’m done.
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Ironically, I WOULD quit my day job if it weren’t for my son’s rather expensive Remicaid habit.
You do a passible job of sounding erudite, bcov, but there are a number of fallacies in your attempt to take me down. Why is it that you folks have to treat everything like a religion? Single Payer…GlobalClimateWarmingChangeConfusion, Wealth redistribution…people either BELIEVE as you BELIEVE or they shouldn’t “quit their day job”? Why do you BELIEVE so in Single Payer?
Your Plato quote applies nicely to Congress. If you are attempting to apply it to me, well, you are quite wrong. But then I’m not a BELIEVER. Do you really think that “well-governed” requires single payer? I don’t. And I never will. By the way, [link=http://www.yourarticlelibrary.com/political-science/platos-theory-of-communism-including-2-forms-of-communism/40134/]Plato[/link] might well have been the first Communist, which would make your use of his quote even more apropos to your pro single payer thoughts.
I have said multiple times that the current system is broken and needs a complete revamp. But that does not automatically indict the private sector, any more than it blesses the government. Neither can make healthcare work properly on their own. Together, things can improve greatly. We have haphazard regulation of the insurance companies, we have Medicare that has been looted, and we have Medicaid that doesn’t work properly. Revamp them, yes. But no, we haven’t tried this in a proper manner. Please tell me when the United States had such a thing as catastrophic coverage for everyone. I’m not aware of such a thing.
I don’t know about you and your RVU deal; I have to assume you are hospital employed, and maybe single payer does look better to you for that reason. But my group must ignore $Millions of self-pay (which equals NO pay, not even Medicaid). So a tax credit for indigent care.would be huge.
The devil is in the details. Try using your obvious intelligence to find alternatives, to discuss ways these ideas and others might possibly be implemented, instead of bending over and BELIEVING.
Addendum: Please see this [link=http://www.auntminnie.com/forum/fb.ashx?m=516770]prior post[/link] from Dr. bcov…. It seems I was right on target with the comment about single payer being better than what he has now…working for IMAGING ADVANTAGE:
[blockquote]I have worked in 4-40 man private practices- 7 different practices plus locums in other practices ranging from solo to 6 or so rads. My wife is in academia- VA linked to a teaching university. Small private practices often have horrible politics- usually run by a tyrant- but the pay is good and inequality less. The inequality in academic departments is epic however. Incomes range from 180K to chairman making 500k to 1 million. I now work for Imaging Advantage and the politics are non-existent. Everyone is compensated on RVUs with stipend for IR to compensate for low productivity. Corporate practices have the least politics in my experience. I also worked for AllegiantMD in Florida and other than pleasing Norsoph there were no politics with the working class rads. Road time was horrible because the practices were scattered all over the Tampa area extending half way to Orlando and north to Ocala. I had to deal with road time less because I was on the 5 pm to 2am shift mainly downtown. The problem with corporate practice is low pay per case. I think hospital employed with rvu bonus is the best situation all around.
[/blockquote] Your credibility just took a major hit, friend.-
The Republic quote applies to patients, physicians, and our “leaders”.
By the way, DoctorDalai, I agree with every one of your criticisms of healthcare on previous posts- just not your solutions.
As far as I know commercial insurance is nothing more than a duplication of medicare. Commercial insurance charges are equal to medicare plus a percentage depending on size/monopoly power of negotiating entities. Crony capitalism? -
[font=”arial,helvetica,sans-serif”][size=”3″]”But my group must ignore $Millions of self-pay (which equals NO pay, not even Medicaid). So a tax credit for indigent care.would be huge.” [/size][/font]
[font=”arial,helvetica,sans-serif”][size=”3″] Is this an argument for the expansion of medicaid? Isn’t that what is being tried now? [/size][/font]
[font=”arial,helvetica,sans-serif”][size=”3″]
[/size][/font]
[font=”arial,helvetica,sans-serif”][size=”3″] FYI DoctorDalia [/size][/font]
[font=”arial,helvetica,sans-serif”][size=”3″] Three traditional laws: identity, non-contradiction, excluded middle. [/size][/font]
[font=”arial,helvetica,sans-serif”][size=”3″] The laws of thought are fundamental axiomatic rules upon which rational discourse itself is often considered to be based. [/size][/font]
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DoctorDalia, healthcare is a classic market failure.
We have all systems in the US and none has demonstrated superiority.
Self pay- the closest thing to “free market” for those who still believe this myth.
VA- English NHS style government employed
Medicare- Single payer Canadian Style
Medicaid- free care funded by general taxation Japan, Northern European style
Commercial insurance- voluntary risk pooling
five primary methods of funding health systems:
[ol][*]general taxation to the state, county or municipality[*]national health insurance[*]voluntary or private health insurance[*]out-of-pocket payments[*]donations to charities [/ol] -
Many a billion, or should I say trillion has been lost on a p value less than .05.
I see this every day- overdiagnosis and overtreatment
[attachment=0]
[link=http://www.dcscience.net/garrow-evidence-bmj.pdf]http://www.dcscience.net/garrow-evidence-bmj.pdf[/link]
[font=”arial,helvetica,sans-serif”]Modern medicine is a negation of health. It isnt organised to serve human health, but only itself, as an institution. It makes more people sick than it heals.[/font]
Medical Nemesis[font=”arial, helvetica, sans-serif”] (1976)[/font]
[font=”arial, helvetica, sans-serif”]Ivan Illich
[/font]Ivan may be exaggerating but we do have a healthcare industrial complex feeding on the public- we all agree spending 20% of our GDP on healthcare is too much.-
1976?
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bvoc: Your posts are becoming rather disjointed and tangential. Are you OK?
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Just my attempt to diagnose what is wrong with US healthcare. It may not be the delivery system but the bad science fueled by bad incentives that is the problem.
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With THAT, I agree completely. Your solution?
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“If you wish to alter or annihilate a pyramid of numbers in a serial relation, you alter or remove the bottom number. If we wish to annihilate the junk pyramid, we must start with the bottom of the pyramid: [i]the Addict in the Street,[/i] and stop tilting quixotically for the “higher ups” so called, all of whom are immediately replaceable. [i]The addict in the street who must have junk to live is the one irreplaceable factor in the junk equation. [/i]When there are no more addicts to buy junk there will be no junk traffic. As long as junk need exists, someone will service it.
Addicts can be cured or quarantined–that is, allowed a morphine ration under minimal supervision like typhoid carriers. When this is done, junk pyramids of the world will collapse.
-William Burroughs
The scientist in me calls for rationed/rational care. The public’s insatiable desire for any and all care without regard to cost must be stymied. Consumer driven healthcare needs to be banished to the dustbin of history.
Unfortunately healthcare is now squarely in the political realm.
[b]”Any one can get angry that is easy or give or spend money; but to do this to the right person, to the right extent, at the right time, with the right motive, and in the right way, that is not for every one, nor is it easy.”[/b]
[b] [/b]Book II, Nicomachean Ethics, Aristotle 1109a.27
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The quotes are cute, but get us nowhere.
Whomever publicly calls for rationed health care will be publicly lynched. You are not going to “cure” the public of their insatiable desire for anything. Look how people on this very board go apoplectic at the suggestion of even a temporary lapse.
So given that, what [i]should[/i] we do? And try to use your own words. But since you like quotes so much…
[blockquote] “We find that whole communities suddenly fix their minds upon one object, and go mad in its pursuit; that millions of people become simultaneously impressed with one delusion and run after it, till their attention is caught by some new folly more captivating than the first.” — Charles Mackay, [i]Extraordinary Popular Delusions and the Madness of Crowds[/i], 1841.
[/blockquote]-
I apologize for the excessive use of quotes.
My initial interest in responding to your post was to question your solution- I didn’t think there was one.
Given our current political climate it is likely an unsolvable problem.
Any big pharma or device manufacturer can sign up for government welfare checks and the parasitic private insurance companies will follow.
Patients will demand what they are told to demand often by drug and device salespeople (I mean physicians).
The system may have to make America bankrupt before it is changed- Ever heard of too big to fail? It’s a popular idea on K street as well as Wall street.
The biggest bailout in history has gone to the healthcare lobby not banks.
All you or I can do now is “put money in thy purse” until the system collapses in internecine chaos. I will maximize my RVUs and you do the same.
Doctors have been marginalized. The decision makers are now captains of industry and their “kept” politicians.
Private enterprise and the “free market” will only exacerbate the problem.
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Are you gonna get the votes? He better get them. He better get them. Oh, he better, otherwise Ill say, Tom, youre fired. Ill get somebody.
~ Trump, threatening to fire Price if Senate healthcare doesn’t pass.
You know the old saying: “The bucks stops at everyone else but me!”-
Trump needs to be careful. His Cabinet is the body that could decide he is “incapacitated” and he would then be removed from office.
Wait – what am I saying? “Trump” and “careful” in the same sentence.
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Quote from Phil Shaffer
Trump needs to be careful. His Cabinet is the body that could decide he is “incapacitated” and he would then be removed from office.
Wait – what am I saying? “Trump” and “careful” in the same sentence.
Trump is an excellent distraction and performing his duties well. His expertise is in entertainment. He reminds me of Zaphod Beeblebrox in Douglas Adams Hitchhikers Guide to the Galaxy.
One of the major difficulties Trillian experienced in her relationship with Zaphod was learning to distinguish between him pretending to be stupid just to get people off their guard, pretending to be stupid because he couldn’t be bothered to think and wanted someone else to do it for him, pretending to be outrageously stupid to hide the fact that he actually didnt understand what was going on, and really being genuinely stupid. He was renowned for being amazingly clever and quite clearly was sobut not all the time, which obviously worried him, hence, the act. He preferred people to be puzzled rather than contemptuous.
“The President in particular is very much a figurehead- he wields no real power whatsoever. He is apparently chosen by the government, but the qualities he is required to display are not those of leadership but those of finely judged outrage. For this reason the President is always a controversial choice, always an infuriating but fascinating character. His job is not to wield power but to draw attention away from it. On those criteria Zaphod Beeblebrox is one of the most successful Presidents the Galaxy has ever had- he has already spent two of his ten presidential years in prison for fraud. Very very few people realize that the President and the Government have virtually no power at all, and of these few people only six know whence ultimate political power is wielded. Most of the others secretly believe that the ultimate decision-making process is handled by a computer. They couldn’t be more wrong.”
[link=https://www.goodreads.com/author/show/4.Douglas_Adams]Douglas Adams[/link], [link=https://www.goodreads.com/work/quotes/3078186]The Hitchhiker’s Guide to the Galaxy[/link]-
ok so is Price going to be fired by the orange guy
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Thanks for putting my long held thoughts down on AM.
But the real question is the voters who vote for and enable President Zaphod. What of their intelligence?-
It doesn’t bode well for them or us Fruminous. The American public may be too dumb to know it- a very dangerous situation.
“Now I observe that when we are met together in the assembly, and the matter in hand relates to building, the builders are summoned as advisers; when the question is one of ship-building, then the ship-wrights; and the like of other arts which they think capable of being taught and learned. And if some person offers to give them advice who is not supposed by them to have any skill in the art, even though he be good-looking, and rich, and noble, they will not listen to him, but laugh and hoot at him, until either he is clamoured down and retires of himself; or if he persist, he is dragged away or put out by the constables at the command of the prytanes. This is their way of behaving about professors of the arts. But when the question is an affair of state, then everybody is free to have a saycarpenter, tinker, cobbler, sailor, passenger; rich and poor, high and lowany one who likes gets up, and no one reproaches him, as in the former case, with not having learned, and having no teacher, and yet giving advice; evidently because they are under the impression that this sort of knowledge cannot be taught. Protagoras 320b323a
I think Trump and most US politicians demonstrate that citizenship is a skill just like medicine.
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[url=http://www.huffingtonpost.com/entry/tom-price-waiving-individual-mandate_us_597df94de4b02a4ebb760112][B]Tom Price Open To Unilaterally Waiving Obamacares Individual Mandate:[/B]The move by the Health and Human Services secretary would hobble the Obamacare exchanges.[/url]
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Time for price to go–tax payers should not have to pay for his private jets–the stock issue should have blocked his confirmation–another arrogant doc who thinks he is GOD and has lost his moral fiber
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Looks like Tom Price might have a short tenure at HHS.
Lots of private jets on the government dime, including for personal travel to his beach house, couple with the failure of healthcare which Trump had said Price was to push through leads to …
[url=http://thehill.com/homenews/administration/352697-trump-says-hes-unhappy-with-price]Trump being quite ‘unhappy’ with Price[/url].
Fire him and say good riddance.
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It won’t be bc of use of govt jets for private travel. All of the administration is all about extracting as much out of the treasury as possible. Fiscally conservative so long it’s not them or their cronies being fiscal
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amen–it is not like he came in with a clean slate and has not done anything on ACA
Quote from dergon
Looks like Tom Price might have a short tenure at HHS.
Lots of private jets on the government dime, including for personal travel to his beach house, couple with the failure of healthcare which Trump had said Price was to push through leads to …
[link=http://thehill.com/homenews/administration/352697-trump-says-hes-unhappy-with-price]Trump being quite ‘unhappy’ with Price[/link].
Fire him and say good riddance.
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Now Price is saying he will repay the taxpayers for his private flights.
Hope he takes it out of the profits from his insider trading.
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Drain the swamp!
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Yea. After he got caught. Sure he will. Should be a 5x penalty on the amount. Scammers.
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says he will pay for his seat–not for the jet fuel or the seat his wife occupied on some trips or the pilot’s salary, etc
Time for this jerk to go -
Quote from wisdom
Yea. After he got caught. Sure he will. Should be a 5x penalty on the amount. Scammers.
He’s cutting a check for $52k.
[i][link=http://www.businessinsider.com/tom-price-and-his-wife-flew-on-us-military-jets-to-europe-2017-9]Business Insider [/link][/i][link=http://www.businessinsider.com/tom-price-and-his-wife-flew-on-us-military-jets-to-europe-2017-9] [/link] estimates cost of Price’s private travel at >$1 million.-
Well I know he’s not Louise Linton in looks and is no one’s trophy wife but all those people sure do have a sense of entitlement and royalty above us commoners. Just ask Louise she was very clear in her twit account & her twits.
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Private Jet travel is the only way to go…..Envy is ugly.
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Quote from Ben Casey
Private Jet travel is the only way to go…..Envy is ugly.
Don’t be a turd.
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Quote from Ben Casey
Private Jet travel is the only way to go…..Envy is ugly.
hypocrisy, uglier.
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